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Co-Occurring Suicidal Ideation and Substance Use

Suicidal thoughts and substance abuse are commonly co-occurring, and each condition can worsen the other. One study from 2015 found that people who suffer from substance abuse are 2x more likely to have thoughts of suicide, 2.5x more likely to attempt suicide, and 1.5x more likely to die by suicide when compared to someone without a substance use disorder.

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Why Suicidal Ideation and Substance Misuse Co-Occur

Suicidal Ideation

Suicide is an unfortunate reality in our world today and is the 10th leading cause of death in America. The mental challenges that lead to suicide attempts, either caused by a mental illness or trauma, can benefit from treatment and care. When someone is having thoughts of suicide, reaching out for help may seem like an impossible task, but help is available. Here, we hope to illuminate the reality of suicide and provide helpful resources so that anyone struggling with these thoughts may the help they need to live another day.

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Suicide in America
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Suicide in America

Even though suicide is the 10th leading cause of death in America overall, this fact does not really paint an accurate picture of the situation. When broken down by age, suicide was actually the 2nd leading cause of death for people aged 10 to 34 years old in 2018 according to the National Institute of Mental Health. Additionally, suicide rates have been steadily rising over the last decade. In 2018 in America, 12 people out of every 100,000 took their own lives whereas, in 2018, this number had climbed to 14.8 out of every 100,000. This trend also disproportionately affects certain demographics, particularly American Indians and Caucasian populations. Among all populations, the suicide rate for men is consistently higher than it is for women; ranging from 3.5 to 4.5 times higher.

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Suicide In The Era of COVID

While the exact numbers won’t be in for some time still, early studies are suggesting that 2020 will end up showing a significant increase in mental health issues in general and suicide in particular. The CDC is still working through all of the reports and collecting data and has not released any figures as of this writing (February 2021). Anecdotal reports from hospital workers, EMTs, and police departments paint a dark picture, with suicides increasing all across the country.

This is not exactly surprising, as suicide shares an intimate relationship with mental health issues, and 2020 was a very stressful year for many, many people. This may be likened to the increases in suicides that were seen in the aftermath of the 2008 financial crisis, albeit much more severe. The COVID pandemic has all the ingredients of the 2008 crisis such as high unemployment and evictions, with the addition of other stressors including health concerns, healthcare provider shortages, isolation, financial struggles, and no clear end in sight.

Although further research is needed to confirm or elaborate this claim, a study done in the Netherlands found that, while the COVID pandemic affected people with and without mental health issues, those with pre-existing mental health conditions reported minimal distress due to the pandemic. While the persons with pre-existing mental health conditions still scored higher on their symptom severity, they showed almost no increase from pre- to mid-pandemic, whereas persons with no such mental health issues showed significant increases in distress from pre- to mid-pandemic. This study is reporting data taken in the first few weeks of the national lockdown in the Netherlands, so further studies are certainly needed. This does, however, help to illustrate the fact that someone need not already suffer from mental health challenges to experience depression, increased anxiety, and even thoughts of suicide due to the added stress of the COVID-19 pandemic.

Suicidal Ideation & Substance Abuse
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Suicidal Ideation & Substance Abuse

According to a study performed at Harvard Medical School, there is a very strong link between substance abuse, thoughts of suicide, and suicide attempts. All substance use issues, including drugs and alcohol, produced higher rates of suicidal ideation and suicide attempts than even anxiety disorders. Out of suicide attempts, alcohol dependence produced the highest rates of all substances, and for suicidal ideation, drug dependence produced the highest rates.

A separate study performed at Harvard University Department of Psychology found that people who struggle with a substance use disorder are significantly more likely to have thoughts of suicide as well as attempt suicide than the general population. This study, along with others, goes on to suggest that suicidal ideation and substance abuse may both be impacted by a behavioral trait, namely impulsivity. While these are distinct conditions, the intensity and frequency of their manifestation may share underlying psychological causes.

Finally, one comprehensive meta-analysis of the link between suicidal ideation and substance abuse included over 870,000 participants. In this review of over 43 separate studies, they determined that people who struggle with substance abuse are just over 2x as likely to experience suicidal ideation, almost 2.5x as likely to attempt suicide, and are almost 1.5x as likely to die by suicide than those who do not have a substance abuse issue. There were two studies included in this review that were outliers, one of which claims that people with substance abuse resulted in a 7.23x greater chance of death by suicide. Whatever the exact numbers may be, there is certainly a strong and well-documented connection between these two debilitating and potentially fatal conditions. The most effective course of action for people to recover from co-occurring drug use and suicidal ideation is to enter an inpatient drug rehab center.

What Factors

Contribute to Suicide

Suicide is a multifaceted and complex issue with no singular, clear cause. Many factors can contribute to someone deciding to take their own life including environmental, social, and mental health factors. Some of the most common factors that can contribute to someone’s risk of suicide include:

  • Family history of suicide or serious mental illness
  • History of abuse or neglect
  • Social stressors (such as prejudice about one’s sexual orientation)
  • Financial, professional, or family instability
  • Mental health issues (more importantly, lack of access to professional help for these issues)
  • Drug or alcohol addiction
  • Social isolation

These are just a few of the factors that may add stress and anxiety to someone’s life while also contributing to depression. Someone who has experienced trauma in the past, or is experiencing overwhelming levels of stress or trauma currently, may come to the conclusion that their only or best option is to take their own life. There are always other options, although this can be very difficult to see when someone is experiencing intense emotional distress.

Suicidal Ideation Others
Suicidal Ideation

How Can I Help Someone Else?

Thoughts of suicide often lead someone to a very lonely and bleak place. It is common for someone experiencing these types of thoughts to retreat into themselves so as not to be a burden on those that care about them. Being willing to show someone that they are not a burden, that they are loved, and that there is hope can literally save their life. Sometimes the most effective way to help someone is to be a shoulder to lean on and a good listener. Someone may also suggest or recommend seeking help, as professional psychiatric and therapeutic care is often the most effective means for relief. That being said, if someone is struggling with suicidal thoughts, it is up to them to actually take the steps to get help and do the work that this entails.

Suicidal Ideation

How Can I Help Myself?

Reach out to others, invite them into your life and struggle, and ask them for help. This could be a family member, a friend, a coworker, a significant other, neighbors, or really anyone. A burden shared is a burden halved, and while this may not solve the struggle, it is an important first step. There are helplines, online chats, text lines, crisis centers, and dual diagnosis treatment centers all over the country that are willing and able to help. The only way that these people can provide help, is if someone opens up and asks them to help.

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Suicide Prevention & Treatment Resources

If someone is struggling with thoughts of suicide in the absence of co-occurring mental health issues, therapy and possibly psychiatric care may be enough. If someone is struggling with suicidal thoughts and has a co-occurring mental health or substance abuse issue, then comprehensive professional help is highly recommended.

Suicidal Ideation

Crisis Hotlines

There are dozens of crisis hotlines all over America that allow someone to talk about their struggles, usually to someone who has been through a similar or identical crisis. These hotlines are frequently manned by volunteers that have personal experience with suicide, either having struggled personally or seen a loved one struggle.

Suicidal Ideation

Prevention Resources

There is a wide variety of suicide prevention resources available online. These can include the stories of suicide survivors, suicide prevention advocacy groups, and many other types of organizations that provide an array of different services.

  • American Foundation for Suicide Prevention: A suicide awareness, prevention, and advocacy group that has dozens of helpful resources for people that have been impacted by suicide or thoughts of suicide.
  • American Association of Suicidology: A prevention and advocacy site that provides a wealth of resources to inform and educate people about suicidal ideation.
  • SAVE (Suicide Awareness Voices of Education): A suicide prevention and advocacy organization that provides resources for anyone affected by suicide, including someone contemplating suicide, suicide attempt survivors, or the friends and families that have been impacted by suicide.
  • Suicide Prevention Resource Center: A resource center that provides a wealth of information for suicide prevention strategies and programs.
  • Ditch The Label: An advocacy group that hopes to destigmatize mental health challenges while also providing helpful resources for those who are struggling with mental health issues.
  • The Trevor Project: An LGBTQ youth organization that provides resources for the unique challenges that young LGBTQ people face today.
  • Stop Bullying: A government site that aims to increase awareness about bullying and the impact this can have on someone’s mental health.
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