Substance Use and Suicide: Finding Help and Hope
It's not talked about enough: Drugs and alcohol play a major role in suicides. But there are many paths out of despair. A top psychologist shares some important guidance
Few people want to talk about addiction, and virtually no one wants to talk to about suicide. It’s understandable, of course. But communication and supportive relationships are essential to helping lift yourself or a loved one out of substance use issues, mental health struggles and feelings of suicide — all of which are often intertwined. These conversations can save lives.
“I see substance use disorder often as a crisis of disconnection. Disconnection from self, from others, from a higher power or God; disconnection from friends, disconnection from pets, disconnection from the world,” said Dr. George Collins, director of psychological services at Malvern Treatment Centers, headquartered in Philadelphia. “And I think that’s often true of suicide and folks in a position where they’re considering suicide. So the solution is connection. Connection in any way possible.”
September is National Recovery Month, and it’s also National Suicide Prevention Month. Understanding how the crises of addiction and suicide are linked — and how people who are suffering can find help — is vital. Connection is a key element in navigating these complex crises, but there are other resources and things worth learning, too.
Understand the Relationship Between Substance Use and Suicide
Substance use disorder (SUD) can make other mental health disorders worse, and vice versa. The connection between them is becoming better understood today, and clinics like Malvern prioritize treatment that addresses these dual issues, called co-occurring disorders, when necessary.
Still, recent research on the role of substances in suicides and suicide attempts is eye-opening. A 2020 study published in the journal Addiction Science & Clinical Practice found that people with alcohol or drug use disorders had five to six times the risk of death by suicide than those without; people with co-occurring alcohol, drug and tobacco disorders were 11.2 times more likely to die by suicide. More than one-third of suicide deaths occur under the influence of alcohol.
“Substance use disorder changes behaviors, changes mood and increases distress, all contributory factors to suicide, suicidal ideation, urges and attempts,” said Collins. It’s intuitive, but the symptoms may not be obvious to people who don’t recognize their substance use or mental health issues. “Using substances can increase helplessness and hopelessness. Often, suicide is not plan A. Often it’s, ‘Oh my gosh, I feel so helpless and so worthless and so unable to figure this out.'”
Substance use can also dampen inhibitions, affect brain circuitry, aggravate mood disorders like depression or anxiety, bring on dangerous hallucinations or lead to feelings of stigmatization and shame, all of which erode mental well-being.
Even the stressors of recovery can be risk factors in suicide. Withdrawal from drugs and alcohol can be destabilizing to mental health, while a return to use often comes with feelings of guilt, shame and harsh self-criticism. A “return to use” is more commonly called a relapse, though many now consider that term to be stigmatizing.
How Can I Find Help? How Can I Help Someone Else?
When a person is dealing with substance use issues, mental health issues and suicidal ideation, it’s terrifying, frustrating and confusing for both the individual and their loved ones. But the situation is not hopeless.
Often, the path to healing starts close to home, with someone’s family, friends or support system. If you’re grappling with SUD and suicidal feelings and aren’t sure where to turn, think first of the people whom you trust. When you reach out to someone, “now they know you need help, and maybe they can join you in trying to find the answers,” said Collins. “So, families, friends, mentors, teachers, clergy, anyone — to not be alone with” your struggles.
Or you may be the person in a position to provide support. Notice if your loved one is talking about wanting to die, giving away possessions, saying goodbyes, engaging in risky behavior or inflicting self-injury through behaviors like cutting themselves. These can be warning signs for suicide. If you can, eliminate access to lethal means.
The best way to understand what’s going on is to listen to what they’re telling you. “There’s a myth out there that if I ask someone about [suicidal feelings], it’ll drive them to it or increase the risk,” said Collins, but the truth is usually the opposite. It’s a form of connection, of showing you care.
A conversation about suicide can be anxiety-producing for anyone, but try to be nonjudgmental, compassionate and to take what the person is saying seriously. “I hear far too often ‘cry for help,'” said Collins — that the person is merely upset. “If they’re crying for help, that means they need help.” Instead of interrupting the conversation with a generic affirmation like “You have so much to live for,” listen to the person, then help them recognize what they truly do have to live for.
Continuing the conversation is essential, whether the person has gone through addiction, mental health problems or suicidal feelings. Collins described what that might sound like. “Asking the loved one in recovery, ‘How can I help? Is there something I could do that would be particularly helpful? Is there something I’m doing that’s not helpful or making things worse?’ Asking them, ‘How am I doing?’ in response to their answers to your questions.”
As the listener and loved one, you don’t need to have a perfect script or all the answers. “Someone can intervene compassionately and not understand or not understand enough,” said Collins. You don’t need to be all-knowing, especially in an emergency. The situation may require you to say something like, as Collins put it, “We need to get you help right now. I don’t fully understand this, but fentanyl can kill you.” All of this follows from simply staying connected. “The understanding comes over time.”
There are other resources and roads out of substance use disorder and suicidal ideation as well. Many resources are now online, and digital communities provide another avenue for connection. A primary care provider can help point you toward mental and behavioral health resources. The national Suicide & Crisis Lifeline has a new number that fields calls, texts and chats 24/7. It’s 988.
Specialized care for substance use or mental health disorders takes many forms, from intensive inpatient treatment to therapy sessions to psychiatric treatment with medications that reduce substance cravings or help stabilize mood.
Hopelessness and helplessness often feel insurmountable. But the darkness is never total as long as you’re alive. There are paths toward getting better, and you have the power to find the one you want to take.
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