Drugs Use and Suicide

It is common for people to use drugs in order to feel good, to feel better, to perform better, or simply out of curiosity. When people consume drugs for the first time, they may perceive positive effects and believe they are capable of controlling their consumption. Drugs, however, can quickly take over a person’s life. Continuing to use drugs over time causes other pleasurable activities to become less pleasurable, and the individual becomes dependent upon the drug just to feel “normal”. Despite the fact that drugs cause many problems for themselves and their loved ones, they have difficulty controlling their urge to consume drugs. Some individuals will feel the need to take more of the drug or to take it more often, even at the beginning of their drug use. These are the steps that lead to an addiction.

There are several problems that may arise as a result of frequent use of alcohol and drugs. Substance abuse can have several life-changing consequences, ranging from a decline in quality of life to legal issues and even overdose. One of the most significant risks associated with substance abuse, often overlooked by loved ones and even treatment centers, is suicide.

Substance use and suicide in numbers

• Worldwide, more than 1 million people commit suicide every year.
• Those with alcohol use disorders are almost 10 times more likely to die by suicide compared to the general population.
• Those who inject drugs are about 14 times more likely to commit suicide compared to the general population.
• 58% of all admissions for suicide were associated with drug and alcohol addiction.
• 25% of alcoholics and drug addicts kill themselves by a variety of means.
• There’s a lifetime prevalence of 18% for suicide among alcoholics and drug addicts in the general population.
• 70% of adolescent suicides are associated with alcohol or drug problems.
• Males outnumber female suicide victims by almost four to one, the association of suicide with substance use disorders in women is markedly stronger.
• Up to 40% of patients seeking treatment for substance dependence report a history of suicide attempts. Substance dependent individuals entering treatment are at elevated risk for suicide attempts for various reasons, they often enter with depressive symptoms and a number of severe stressors (relationship loss, job loss, health and financial problems) that not only impel them to seek treatment but also put them at higher risk for suicidal behavior.

The association of alcohol and drugs with suicidal thoughts and behaviors is both causal and contributory. Alcohol and drug addiction are important risk factors for suicide, both as direct causes and as triggers for suicidal behavior. Chronic use of alcohol and drugs plays an important etiological role in the development of suicidal thoughts and actions through pharmacological effects on the brain that impair judgment and cognition and cause severe depression. In addition, the crisis-oriented lifestyle of alcoholics and drug addicts with subsequent interruption of interpersonal relationships is conducive to the development of suicidal impulses.

The subjective state of hopelessness is key to the disposition to actual suicide. “Hopelessness” is the imminent feeling that appears to precipitate self-inflicted destruction. It correlates highly with suicide and is central to the suicidal state, whether drug-induced or from some other cause. The mind apparently requires hope not only to sustain sufficient mental inertia for survival, but also to avoid self-extinction.

Alcohol and drugs create feelings of hopelessness through their toxic effects, by disrupting interpersonal relationships and social support, and possibly manipulating neurotransmitters responsible for mood and judgment. Because alcoholism and drug addiction are major risk factors for suicide and suicidal behavior, anyone who is dependent on alcohol or drugs should be screened for suicide, especially if they are actively using alcohol or drugs.

In addition, the presence of psychiatric comorbidities in chemically dependent individuals is associated with a higher prevalence of suicide. Alcoholism and drug addiction can have co-occurring mental disorders, with suicide as an important risk factor. The most common comorbid psychiatric disorders are depression, borderline personality disorder, mania, and schizophrenia. A family history of depression, suicide, and alcoholism was prominent in suicidal cases.

Drugs associated with suicidal behavior include depressants specially alcohol, sedative, hypnotics, and opiates, as well as stimulants such as cocaine and amphetamines.

The pharmacologic actions of these drugs induce depression that is similar to depressions from other causes. We can diagnose depression by looking out for a depressed mood, a psychomotor retardation, a social withdrawal, guilt, and self-reproach. Depressants tend to produce depression during intoxication, whereas stimulants usually produce depression during withdrawal. These drugs of addiction provide a neuropsychopharmacologic model for depression and suicide and may provide insights into mechanisms underlying suicidal behavior.

A person suffering from comorbid depression caused by alcohol and drug abuse may gradually recover from it during abstinence. Usually, an alcoholic or drug addict experiences depression, paranoia, and anxiety due to alcohol and drugs, so abstinence from both is imperative. However, a high rate of relapse is seen among alcoholics and drug addicts, and specific treatment must be provided for the addiction.

When a specific treatment plan is implemented for the addiction, hopefulness generally reappears after prolonged abstinence. The suicidal thinking and behavior usually dramatically diminish with abstinence and treatment of addiction. In the early months of the treatment, however, they may persist at chronically lower levels due to the prolonged pharmacological effects of the medication. The degenerated state of the personality and the impaired mental state of the addicted individual play prominent roles. Despite recurrent suicidal thoughts, the suicide risk is low for most alcoholics and drug addicts in early recovery since most of these factors respond to treatment. The use of antidepressants and antipsychotics is not indicated in the majority of cases of chemically induced depression and may be detrimental in a population prone to adverse drug effects such as sedation, reduced cognition, and altered mood. However, if threatening and dangerous suicidal thoughts persist, selective use of antidepressants should be initiated.

A careful examination is important for the diagnosis of alcoholism and drug addiction in the context of a suicide attempt. If alcoholism or drug addiction is not identified as a cause or trigger for a suicide attempt and is not properly treated, the likelihood of another suicide is high. If only specific treatment is prescribed for accompanying psychiatric symptoms, feelings of hopelessness remain, as well as a serious threat of suicide.