Guest Blogs

The following is a guest post by Brenda Abbott, Executive Assistant at Saint Jude Retreats. Saint Jude Retreats is an alternative to traditional alcohol and drug treatment centers and rehabs. They offer a non-treatment, non-12 step and non-religious, educational program. Their curriculum and methods present an opportunity for an individual to take control of his/her own thoughts, choices and actions, learn more productive behavioral patterns, build an envisioned future, and accomplish goals and dreams.

Suicide & Suicide Attempts: Do Substance Use & Alcohol Play a Role?

Many have questioned if drugs and alcohol have any correlation with the reasons behind suicides and suicide attempts. According to Michael Bohn’s article “Suicide and Substance Abuse,” illicit drugs and alcohol have a connection in about 50% of all suicide attempts, and about 25% of the individuals who committed suicide had shown signs of heavy substance use.

What does this really mean? Does it mean that people who are substance users are at higher risk to commit a suicide or does it simply state the fact that substances were present in the reported cases in the study, regardless of previous substance use history of the individuals? Or does it mean that people use substances to commit suicide more often? Does a person reach for a bottle of prescription drugs because they have a previous history of prescription drug abuse or does this person rely on  “common knowledge” that prescription drugs are one way to commit suicide? If it’s the former, how often are accidental overdoses considered a suicide? What we know is that approximately 33% of the individuals who committed suicide tested positive for alcohol, 23% for antidepressants, and 20.8% for opiates (in which heroin and painkillers were included). Are these substances the reason for a suicide or just vehicles to carry it out?

According to Brady, “acute alcohol use can also precipitate suicidal behaviors through induction of negative affect and impairment of problem-solving skills, as well as aggravation of impulsive personality traits, possibly through effects on serotonergic neurotransmission.” (Brady 2006). There is also evidence that suggest expectations formed by the individual guide the extent to which they feel “out of control” while under the influence. The same article also states that “alcohol has a biphasic effect on emotion, with low doses often ameliorating negative effect, but higher doses producing central nervous system depressant effects” (Hufford 2001).

In simpler terms that means that individuals are more likely to feel better as their blood alcohol concentration (BAC) gets to about .05, which is the first stage of the biphasic effect.  If the individual continues to drink, their BAC rises and that is when an individual hits the second stage of the biphasic effect, where some individuals might feel worse after drinking. Making the choice not to drink at all or drink in moderation might make all the difference in these cases. Once again, we see that the individual’s choices guide this spiral.

In suicide and suicide attempts, gender can be a significant factor as well. InterventionStrategies.com presents the following information from 2010; the segment of suicides divided by gender that represented the male population, was about 78.8% in the United States. The reasons behind this can be many. Women tend to be more emotional, speak more openly and are able to communicate more clearly which makes them feel relieved to a degree. In comparison, men are raised not to show emotion and deal with their problems more privately.

It is true that consuming alcohol or drugs does correlate to suicidal behavior. But when we are discussing such a complex issue, we have to consider other factors besides the obvious as well.  A large number of individuals who actually follow through with suicide, may have mental disorders for example (InterventionStrategies.com). The same research states that violence may be held partly responsible for the link between suicide risk and substance use along with individuals having a history of major depression, social isolation, serious physical or mental illnesses, abuse and neglect, not having access to proper mental health resources and at the same time having easy access to substances.

Having said that, it is worth mentioning that based on the information from The National Violent Death Reporting System (NVDRS) the top substances used in suicide and suicide attempts are as follows:

• Prescription drugs (e.g. diazepam, opioid, oxycodone, fluoxetine, benzodiazepine)
• Over-the-counter medications such as acetaminophen (Tylenol)
• Street/recreational drugs (e.g. crystal meth, ecstasy, cocaine, heroin, amphetamines, etc.)
• Alcohol

In general, individuals who take in large amounts of alcohol carry a higher suicide risk than those who have a lower alcohol intake, when comparing the two. However, people who never drank or drugged in their life can very well commit suicide through substance use, and they do.   Suicide risks could increase in individuals who use more than one drug at the same time, and those who use both drugs, and alcohol at the same time. The reason for this is not only because of adverse effects from the substances, but also because this factor increases the chances of accidental overdose. However, the majority of suicides and suicidal attempts that involve substances do not indicate a long term substance use problem or any substance use problem at all. It could be that the substances have been used as a way to carry out the suicide, because of ease of access alone. Prescription medications are a good example.

As the most common method for suicide, prescription medications are surprisingly easy to get access to:

• through family members and friends (with or without their knowledge)
• through provided or purchased from peers or co-workers
• through “doctor shopping,” which is going from doctor to doctor to get scripts filled

Many people are aware of the danger of inappropriate use of prescription medication; however, some do not realize the danger of over-the-counter medications as well. Over-the-counter medications can be as lethal as prescription medication when used inappropriately. Examples of such medications are Tylenol, Motrin (Advil), etc.

The reasons behind a suicide attempt or a suicide are highly complex and deeply personal. The truth is that in some cases (history of substance use or not) there might not be a way to prevent them. Humans are born with autonomous thought and free will: two natural traits that allow for complete control over one’s actions – including, unfortunately, suicide. However, there are many individuals who could have been saved, provided they had the right information and help at the right time. It is important to remember that at the end it doesn’t matter what life hands us, good or bad. What matters is how we react to it, through the choices we make. It is easier said than done. But by learning from our mistakes, by gaining self-respect and confidence, and by following the lessons of our life experience, based on our choices and courage, we can move in the right direction to have happy, long and fulfilling lives. No matter how alone a person may feel, ultimately the individual can still choose life over death.

Resources

Unknown. (2014). Substance abuse and suicide risk. Intervention Strategies. Retrieved from http://alcoholrehab.com/alcohol-rehab/substance-abuse-and-suicide

Bohn, M. (2001) “Suicide and Substance Abuse.” Encyclopedia of Drugs, Alcohol, and Addictive Behavior. Retrieved from Encyclopedia.com: http://www.encyclopedia.com/doc/1G2-3403100435.html

Brady J. (2006) The Association Between Alcohol Misuse And Suicidal Behavior. Oxford University Press Vol. 41, No.5,pp. 473-478. Retrieved from http://www.elementsbehavioralhealth.com/mental-health/substance-abuse-and-suicide/

llgen, M and Kleinberg, F.(2011) The Link Between Substance Abuse Suicides Due to Alcohol and or Drug Overdose 2005-2007. Psychiatric Times.  Retrieved from http://www.psychiatrictimes.com/substance-use-disorder/link-between-substance-abuse-violence-and-suicide

National Center for Injury Prevention and Control. (2007). Suicides due to alcohol and/or drug overdose. Retrieved from http://www.cdc.gov/violenceprevention/pdf/NVDS_Data_Brief-a.pdf