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Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition

Suicide and addiction

by Anne M. W. Kelly, PhD

Category: Psychological issues and behaviors

Definition: Addiction is associated with suicidal behavior more frequently than mood disorders and schizophrenia. Addiction also increases social problems and mental health issues associated with suicide attempts and completed suicides. The complex relationship between addiction and suicide must be better understood to improve treatment outcomes for substance use disorders and suicide prevention programs.

Suicidality

Suicide is a serious public health problem and a leading cause of death among substance misusers and among persons who are chemically dependent. Heavy substance users are more likely than the general population to die by suicide. The risk of suicide increases as substance use progresses into misuse and addiction.

Addiction is a primary contributor to suicide risk. The risk of suicide attempts is highest among people who misuse amphetamine, methamphetamine, and cocaine; however, more suicide attempts are associated with alcohol misuse because more people consume alcohol. Determining a primary substance can be difficult because substance misusers often use multiple substances in combination. Multi-substance misusers are more likely than single-substance misusers to engage in suicidal ideation, or thoughts about taking one’s own life.

Suicidal ideation is a predictor of suicide among substance misusers. People with substance use disorders who have thoughts about attempting suicide are more often depressed, take more health-related risks, and show more aggression than substance misusers who have not thought about suicide. Suicidal ideation often occurs during the “crash” or withdrawal, in which the pleasurable effects of a drug give way to agitation and depression, increasing the risk of suicide.

The relationship between suicide and substance misuse is complex. Suicide and substance misuse are not consequences of one single cause. They are behavioral outcomes that result from a combination of interacting stressors. The risk factors that contribute to suicide also can contribute to substance misuse.

Risk Factors

Factors associated with increased risk for suicide and addiction often overlap and include childhood abuse or trauma, sexual abuse, poor family relationships, poor communication and interpersonal conflict, family psychiatric history, unemployment and financial stress, biological correlates, impulsivity, hopelessness, previous suicide attempt, history of violence, and mental health problems including depression, bipolar disorder, and generalized anxiety disorder.

Substance misuse increases the risk of suicide by affecting cognition, mood, and impulsiveness. Substance misuse impairs judgment, increases affective instability, and reduces inhibition. This makes self-directed aggression more likely, particularly for people who have access to firearms or other means of suicide. Substance-related suicide attempts are more likely to have an impulsive component and to occur during a short-term crisis, during stress, or following a loss.

Gender also may have a part in mortality rates from suicide. Female suicide mortality rates are strongly related to alcohol consumption. The social stigma and inaccurate stereotypes attached to women with drinking problems can contribute to guilt and shame and can serve to increase a woman’s sense of isolation and loneliness. The exacerbation of these feelings by alcohol use adds to the likelihood of suicidal ideation and suicide attempts, creating a history of suicidal behavior that, in turn, has been linked to later alcohol problems among women.

Among men, serious substance misuse and addiction are correlated with higher rates of completed suicides.

The majority of persons who attempt suicide suffer from comorbidity, or the presence of more than one disorder that coexists with a primary disorder but may be unrelated. Depression or other mental health problems, such as bipolar disorder, along with a substance use disorder may overlap and contribute to suicidal behavior.

It is not uncommon for persons with a psychiatric illness to self-medicate with drugs or alcohol. If the person enters a treatment program or abstains from substance use, then the effects of the illness can escalate, creating stress in the user and contributing to suicide risk. Effective prevention and treatment programs need to focus on psychiatric disorders and addiction, especially among multi-substance misusers who are more likely to die by suicide than are single-substance misusers.

Treatment

Treatment of addiction is an important part of a comprehensive approach to suicide prevention. Addiction counselors need to know how to screen for suicide risk and assess the risk of suicidal danger. Examples of screening and assessment tools include the modified mini screen, which is used to identify people who need a mental health assessment, and the addiction severity index, which is designed to assess factors contributing to substance misuse problems.

Evaluating the risk for suicide in a patient who has a substance misuse disorder is not easy. The patient may not be able to remember the details of a suicide attempt. It also may be difficult to establish that the patient intended to attempt suicide, as in the case of an overdose, which may appear to have been accidental. The difficulty in assessing and evaluating risk for suicide in addiction treatment programs and a lack of knowledge about the correlation between addiction and suicide has resulted in moving patients out of addiction treatment programs and into the mental health system. This places suicidal patients at greater risk for self-harm because the addiction, which is a primary contributor to suicide risk, is no longer being treated. To improve outcomes for persons with substance use disorders, suicide prevention programs need to include addiction treatment programs.

Patients who are in treatment for substance use disorders and have attempted suicide report more psychiatric illnesses and more problematic substance misuse. These patients benefit from inpatient treatment and increased intensity of care during the early phases of treatment. Motivational interviewing, which helps the patient understand the problems and consequences of substance misuse; continuing care; and psychosocial therapy, which focuses on improving communication skills and interactions a patient has with family and friends, also have contributed to improved treatment outcomes for persons with substance use disorders and a history of suicide attempts. Effective strategies for suicide prevention include restricting access to firearms and other means of suicide, gatekeeper training to enhance communication and intervention skills, public education campaigns, crisis hotlines, physician training, addiction treatment programs, and controlling the availability of drugs and alcohol.

For Further Information

Glass, Joseph E., et al. “Inpatient Hospitalization in Addiction Treatment for Patients with a History of Suicide Attempt: A Case of Support for Treatment Performance Measure.” Journal of Psychoactive Drugs 42.3 (2010): 315–25. Print.

Kaminer, Yifrah, and Oscar G. Bukstein, eds. Adolescent Substance Abuse: Psychiatric Comorbidity and High-Risk Behaviors. New York: Routledge, 2008. Print.

Landheim, A. S., K. Bakken, and P. Vaglum. “What Characterizes Substance Abusers Who Commit Suicide Attempts? Factors Related to Axis I Disorders and Patterns of Substance Use Disorders.” European Addiction Research 12 (2006): 102–8. Print.

Mann, Robert E., et al. “Alcohol Factors in Suicide Mortality Rates in Manitoba.” Canadian Journal of Psychiatry 53.4 (2008): 243–51. Print.

Mino, Annie, Arnaud Bousquet, and Barbara Broers. “Substance Abuse and Drug-Related Death, Suicidal Ideation, and Suicide: A Review.” Crisis: The Journal of Crisis Intervention and Suicide Prevention 20.1 (1999): 28–35. Print.

Nunes, Edward V., et al., eds. Substance Dependence and Co-Occurring Psychiatric Disorders: Best Practices for Diagnosis and Clinical Treatment. Kingston: Civic Research Inst., 2010. Print.

Citation Types

Type

Format

MLA 9th

Kelly, Anne M. W. "Suicide And Addiction." Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition, edited by Paul Moglia, Salem Press, 2018. Salem Online, online.salempress.com/articleDetails.do?articleName=Addictions2e_0304.

APA 7th

Kelly, A. M. (2018). Suicide and addiction. In P. Moglia (Ed.), Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition. Salem Press. online.salempress.com.

CMOS 17th

Kelly, Anne M. W. "Suicide And Addiction." Edited by Paul Moglia. Salem Health: Addictions, Substance Abuse & Alcoholism, Second Edition. Hackensack: Salem Press, 2018. Accessed September 13, 2025. online.salempress.com.

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