Substance
Abuse and Suicide
T. Allan Pearson, MSW
Volume
6, Number 3, July 1991
c
As
more and more information is gathered about substance
abuse/depression/self-destructive behavior, the muddier the water seems to
become. In this age of professional
specialties, people seem to rise out of a pool of multiple (not just dual)
disabilities. A suicidal person is one
example of just how complex a given behavior can be. While we can al identify a specific case of
classic grief reaction or sudden overwhelming loss which triggers suicidal
behavior, the majority of suicides and suicide attempts are much more complex and
defy our ability to accurately predict.
However, the evidence correlating substance abuse and suicidal behavior
is overwhelming, as is the depression-suicide connection.
For
the general population, substance abuse has been – and continues to be—highly
correlated with suicidal behavior. It is
estimated that about one out of six (16%) of all substance abusers will die by
suicide! This is the same percentage
indicated for seriously depressed persons.
Recent studies point out that about 1/3 of the mentally ill also have
substance abuse problems—a potentially very lethal combination. Other studies note that substance abuse is a
factor in anywhere from 50-80% of all suicide attempts. The relationship to completed suicides varies
from 30-60%.
Youth
suicide has been of particular concern in the past few decades. Schuckit and Schuckit (Report of the
Secretary’s Task Force on Youth Suicide), in a rather complex review of the
literature, found that youth who are heavy substance abusers had a four-fold
increased death rate. Among adolescent
suicide completers, they found 70% had used drugs frequently, 50% had alcohol
in their blood and 75% fit the criteria for a drug or alcohol use disorder. The substance abuse/suicide connection is so
strong that others (Fowler, Rich, Young) concluded
that the increasing rate of drug abuse is part of the reason for the increase
in suicide more likely to be drunk or high on drugs than their counterparts 20
years ago. He also found, if
intoxicated, teens are seven times more likely to use a gun.
Other
researchers in terms of prevention, indicate a strong
correlation between the alcoholic family environment and suicidal
behavior. In Youth Suicide - Depression and Loneliness (Hafen/Fransen), the authors point out that about 20%
of all adolescents who attempt suicide come from homes where one or both
parents have drinking problems. Others
(Garfinkel, McHenry) found similar connections.
A
In
conclusion, it is apparent that persons who use/abuse drugs (including alcohol)
have to be considered at an increased risk for suicide. When one adds the depression link, the dual
disability dramatically increases the probability of suicidal behavior. Substance abuse is frequently seen as a
defense mechanism to combat depression or as a means of self-medication. Substance abuse can also trigger depression. Substance abuse frequently indicates low
impulse and lowered tolerance for frustration and stress—which may also trigger
suicidal behavior. Additionally, an
intoxicated or “high” person has significantly lowered ego control and would
therefore, be more likely to act on impulse.
And finally, alcohol and other drugs, in and of themselves, provide the
means by which to attempt suicide.
As
we continue to work to prevent suicides, we must continue to examine the
interrelationships and complexities of this most destructive human
behavior. The substance abuse/suicide
connection has ramifications not only in treatment, but also in our prevention
and intervention efforts. Suffice to
say, those who work in human services need to broaden their knowledge base if
they are to significantly reduce suicides.
References:
Berman, Al.
Schwartz R.H. American Journal of
Diseases of Children, 144:310-314, 1990.
Blazer, D. Depression in Later Life.
Boyd, J.J., Moscikiek. “Firearms and Youth Suicide” American
Journal of Public Health, 76:1240-1242m 1986.
Brent, D.A., Perper, J.A., Allman,
C.J. “Alcohol, Firearms and Suicide Among Youth”, JAMA,
257:3369-3372, 1987.
Fowler, R.C.,
Rich, C. L., Young D. “San Diego Study II—Substance Abuse in Young Cases” Archives of General Psychiatry,
43:962-965, 1986.
Hafen, B.Q.
Frandsen, K.J. Youth Suicide - Depression
and Loneliness. Cordillera
Press, Inc., 1986.
Meneese, W.B., Yutrzenka, B.A.
“Correlates of Suicidal Ideation Among Rural
Adolescents.” Suicide and Life
Threatening Behavior, 20 (3), 206-212, Fall, 1990.
“Monthly Vital Statistics Report”, National Center for Health Statistics, U.S.
Department of Health and Human Services, November 26, 1990.
“Report of the
Secretary’s Task Force on Youth Suicide, Superintendent
of Documents,