Suicide, depressed, paper, black, blue, head, sad

Substance abuse and suicide are closely linked. Over 90% of people who commit suicide have a mental health disorder, with mood disorders and substance use disorders being the most common. Over 15% of American adults struggled with a substance use disorder in 2020, and nearly 5% of adults reported having thoughts of suicide. These alarming statistics prove that addiction and suicide are growing threats to public health. People who struggle with an addictive disorder are at higher risk for suicide for a number of different reasons, which will be outlined in this article.

Addiction increases the risk for suicide in several ways, including interfering with mood-stabilizing brain chemicals and lowering a person’s inhibitions, making them more likely to act on destructive impulses. While many people turn to drugs and alcohol to relieve stress, addictions create more stress in the long run by causing financial, legal, social, and work-related problems. Over time, these stress factors can compound, leading to feelings of hopelessness, deteriorated mental health, and sometimes thoughts of suicide.

Everyone who dies from or attempts suicide has a unique history and individual reasons for their actions. However, the following factors are known to heighten the risk for suicide among people who abuse drugs and alcohol:

  • Imbalances in brain chemistry: Alcohol is a known depressant due to its effects on mood-regulating brain chemicals, and other sedative drugs have similar effects. Even drugs with no depressant effects can disrupt the brain’s pleasure and reward system by causing the overproduction of the pleasure chemical dopamine. When dopamine is depleted, it can leave people feeling depressed and apathetic.

  • Secondary stress related to substance abuse: One of the hallmark signs of addiction is when a person’s drug or alcohol use begins to negatively impact an important area of their life. Substance abuse can damage interpersonal relationships, careers, and finances and can cause legal headaches and physical or mental health problems. These issues can increase feelings of stress, helplessness, and hopelessness, even leading to suicidal thoughts.

  • Co-occurring mental health disorders: 38% of American adults who abuse drugs have co-existing mental health diagnoses. [5] Over 90% of people who commit suicide have some kind of mental illness or substance use disorder. Schizophrenia, bipolar disorder, and depression all increase vulnerability to suicide, and this risk is even higher when the person has a substance use disorder as well.[1][2][6]

  • Intoxication & impaired decision making: Being under the influence of alcohol and drugs can impair their decision-making, reduce inhibitions, and increase impulsivity and aggression, making suicide more likely. Alcohol intoxication is very closely linked to suicide for these reasons and is a contributing factor in one in every three suicide deaths in the US.[1][2] In 22% of suicide deaths, blood alcohol concentration (BAC) exceeded the 0.08% legal driving limit.[2][7]

  • Intentional overdose: While it is difficult to determine whether a person’s overdose was intentional or not, it’s highly likely that at least some overdoses are not accidental in nature. Some people who have suicidal thoughts may deliberately overdose, and these deaths are sometimes ruled accidental instead of being counted as suicides. One source estimates that between 20% and 30% of opioid overdoses may fit the description of suicide.[8] 

Get help during covid-19

Get help during Covid-19

At Recovered, we recognize the impact COVID-19 has had and the continued challenges it poses to getting advice and treatment for substance use disorders. SAMHSA has a wealth of information and resources to assist providers, individuals, communities, and states during this difficult time and is ready to help in any way possible.

Speak to SAMSHA

Alcohol and suicide

Abusing any substance can increase a person’s risk for suicide, but this risk is highest among people who abuse alcohol.[1][2] People treated for alcohol abuse or dependence have at least ten times greater risk of suicide than the general population.[6] Some studies suggest their risk is as much as 120 times higher.

The link between alcohol and suicide is multi-faceted. Alcohol can increase a person’s risk for suicide in a number of different ways, including:[1][2]

  • Depressant qualities: Alcohol is considered a depressant because of the effects it has on the brain and body, including making people more likely to feel tired, down, unmotivated, and sad. For a person who already struggles with depression, sadness, or suicidal thoughts, alcohol can further intensify these feelings.[10]

  • Reducing inhibitions: It’s well-known that alcohol reduces a person’s inhibitions, making them more likely to act impulsively and recklessly. When a person who has suicidal thoughts drinks too much, they become much more likely to act on suicidal urges than they would be if they were sober. One study found that people with normal drinking patterns are six times more likely to attempt suicide when drunk than when sober.[11]

  • Stress caused by alcohol abuse: Over time, alcohol use disorder can have devastating effects on a person’s work, finances, life, and relationships. Long-term alcohol use can also cause chronic health problems like cirrhosis. Over time, these cumulative effects can lead people to feel stuck, hopeless, and depressed, even leading to suicidal thoughts.

Read here to learn more about alcohol and mental health

Drugs and suicide

Drug use also increases the risk of suicide, both directly and indirectly. Research suggests that opioid use is present in 20% of suicide deaths and that people who inject drugs have a suicide rate 14 times higher than the general public.[1][2][9] CDC data also found that marijuana was detectable in 10.2% of suicide victims, cocaine was detected in 4.6% of victims, and amphetamines in 3.4% of victims.[7] Other studies have found that the type of drug being used is less relevant to suicide than the number of drugs used.[12] 

While the specific impacts on the body and brain vary depending on the drug(s) involved, there are a number of ways that drug use can increase the risk of suicide including:[2]

  • Intoxication and impaired decision making: Many illicit drugs lower inhibitions, cloud judgment about long-term consequences, and create transient low mood, paranoia, and obsessiveness—all increasing the likelihood of suicide. When people are intoxicated, they’re much more likely to act in destructive, dangerous, or impulsive ways than if they were not under the influence of a drug.

  • Overlapping risk factors & isolation: Drug use and suicide have overlapping risk factors, including family history, trauma, and abuse. This may indicate a shared genetic, environmental, or neurological origin. Many people with drug addictions burn bridges with friends, family, and other supports, leading them to become isolated. Social isolation is a known risk factor for depression, mental illness, worsened addiction, and also suicide.

  • Chronic pain or health conditions: For a significant number of people, chronic pain is a trigger that leads to the prescription of narcotic painkillers. These prescribed medications are highly addictive when used long-term, which can begin the cycle of opioid abuse. Some drugs even do long-term damage to the body and brain, which can leave people feeling as if it’s pointless to put in the effort it takes to get clean and sober, causing them to slide further into severe addictions.

  • Access to lethal means: Access to lethal means is another major risk factor for suicide that’s relevant to people who misuse drugs. High numbers of drug overdoses are at least partly intentional. In a survey of overdose patients at a Michigan emergency department, 39% of those with an opioid or sedative overdose reported wanting to die or not caring about the risks, while another 15% said they were unsure of their intentions.[13]

  • Depressive episodes & crashes: Many illicit drugs impact the chemicals in the brain that help to regulate a person’s mood. Long-term abuse of a drug can disrupt the normal brain chemistry in ways that can lead to depressive episodes and sometimes even suicidal thoughts. The ‘crash’ after taking certain stimulant drugs can be especially difficult for people to cope with.

Read here to learn more about drug abuse and mental health.

Addiction and suicide statistics

The following statistics help to illustrate how big of a problem addiction and suicide are becoming in our society. 

  • Suicide is the 10th leading cause of death in the US, and the 2nd leading cause of death in people ages 10-42.[2]

  • In 2020, nearly 5% of American adults (18 and over) had thoughts of suicide, 1.3% made a suicide plan, and .5% made a suicide attempt.[3]

  • In 2020, 12% of American adolescents (ages 12-17) had serious thoughts of suicide, 5.3% of US teens made a suicide plan, and 2.5% of US teens made a suicide attempt.[3]

  • In 2020, almost 15% of Americans over the age of 12 had a drug or alcohol use disorder that qualified as needing treatment.[3]

  • Between 30-40% of people who attempt suicide are under the influence of alcohol at the time.[2]

  • Alcohol is involved in 33% of suicides and opioids are involved in 20% of suicides.[1][2][7]

  • People who abuse alcohol have a suicide risk 10 to 120 times higher than average and people who inject drugs have a suicide risk 14 times higher than average.[1][9]

  • Around 10% of suicide deaths in England are among mental health patients with a history of alcohol misuse.[14]

  • In the UK around half of people who die by suicide who are in recent contact with mental health services have a history of drug or alcohol misuse.[15]

Getting treatment for addiction

Substance use disorders greatly impact a person’s risk for suicide, but they can be treated. Getting treatment for a substance use disorder is one of the best ways to prevent suicide while also helping to address the underlying stressors and causes. While many people struggling with addiction feel hopeless about their ability to recover, the reality is that most people who struggle with an addiction do eventually get clean and sober. 

Seeking treatment makes this process easier by providing structure, support, and assistance to those working to overcome an addiction. There are many proven treatments that can help to treat a drug or alcohol addiction including inpatient or outpatient rehab or group or individual counseling, sometimes in addition to medication. Visit our rehab directory to find help for substance misuse today. 

The first step in seeking help for addiction & suicide

When beginning treatment, you should disclose any suicidal thoughts or previous attempts. This information is important for your provider to know in order to ensure you get the right kind of help. Your treatment can be personalized to address these thoughts and conducted in such a way as to keep you safe. For example, inpatient treatment might be more appropriate for people who have active suicidal thoughts, a plan to harm themselves, or recent attempts.

During the initial intake appointment, you will also be assessed for co-existing mental health disorders that may be driving or worsening your suicidal thoughts. These will be treated simultaneously with your substance abuse using integrated treatment approaches. Therapeutic pathways often used in addiction treatment can also be helpful for suicidal thoughts and behaviors. 

For instance, cognitive behavioral therapy (CBT) can help you learn how to stop and rethink negative or harmful thoughts and Motivational interviewing (MI) can help you make an action plan for recovery. Third-wave therapies like Acceptance and Commitment Therapy teaches people how to experience difficult thoughts, urges, and emotions without acting on them. These are just a few of the many evidence-based therapies that are proven to help people suffering from addictions, depression, or other mental health conditions.[16]

Suicide prevention helplines

If you're going through a difficult time, help is available. The following hotlines are confidential and most provide 24/7 phone support to people struggling with suicidal thoughts:

  • 988 Suicide and Crisis Lifeline: Text or call 988 for 24/7 support on any phone or phoning -800-273-TALK (8255). The Lifeline is available 24 hours a day, 7 days a week.

  • Crisis Text Line: For those who prefer to text rather than call, text HELLO to 741741 to open a dialogue with a trained responder (24/7 support available)

  • Veterans Crisis Line: Specifically for active duty or retired US military veterans. Dial 1-800-273-8255 and Press 1 to talk to someone or send a text message to 838255 to connect with a VA responder.  You can also start a confidential online chat session at Veterans Crisis Chat.

  • Samaritans (UK only): Call, email, or online chat with a trained support person any time of the day or night, 365 days a year. Call them for free on 116 123, email them at [email protected], or visit samaritans.org to find more details.