Suicide is a preventable tragedy. After it happens, everyone struggles to understand why. There are risk factors and warning signs that so often go unrecognized before it is too late. A deep feeling of hopelessness, and an inability to see solutions to problems, may lead people to take their own lives.
The Suicide Crisis
Suicide rates have reached epidemic levels, and they are continuing to rise. The Centres for Disease Control and Prevention (CDC) report that suicide is the 10th leading cause of death in the United States, the third among adolescents aged 10-14, and 2nd among young adults 15-25. Over 44,000 individuals died by suicide in 2015 alone.
The suicide crisis is interconnected with mental illness and substance abuse. 90% of suicide victims suffer from depression or other mental health disorders, or addiction, or both. In Canada, about 4,000 people die by suicide every year.
Frequently, addicts turn to drugs or alcohol to relieve symptoms of those conditions, and they may develop a physical and psychological dependence. This exacerbates the mental illness, which leads to more drug and alcohol use, and leaves the underlying condition untreated. If suicidal thoughts are not addressed, the individual is at great risk.
This pattern will eventually lead to a substance use disorder. When that happens, the addiction and mental illness become co-occurring disorders. Anxiety, depression, bi-polar disorder, obsessive-compulsive disorders (OCD), schizophrenia, eating disorders, attention-deficit hyperactivity disorder (ADHD), and post-traumatic stress disorder (PTSD) are the most common mental health problems from which addicts suffer, that often result in substance abuse.
Alcohol and drug abuse, along with a mental health condition, significantly increases the risk of suicide.
Substance Use Disorder and Suicide
The link between addiction and suicidal behaviour has been a focus of researchers in recent years. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 7.9 million Americans have co-occurring disorders, and studies have found a strong correlation between substance abuse and suicide.
Drug or alcohol abuse contributes to suicidal behaviour in many ways. Addicts often have a number of other suicide risk factors, such as financial or legal problems, or poor impulse control. This leads to high-risk behaviour, particularly in young adults.
Individuals who abuse drugs or alcohol are 10 -14 % more likely to contemplate, attempt or complete suicide. For example, alcohol addicts are more susceptible to suicidal ideation because depression can be triggered by excessive alcohol consumption. The risk of suicide increases if other substances are combined with the alcohol, such as prescription medications, cocaine or heroin.
Of all the substances being abused, opioids, a prescription painkiller, may be the most dangerous. Opioid use disorder occurs when the medication is misused, or when the user becomes addicted and cannot stop. It is a very serious issue that has captured the attention of researchers and medical practitioners.
In 2015, SAMHSA reports that there were more than 33,000 opioid-related deaths in the U.S. While it is difficult to know how many of those were suicides, and how many were accidental overdoses, opioid use is associated with a 40-60% increased likelihood of having suicidal thoughts, and a 75% increased likelihood of a suicide attempt. This effect is significantly more dramatic for women than for men.
Drug and alcohol addicts often attempt to stop consuming the substance on their own. This can result in very serious, potentially life-threatening, withdrawal symptoms. A medical detox, supervised by a treatment provider, in a rehab facility or hospital, is safer than attempting to quit “cold-turkey”, without the support of a health care professional.
Warning Signs and Suicide Risk Factors
Suicide is an incredibly complex issue, with no single cause or simple explanation. Many underlying challenges converge to create a situation in which an individual is at risk of becoming a victim of suicide. Depression is the most common mental health disorder associated with suicide, and is often untreated, leading to self-medication with drugs or alcohol.
Any addiction or mental illness that is not properly managed significantly increases the likelihood of a suicide attempt.
Changes in behaviour, particularly if they are sudden and related to a painful loss or event, are one of the strongest indicators that someone may be at risk for suicide. Most people who take their own lives exhibit prior warnings signs.
These may include the individual actually talking about killing themselves and making a suicide plan. If they do not go as far as explicitly discussing suicide, they often share feelings of hopelessness, of having no reason to live, of being a burden to others, or feeling trapped.
Increased drug or alcohol use, suicidal behaviours such as looking for ways to kill themselves, withdrawing from activities, isolating from family and friends, sleeping too much or too little, calling people to say goodbye, or giving away possessions are all warning signs.
Other indicators that an individual is at risk of suicide are changes in mood. These can include new or worsening anxiety or depression symptoms, loss of interest, irritability, shame or humiliation, anger, or sudden improvement and relief.
Suicide Risk Factors
There are a variety of characteristics, underlying issues, and/or medical conditions that increase the probability that a person may take his or her own life.
Health-related challenges associated with the risk of suicide include mood disorders like anxiety and depression, problems with substance abuse, bipolar disorder, schizophrenia, changes in mood, aggression, and difficulties with relationships.
Access to the means for suicide, like a gun or drugs, prolonged periods of stress at home or in the workplace, life changes such as divorce, financial problems, or other change or loss, witnessing another suicide or graphic representations of it, are environmental factors that can lead to suicidal thoughts.
It is important for friends and family members to listen to the individual for indicators of risk. Previous suicide attempts, a family history of suicide, and childhood trauma or abuse are also cause for concern.
The warnings and risk factors all combine to create a picture that is different for every individual. They need to be taken seriously, and they require immediate intervention by a medical professional in order to prevent another moment of wondering “why” after losing a loved one.
Saving a Life – Suicide Prevention
Not every suicide can be prevented, but there are ways to reduce the risk. Working towards physical and mental well-being, and addressing the warning signs, are the first steps. Individuals who are struggling need to seek treatment for mental health concerns. It is also critical to build a support network of friends, family, and peer groups. Both of these steps will allow the addict to develop new coping skills to deal with problems.
Recognizing and Responding to Suicidal Thoughts in Oneself
If an individual displays any of the warning signs or risk factors, that is cause for concern. Being very honest with oneself about contemplating suicide may be a good way to start addressing this serious issue.
If there are suicidal thoughts and a plan, with the means to carry it out, it is critical to get professional help immediately by dialing 911, or visiting the nearest emergency room.
Individuals who are suicidal are often isolated from family and friends, and they may have difficulty dealing with stressors. They may also have poor impulse control, making actually completing suicide easier. Because of this, it can be very challenging to reach out for help, and often, the result is another tragic death.
Today, there are a large variety of ways to get help. Many agencies have a crisis telephone line or online services. For some people in certain situations, it is easier to reach out to a stranger than it would be to talk to a friend. These people can assist the individual in connecting with medical professionals, support groups or loved ones, or they can simply be someone to listen.
The most important thing is to talk to someone, as scary as that may seem. Starting the conversation is the hardest part.
Intervening with Someone Else
The most important thing to do as a friend or family member is to look carefully for warnings signs, and take them seriously. Any talk of suicidal thoughts or a plan is a strong risk factor, and immediate intervention is essential.
It may be a difficult conversation to have, but the alternative, not addressing serious concerns and losing that individual to suicide, is far worse. If there have been enough signs, including talk of the individual ending his or her own life, the probability of suicide is great.
When speaking to a suicidal person, it is important to put them at ease, and to reassure them that everyone wants to help. Also, listening while being sympathetic and non-judgemental, will offer the best chance of success. Believing that they may actually follow through with any threats of self-harm may save a life.
Responding in a Crisis
There are ways to assess levels of suicide risk. If the individual has some suicidal thoughts, doesn’t have a plan, and says that he or she will not act on suicidal thoughts, that is the lowest level. Moderate risk is suicidal thoughts, a plan that isn’t very clear, and stating that he or she will not go through with suicide. The risk is high when the person has suicidal thoughts, a specific and lethal plan, and states that he or she will not end his or her own life.
All of these individuals need immediate support from friends and family members, and professional help. The treatment plan should include therapy, counselling, and/or medication.
If a person has suicidal thoughts, a very specific and lethal plan in place, and says that he or she will go through with suicide, the level of risk is severe. This will include details about where they will do it, a time, the means, and an intention to follow through.
If a friend or family member shares all of this, and he or she has access to everything needed to carry out the plan, immediate intervention, such as contacting emergency services by phone or in person, is critical.
As 90% of individuals who die by suicide have a mental health disorder, addressing those underlying conditions is the most certain means of prevention. A combination of therapy, counselling, and/or medication has long been found to be effective in treating mental illness and addiction.
Research into suicide has been on the rise in recent years, and an understanding of that complicated health issue is evolving. There are medical interventions available for those as well.
Personalized safety plans have been shown to reduce suicidal thoughts and behaviours. Patients work with a health care provider to create a plan that addresses access to the means, such as pills, guns, or poison. They also develop strategies for coping with problems, and what to do in a crisis. The plan is accompanied by a series of follow-up phone calls, to provide ongoing emotional support.
The safety plan is a short intervention, followed by more intensive treatment. There are two psychotherapies that have been found to be helpful with individuals who have made a suicide attempt.
Cognitive Behaviour Therapy (CBT) helps people understand why they made the choices they did by exploring their thought patterns. They then can develop new, healthier ways of responding to problems and stressors.
Dialectical Behaviour Therapy (DBT) is often used with adolescents and individuals with borderline personality disorder (BSD). The challenges with shifts in mood, behaviour and self-image that are characteristic of both youth and BSD, often result in difficulties with relationships, and impulsive actions. A therapist, usually a psychologist or psychiatrist, works with the patient to improve understanding of his or her feelings, and to learn new strategies for responding to emotional upset.
Medication can be very helpful in managing the symptoms of any mental illness, and it is often part of a comprehensive treatment plan. Finding the best medication and dosage is an ongoing process that is done in consultation with a health care practitioner.
Clozapine, an anti-psychotic used to treat people with schizophrenia, is the only medication officially identified by the Food and Drug Administration (FDA) in the U.S. as reducing suicidal behaviour in those individuals.
The use of other medications has been studied, but the results were inclusive. However, there are many medications available to treat depression or other mental illnesses, and substance abuse, and these are well supported by research.
Treating the underlying mental health disorder and co-occurring addiction is the most effective way to reduce suicide rates, and save lives.
A Preventable Tragedy – A Team-Based Approach
Treatment by a team of care providers, including a specialist in mental health, like a psychologist or psychiatrist, working collaboratively with the family and with the individual who is struggling, is crucial. The substance use disorder and mental illness need to be treated in an integrated approach, as they are strongly linked.
Virtually everyone who dies by suicide has a mental health disorder, and drug and alcohol abuse increases the risk of taking one’s own life dramatically.
Fortunately, there are usually signs, and help available. Suicide is a preventable tragedy.
Suicide The Centre for Addiction and Mental Health (CAMH), Copyright 2019
Suicide Prevention Mental Health Commission of Canada, Copyright 2019
Suicide and Suicidal Thoughts The Mayo Clinic staff, Copyright 2019
Suicide Rising Across the U.S. Centres for Disease Control (CDC), Article Date: June 7, 2018
Addiction and Suicide: An Un-met Public Health Crisis Ahmed, S., M.D., et al., American Psychiatric Association (APA), December, 2017
Substance Use and Suicide: A Nexus Requiring a Public Health Approach Substance Abuse and Mental Health Services Administration (SAMHSA), 2016
Addiction and Suicide: A Review Youdelis-Flores, C., et al., U.S. National Library of Medicine, March 24, 2016
Suicide: One of Addiction’s Hidden Risks, Psychology Today, February 20, 2014