In Mental Health
Is your loved one struggling with a substance use disorder? Do they seem to be at risk of suicide? The two issues are often deeply entwined.

One study found that men who struggle with substance abuse are 2.3 times more likely to commit suicide compared to men who do not drink or use drugs. Similarly, women who struggle with a substance use disorder are 6.5 times more likely to die by suicide.

If you are concerned that your loved one is at risk of suicide, and drug abuse is also an issue, you can take action and intervene.

Drug Use and Suicide: The Connection

It is exceptionally common for someone living with a mental health disorder like depression to turn to drug and alcohol use as a means of managing the resulting symptoms. When no other coping mechanisms are sought, a drink, a pill, or another drug can feel like the only means of escape from an otherwise overwhelming and debilitating depression.

Similarly, use of substances can trigger or worsen co-occurring mental health disorders. In both cases, suicide becomes an increased risk.

Stacy Lott, PsyD, CADC, is the Regional Director of Operations for Footprints to Recovery. She says, “People suffering from substance use disorders are likely to have depression, anxiety, and other mental health issues, which can increase the risk of suicide. “

Unfortunately, after the cessation of all use of drugs and alcohol while in recovery from addiction, suicide can become an even greater specter.

“When attempting to stop using drugs, people often feel overwhelmed by the return of painful emotions that they had been medicating with drugs,” says Dr. Lott.

Learning how to manage the underlying mental health disorders is ultimately of far greater importance than managing the physical withdrawal symptoms often associated with detox. Once the physiological symptoms fade, the original mental health symptoms that sparked drug use in the first place persist.

In many cases, ongoing mental health symptoms may be even more difficult to manage after addiction due to the trauma associated with active addiction and the neurological changes wrought by consistent, high-dose substance abuse.

Risk Factors for Addiction and Suicide

Risk factors, or behaviors or environmental characteristics that predate active addiction or suicide attempts, play a big part in the likelihood that someone may attempt suicide in combination with drug use.

In some cases, problems that someone is facing in life or relationships can be an indicator. For example, Dr. Lott says that substance abusers are also more likely to have social and financial problems. Someone in the midst of a contentious divorce, or who is struggling after a layoff, and using drugs or alcohol to cope may be at high risk of suicide.

Some risk factors for addiction include:

  • Early first use of any substance.
  • Regular use of substances during the teen years.
  • Growing up in an environment that is permissive of drug use.
  • A childhood governed by caregivers who used drugs.
  • Close genetic relationship with someone who struggled with addiction.
  • A mental health disorder.
  • Experience of trauma or extreme loss.

Risk factors for suicide include:

  • Depression or feelings of hopelessness.
  • Experience of trauma.
  • Extreme or unexpected loss.
  • Financial distress.
  • Family history of suicide or suicide attempts.
  • Physical illness, either extreme, acute, or chronic.
  • Easy access to guns, pills, or other methods of self-harm.
  • Substance use and abuse.

According to Dr. Lott, suicidal tendencies and drug use often go together and share some risk factors. “Substance abuse can be a risk factor for suicide because substance use is common among those prone to impulsivity, and among those who engage in many types of high-risk behaviors that result in self-harm.”

Warning Signs of Substance Use, Abuse, and Addiction

The specific signs of drug use are variable, based heavily on the drug of choice, the dose, and the person’s tolerance level.

For example, someone under the influence of marijuana might have red or bloodshot eyes, seem unable to follow the intricacies of a conversation, and may “zone out” easily. Someone under the influence of crystal meth or cocaine may be excessively chatty, have dilated pupils, and/or exhibit paranoia.

In general, you may notice some behavioral changes when a loved one begins to abuse drugs. These may include:

  • A change in sleeping or eating habits.
  • Coming home late or not at all.
  • A lack of money.
  • Vague answers to questions about their whereabouts or what happens to their money.
  • Showing up late to work or missing days.
  • Often hungover, tired, or “sick” when not out and about.
  • Spending more and more time in isolation.

Should drug use become a regular habit or an addiction develops, you may notice that your love one:

  • Lies about whether they are under the influence, what they used, or how much.
  • Steals money and items they can sell for quick cash.
  • Loses their job and is unable to find or keep a new one.
  • Becomes aggressive when pressed about their drug or alcohol use.
  • Is unable to stop drinking or using drugs on their own despite a real effort to get sober.

Warning Signs of Suicidal Tendencies

According to Dr. Lott, there are a number of warning signs of suicide that friends and family members can look for, including:

  • Depression.
  • Previous suicide attempts.
  • Preoccupation with death.
  • Statements like, “You would be better off without me,” or “I wish I were dead.”
  • Talking openly about wanting to engage in self-harming behaviors.
  • Development of a suicide plan, including acquiring the means to carry it out, “rehearsal” behavior, and setting a time for the attempt.
  • Making out a will or giving away favorite possessions.
  • Inappropriately saying goodbye.
  • Making ambiguous statements like, “You won’t have to worry about me anymore,” “I wish I could go to sleep and never wake up,” or “I just can’t take it anymore.”
  • Suddenly switching from being very depressed to being very happy or calm for no apparent reason.

If you believe your loved one is suicidal, do not wait to respond, ignore the problem, or think it will go away on its own. Especially when they occur in the midst of heavy drug use or addiction, signs of suicide may be the only warning you have that your loved one’s life is in danger. An immediate response is recommended.

Prevention and Intervention: How to Respond to a Loved One in Crisis

Both drug addiction and suicide, separately and on their own, can be deadly. When combined, the risk for early death escalates dramatically.

Says Dr. Lott, “Substance abuse not only increases the likelihood that a person will take their own life, but it is also used as a means to die by suicide.”

This means that the use of substances may worsen depression and become the tool by which someone takes their own life, such as via a purposeful drug overdose. In other cases, the person may drink or use drugs and then go through with suicide while under the influence.

She encourages family members and close friends to take action if they see a loved one in crisis, especially if they are going through something disruptive and do not seem to be managing the problem well.

“Transitions, such as entering or leaving treatment, relapse, death, divorce, or other major life changes can be especially vulnerable times,” Dr. Lott says.

She urges family and close friends to keep a few things in mind when it comes to approaching someone who may be considering suicide while also dealing with a substance use disorder.

  • Your loved one may not ask for help. It will be incumbent upon you to check in with them.
  • If you believe your loved one is considering suicide, do not wait to step in.
  • Spending time with your loved one can help them to get through the hardest parts, giving them more time to heal.
  • You can broach a conversation by saying something like, “I’ve known you for a while, and you don’t seem like yourself lately. Is there something going on?”
  • Listening is one of the best things you can do for your loved one. Support them as they talk, and avoid arguments or trying to downplay or gloss over their concerns.
  • It may take consistent and repeated effort and intervention for them to begin to turn things around for themselves.
  • Even if you are frustrated or upset with them, avoid sharing that with them.
  • Though you are an important part of your loved one’s path to recovery, you cannot save them. You should not be their only means of support. Help them connect with other people who love them.
  • Encourage your loved one to connect with professional treatment providers who specialize in addiction and mental health treatment.

Above all, take your loved one seriously if they are talking about suicide, and do not give up trying to help them get better. Connecting them with specialists who can help them follow a personalized treatment path to recovery is an essential piece of the puzzle. Without assistance, it is unlikely that your loved one will seek help on their own.

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