In 2018, over 48,000 people committed suicide, making it a leading cause of death with incidences more than doubling the number of homicides, according to the Centers for Disease Control and Prevention (CDC) website. Suicide is the second leading cause of death for young people age 10 to 34, and the fourth leading cause of death ages 35-54.

Substance use, especially alcohol, has been linked to a considerable number of suicide attempts and suicides.

In 2013, the Substance Abuse and Mental Health Services Administration (SAMHSA) reported approximately 22% of deaths by suicide involved alcohol intoxication with a blood-alcohol content at or above the legal limit, while 30-40% of suicide attempts involved acute alcohol intoxication. Opiates were present in 20% of suicide deaths.

And the numbers linking suicide to opioid misuse continue to rise. A 2017 study by Ashrafioun et al. found that people who misused prescription opioids were 40-60% more likely to have suicidal ideation, and people with an opioid use disorder were twice as likely to attempt suicide.

Additionally, we know those suffering from substance use disorders also frequently have co-occurring conditions such as mood or anxiety disorders or suffer from untreated trauma or post-traumatic stress disorder (PTSD). All of these factors are associated with increased suicide risk.

And the reverse is also true.

Half of all individuals with a mental health condition will have a substance use disorder at some point in their life.

According to SAMHSA, in 2015, 2.7 million adults reported having a suicide plan, and 1.1 million people reported a suicide attempt.

Risk factors for suicide vary widely from mental health disorders and substance use disorders to environmental factors like bullying. Significant life events, loss of a loved one or job, and historical elements like a family history of suicide may also increase the risk of suicide.

Risk factors

• Mental disorders, particularly mood disorders, schizophrenia, personality disorders, and anxiety disorders
• Alcohol and other substance use disorders
• Hopelessness
• Aggressive or impulsive tendencies
• History of abuse
• Major physical illnesses
• Previous suicide attempt(s)
• Family history of suicide
• Financial or job loss
• Loss of relationship(s)
• Access to lethal means
• Local clusters of suicide
• Lack of social support
• Sense of isolation
• The stigma associated with asking for help
• Lack of healthcare, especially substance use and mental health and treatment
• Religious or cultural
• Exposed to others who have died by suicide, including in the media or internet

Warning signs

• Researching ways to kill themselves, like online search or purchasing a weapon.
• Talking about wanting to kill themselves or die
• Talking about having no reason to live
• Talking about feeling hopeless
• Talking about feeling in unbearable pain or trapped
• Talking about being a burden to others
• Increasing the use of alcohol or drugs
• Acting anxious or agitated; behaving recklessly
• Sleeping too little or too much
• Withdrawing or isolating themselves
• Showing rage or talking about seeking revenge
• Demonstrating extreme mood swings

If you or a loved one are in crisis, call the National Suicide Prevention Lifeline at 1-800-273-8255 for free and confidential support 24/7.

The Lifeline website also provides prevention and crisis resources for you or your loved ones and best practices for professionals. Visit suicidepreventionlifeline.org for more information.

References:

Centers for Disease Control and Prevention. Preventing suicide. https://www.cdc.gov/violenceprevention/suicide/fastfact.html

Substance Abuse and Mental Health Services Administration. Substance use and suicide: A nexus requiring a public health approach.  https://store.samhsa.gov/sites/default/files/d7/priv/sma16-4935.pdf

Substance Abuse and Mental Health Services Administration. Suicidal thoughts and behavior among adults: Results from the 2015 National Survey on Drug Use and Health

https://www.samhsa.gov/data/sites/default/files/NSDUH-DR-FFR3-2015/NSDUH-DR-FFR3-2015.htm

Ashrafioun L, Bishop TM, Conner KR, Pigeon WR. Frequency of prescription opioid misuse and suicidal ideation, planning, and attempts. J Psychiatr Res. 2017 Sep;92:1-7. https://pubmed.ncbi.nlm.nih.gov/28364579/

National Suicide Prevention Lifeline. 1-800-273-TALK (8255). https://suicidepreventionlifeline.org

National Suicide Prevention Lifeline. We can all prevent suicide.

https://suicidepreventionlifeline.org/how-we-can-all-prevent-suicide/