When you are addicted to drugs, alcohol or certain behaviours such as gambling, then there exists a wide range of dangers to your physical and mental health. Drug and alcohol users are often concerned with the risk of overdose, and often overlook psychological risks such as suicide. However, in this post we outline the dangers of this assumption. We subsequently argue for the need for the assessment and treatment of suicide ideation of those suffering from an addiction.
An overview of suicide in the United Kingdom
In the United Kingdom, suicide is the number one cause of death for males under the age of 35. In 2013-2014, 6,233 suicides occurred in the UK. There are around 11.9 suicide deaths per 100,000 population. The figures say you’re three times more likely to commit suicide if you are male. If you are male, you are most likely to commit suicide between the ages of 45-59.And the most common method of suicide is ‘hanging, strangulation and suffocation.’
Globally, around 1 million people die each year due to suicide. Around 40,000 of these deaths occur in the United States.
Compared to the general population, individuals treated for alcohol abuse or dependence are at about 10 times greater risk to eventually die by suicide compared with the general population, and people who inject drugs are at about 14 times greater risk for eventual suicide. In fact, a 2004 study found suicide is the leading cause of death among people who abuse alcohol and drugs. The study also found that acute alcohol intoxication is present in 30- 40% of suicide attempts/completed suicides.
However, when addiction is involved, women were more likely to commit suicide compared to their male peers. In 2014, 27% of all female suicides were linked to addiction, compared to just 15% of male suicides.
Shockingly, acute alcohol intoxication is present in 30- 40% of suicide cases.
Figures 1 & 2 – page 23-24 of https://webarchive.nationalarchives.gov.uk/20160105160709/https://www.ons.gov.uk/ons/dcp171778_414574.pdf
Problems that accompany addition
It’s clearly no secret that addiction degrades a person’s lifestyle and living conditions. This ranges from social isolation right up to extreme traumatic events such as rape and sexual assault. Below we list a number of negative social, physical and psychological implications of addiction. Taken together, these problems help explain why suicide is prevalent for those suffering from addiction.
One must also understand that addiction may result from mental health problems rather than the reverse. This is because many people ‘self-medicate’ with drugs, alcohol and certain behaviours in order to ‘block out’ the pain caused by mental health problems such as anxiety and depression. However, like the lyrics to the 1997 song by The Verve, “the drugs don’t work, it just makes it worse.” This is because substance abuse typically antagonises and exacerbate mental health problems. As the sufferer’s tolerance to the substance increases, a greater quantity of the substance is required in order to ‘block out’ negative thoughts and feelings. Eventually, substances will no longer work and the suicide threat is greater than ever.
Here’s a list of negative factors that often accompany addiction:
- Social isolation
- Psychological instability e.g. shame, anger, fear, guilt and feeling their life is out of control
- Obsession with stimuli associated with addiction
- Getting in trouble with the law
- Negative vocational consequences
- Negative financial consequences
- Negative family consequences
- Sleeping disorders
- Weight loss
- Withdrawal symptoms
- Suicidal ideation
- Serious physical health concerns e.g. HIV, liver problems etc.
Post addiction issues
Even those who have defeated addiction remain at a heightened risk of committing suicide. This is because it may take many years for the brain to restore to its pre-addiction state. Negatives symptoms experienced by former addicts are known as ‘post-acute’ withdrawal symptoms. These symptoms range from depression, anxiety and continued cravings.
Here’s a list of ‘post-acute’ withdrawal symptoms:
- Continued cravings for the addiction substance/behaviour
- Mental health problems e.g. depression, anxiety etc
- Anhedonia
- Trauma & grief
- Cognitive distortions
These symptoms are particularly great when the recovered addict first returns home following a stint in a treatment centre. Returning home can be a scary experience for the recovered addict, and a time when social isolation and depression can kick in. Many of the former addict’s friends and associates may be drug users, and the recovered addict will aim to avoid these people. However, this could result in social isolation, since this person does not know any ‘non-using’ friends. This social isolation could trigger severe depression followed by suicide. It’s thus essential for treatment centres to ensure their clients are well integrated back into society following the completion of treatment.
Other factors that increase the risk of suicide
The evidence demonstrates that suicide is often the cause of many factors, with addiction being one such factor. Below we list a number of additional suicide risk factors you should be aware of.
Here’s a list of additional non-addiction suicide risk factors:
- Previous suicide attempts
- Co-occurring mental health problems
- Unemployment
- Victim of rape or sexual assault
- Deliberate self harm
- Legal problems
- Social isolation
- Recent divorce or separation
- A history of childhood abuse
- Low self-esteem & self-loathing
Recognising suicidal ideation
If your loved one is addicted to drugs/alcohol or certain behaviours, we urge you to be on the lookout for the signs of suicide. The most common warning sign is the person expressing a wish to ‘end it all’. This person may be open about how they plan to carry out their suicide. If this is the case, we urge you read the paragraphs below detailing what steps you may take to try to avoid your loved one committing suicide.
Below we now list a number of suicide ‘warning signs’ you really should be aware of:
- Communicating an intent to commit suicide
- Active preparation for suicide
- Spending too much time alone
- Loss of interest in hobbies
- Abusing substances
- Expressing negative emotions such as hopelessness, grief and depression
- Recklessness
- Pessimistic about the future
- Mood swings
How to assist someone to avoid suicide
If you believe your loved one is preparing his or her suicide, you will probably be seeking strategies that will help him or her overcome these suicidal tendencies. First off, we recommend you confront your loved-one regarding his or her intent to commit suicide. If your suspicion is confirmed, we recommend you ask your loved one if he or she has taken any steps to attempt suicide yet.
If you follow this approach, it’s essential you adopt the role of a good listener. Ensure your empathy and ambivalence is apparent. During this phase you are essentially information gathering. Once you’ve built up a good pictures of your loved-one’s problems, it’s now important to recruit the help of other family members and close friends. You may also reach out to adult social services or other relevant agencies.
It’s highly likely the person will require professional treatment. This treatment typically takes place on a residential basis, where the sufferer will live within a professional caring environment for around 4-12 weeks. During this time, your loved one will receive a number of therapies designed to tackle substance abuse and co-occurring mental health problems.
Once the person has overcome his or her addiction and suicidal ideation, it’s essential you frequently check in on their progress for at least another 12 months, because suicidal ideation is known to rebound following treatment. Ensure you visit your loved-one regularly, as well as making frequent telephone check-ins.
Specific addictions and suicide
We now outline the risk factors associate with a number of substance addictions. This includes an addiction to alcohol, cannabis, opiates and cocaine.
Alcohol and suicide
Alcohol is perhaps the most well-known drug that’s associate with suicide. Alcohol addiction causes a number of negative conditions in the sufferer’s lifestyle. These conditions cause a number of mental health problems such as depress and anxiety that significantly increase the risk of suicide. Around 1/3 of people who commit suicide are acutely intoxicated with alcohol.
Cocaine and suicide
A study demonstrates a strong link between mixing cocaine/alcohol and suicidal ideation. The study examined 874 cases of attempted suicide treated at US hospitals. The data shows when alcohol is mixed with cocaine, there’s a corresponding increased risk of the user attempting suicide.
Cannabis and suicide
Unfortunately, there exists a link between long-term cannabis use and suicide. This is predominately because cannabis is known to antagonise existing mental health problems such as anxiety and depression. Long term cannabis use is known to cause psychosis. Furthermore, cannabis use may also decrease the quality of the sufferer’s lifestyle by causing money, relationships and career problems. Thus, cannabis may indirectly increase the risk of suicide.
Heroin and suicide
There exists a powerful link between heroin use and suicide. Heroin use depreciates every aspect of the user’s lifestyle including finances, relationships, job prospects and mental outlook. Many heroin addicts complain of experiencing feelings of ‘hopelessness’ and despair. Many of these people thus express their design to commit suicide.
Heroin use may also cause a number of physical health problems such as HIV and hepatitis. All of these consequences of heroin use may lead to a deterioration in the user’s mental health and a corresponding increase in the risk of the user committing suicide.
Studies show heroin addicts are particularly at risk of committing suicide when attempting to detox from the drug. Detoxing from heroin results in painful withdrawal symptoms. Many people undergoing an unsupervised heroin detox may decide to commit suicide as a way to avoid these unbearable withdrawal symptoms.
