What is the role of substance abuse in the development of suicidal behaviors?

Updated: Jul 26, 2021
  • Author: Stephen Soreff, MD; Chief Editor: Glen L Xiong, MD  more...
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Substances can contribute to self-destructive behaviors in all 3 phases of their use—intoxication, withdrawal, and chronic usage. A depressed person commonly becomes acutely suicidal after a few drinks. Similarly, some people can become suicidal after ingesting lysergic acid diethylamide (LSD). Still others encounter depression during substance withdrawal and respond by killing themselves.

According to the Drug Abuse Warning Network, emergency department (ED) visits involving drug-related suicide attempts increased 41% from 2004 to 2011, from an estimated 161,586 to 228,366 visits. There was a total of about 1.5 million ED visits involving drug-related suicide attempts between 2004 and 2011. [32]

A person who engages in chronic alcohol and drug use often experiences a number of major losses, including of his or her job, spouse, and family, and these, in turn, contribute to the individual becoming suicidal. [15]

Even persons in drug recovery programs remain at risk. For example, patients in opiate dependency programs, especially those with chronic pain, those with the availability of firearms, those who use other street drugs, and those new to the program, are at particular risk. [33]

In a US study, Bohnert et al found that suicide and overdose are connected, yet distinct, problems. Patients who have a history both of suicide attempts and of nonfatal overdoses may have poor psychological functioning, as well as a more severe drug problem. [34]

The physical and mental health effects associated with methamphetamine (MA) use have been documented; however, little is known about the effects of injection MA and suicidal behavior.

The Vancouver Injection Drug Users Study (VIDUS) found that MA injection was associated with an 80% increase in the risk of attempted suicide, suggesting that individuals who inject MA should be monitored for suicidal behavior. The study elicited information regarding sociodemographics, drug use patterns, and mental health problems, including suicidal behavior. Of 1873 eligible participants, 149 (8%) reported a suicide attempt. [35]

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