Substance Abuse and Suicide: A Guide to Understanding the Connection and Reducing Risk

Alcohol and drug abuse are among the leading risk factors for suicide. People with substance use disorders may experience hopelessness and suicidal thoughts, but treatment for addiction has helped people find purpose and happiness in life.

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If you’re contemplating suicide, please call the National Suicide Prevention Lifeline at 1-800-273-8255.

Alcohol and other drugs can cause a range of health problems. Substance addiction also increases a person’s risk of facing other life-changing consequences. Overdose, disease and legal problems are among the top hazards for people with substance use disorders, but there’s another major risk that’s often overlooked. “A lot of times, suicide is not on the radar of drug and alcohol treatment providers or families because, for understandable reasons, they’re so focused on safety around substance use,” Mark Ilgen, a psychologist at the University of Michigan, told “Sometimes suicide risk goes unnoticed and doesn’t get the attention it needs.”
Mark Ilgen

Mark Ilgen, director of the University of Michigan’s Addiction Treatment Services

Ilgen is the director of the University of Michigan’s Addiction Treatment Services, and he’s an investigator for the VA Ann Arbor Healthcare System. He studies ways to improve treatment for alcohol and drug use disorders and the association between substance use disorders and suicide risk. Despite their commonalities, depression isn’t the same as having suicidal thoughts, Ilgen said. However, depression is the leading risk factor for suicidal thoughts. “There’s a complicated relationship between drug and alcohol use, mood, and suicidal thinking and behaviors,” Ilgen said. “What we know is that if someone has a drug or alcohol problem, they’re much more likely to have suicidal thoughts, to make a non-fatal suicide attempt and to die by suicide.” It’s difficult to determine exactly how often substance abuse contributes to suicide. Studies have estimated that between 19 and 63 percent of suicide decedents were affected by alcohol or other drugs, according to a 2009 analysis published in the Archives of Suicide Research. Using data from 17 states, researchers from the Centers for Disease Control and Prevention determined that suicides accounted for 66 percent of violent deaths in 2013. About 18 percent of suicide decedents were known to have problems with alcohol, and 16 percent had problems with other substances.

Percent of People Who Tested Positive for Various Substances After Death by Suicide, 2013

graph of Percent of Suicide Decedents Who Tested Positive for Various Substances in 2013

Source: Centers for Disease Control and Prevention

Finding a reason to live is a key component of recovery from addiction. When people feel like they have no purpose, they’re more likely to turn to substances of abuse to feel artificial happiness. They’re also more likely to contemplate ending their lives. The good news is that depression, suicidal thoughts and substance use disorders are treatable conditions. Without treatment, they can worsen drastically. With treatment, many people find purpose and live happy and fulfilling lives.

Robert Fishman of Advanced Recovery Systems explains how admissions coordinators at rehab facilities assist people who are having suicidal thoughts or who have a history of suicidal thoughts.

Quality addiction treatment facilities can address substance abuse issues and provide treatment or referrals for people with suicidal thoughts. It’s important to talk to intake coordinators and therapists about suicidal thoughts during the addiction treatment process.
man in suit staring out a window in his home

How Substance Abuse Contributes to Suicide Risk

Substance abuse commonly co-occurs with several mental health disorders, including depression, anxiety and attention-deficit/hyperactivity disorder. People with mental illness are more likely to use alcohol or other drugs, and some of them use the substances to self-medicate symptoms of their mental illness.

Depression and other mood problems are common side effects of several substances of abuse, and withdrawal from many substances can worsen symptoms of mood disorders. Some people develop suicidal thoughts during early recovery from addiction because they’re going through withdrawal and their brain is relearning to function normally.

Suicides accounted for 66 percent of violent deaths in 2013.

Source: Centers for Disease Control and Prevention

People are also at an increased risk for suicidal thoughts during early recovery because most attempts at recovery occur after a stressful event, such as a DUI arrest, a breakup or an accident. Those events are often associated with guilt and shame, which may be more likely to cause suicidal thoughts than depression alone.

“Many people who have mood-related problems don’t think about or engage in suicidal behaviors,” Ilgen said. “It’s thought that other constructs, such as hopelessness, a feeling of isolation or a sense of self-hatred, have a stronger relationship with suicidal thinking and behavior.”

Those types of feelings commonly occur alongside depression and other mental health problems, and addiction to alcohol or other drugs can exacerbate those feelings.

“When you see someone who is struggling with significant addiction, they often have a sense of frustration from the inability to control it,” Ilgen said. “Isolation comes with addiction. The sense of failure from wanting to change their behavior but being unable to do it can drive suicidal thinking and behaviors.”

The Role of Brain Chemistry

Substances of abuse alter brain chemistry. They disrupt the pleasure and reward system in the brain, making the brain prioritize substances over other things that normally cause joy. That’s why individuals with addiction stop participating in activities that they once found enjoyable.

The disease of addiction makes a person obsess over drinking or using drugs. It also causes feelings of apathy or low motivation, according to multiple studies.

Research suggests that alcohol impairs normal thought processes, making drinkers more likely to act impulsively. Individuals who have thoughts of suicide may be more likely to act on those thoughts when they’re intoxicated because alcohol inhibits them from weighing the consequences of their actions.

“A substantial number of suicide attempts were most likely impulsive,” Ilgen said. “The attempts didn’t have much more than 15 minutes of planning before someone took their own life. Those types of attempts seem to be more likely in individuals who have drug or alcohol problems.”

The Role of Genetics

Suicidal thoughts and substance abuse may have a common genetic cause. Research clearly indicates that genetic factors make some people more likely to abuse alcohol and other drugs, and people with a family history of addiction are more likely to develop an addiction.

Similarly, a family history of suicide increases the risk of a person attempting and completing suicide. Genetics can also increase a person’s risk for major depressive disorder or impulsive behaviors.

An estimated 38 percent of people who died by suicide in 2013 were described as having a depressed mood. depressed teens

Source: Centers for Disease Control and Prevention

“Individuals who develop a drug or alcohol problem are more likely to have impulsive personality traits,” Ilgen said. “The substance use disorder could be a marker of that impulsivity but not necessarily a cause of impulsive behavior.”

While some genes increase a person’s risk for addiction or suicidal thoughts, other genes may be protective. A person who has a family history of depression and suicidal thoughts may also possess a gene that decreases their risk of alcohol consumption. Thus, their risk of committing suicide as a result of drinking may be decreased. Overall, more research is needed before clear, firm conclusions on genetics can be determined.

depressed man infront of a window palming
his forehead

Common Risk Factors for Suicide & Substance Abuse

Substance abuse and suicide share numerous risk factors. Most of the time, a single risk factor doesn’t cause suicidal thoughts. Experiencing multiple risk factors increases a person’s risk of developing depression, using substances of abuse, contemplating suicide or experiencing a combination of any of those mental health disorders.
Common Risk Factors for Substance Abuse, Suicide and Depression
Risk Factor Substance Abuse Suicide Depression
Family history
Emotional abuse
Physical abuse

A person may not consider ending his or her life even after experiencing several risk factors, developing depression and using substances of abuse.

“Environmental stressors are a part of what can place someone at increased risk for making an attempt,” Ilgen said. “But it’s the perceptions that those aren’t changeable or that there are signs of a really core flaw that often makes one think seriously about making an attempt.”

One risk factor for suicide is exposure to it in the home or community. Several studies have provided limited evidence that teens and young adults, especially those with prior histories of mental illness, are more likely to develop suicidal thoughts after someone in the community commits suicide.

Suicide was the 10th leading cause of death in the United States in 2015.

Source: Centers for Disease Control and Prevention

“The extent to which you have a family member who has engaged in suicidal behaviors themselves definitely increases someone’s risk,” Ilgen said. “If you have a loved one who’s died by suicide, that’s a strong risk factor for engaging in suicidal behaviors.”

The strongest risk factor for suicide is a prior suicide attempt. Someone who has made an attempt in the past is more likely to make a future attempt, even if they appear to be thinking positively. Major stressors, such as addiction relapse, the end of a relationship, financial problems or the loss of a loved one, can trigger an increase in suicidal thoughts.

“Even if someone is engaged in very future-oriented thinking within the past few days or hours, if they get into a suicidal crisis, they can get overwhelmed and they can be at suicidal risk,” Ilgen said.

Determining When Someone Is at Risk for Suicide

People contemplating suicide don’t always tell others. They might beat around the bush, or they may mention it sarcastically. If someone who is addicted to alcohol or other drugs appears to be making jokes about ending their life, they may not be joking.

In addition to talking about suicide, warning signs that someone is considering making a suicide attempt include:
  • Extreme mood swings
  • Cutting off friends or family
  • Increasing substance abuse
  • Feeling like a burden to others
  • Feeling trapped
  • Feeling hopeless
  • Looking for ways to commit suicide

Warning signs for suicide are serious and shouldn’t be ignored. A person may not appear to be seriously considering ending their life in the short-term, but a stressful event can trigger a suicidal crisis. Finding help before that occurs can save their life.

standing on the edge of a building
looking down

Preventing Suicide and Recovering from Addiction

Friends or family members of a person experiencing suicidal thoughts should be open, honest and non-judgmental in their interactions with the person. If possible, weapons, dangerous chemicals and substances of abuse should be removed from the person’s environment.

It’s important for friends and family members to show love and support, but most of the time contacting mental health professionals is the most important thing a person can do.

“We want loved ones to work to support their family member and encourage them and be a part of that process of helping someone feel cared about,” Ilgen said. “But also know that there are times they need to pull in experts to help.”

“For most people with substance use disorders, a suicidal crisis can come on quite suddenly.”
Mark Ilgen, a psychologist at the University of Michigan

Suicide prevention hotlines are available in every community in the United States, and many therapists have on-call emergency numbers. Short-term solutions can keep a person safe until they’re able to access addiction treatment and long-term mental health counseling.

“For most people with substance use disorders, a suicidal crisis can come on quite suddenly,” Ilgen said. “But it also passes. Even though in the moment it doesn’t feel like it will, it will pass. A lot of suicidal risk management techniques focus on helping someone stay safe over the short-term. In many individuals, they feel better and they have a chance to take stock of things. Then the suicidal crisis passes.”

stressed woman sitting in a tunnel

Treating Co-Occurring Addiction and Suicidal Thoughts

Research on treatment for addiction and co-occurring suicidal thoughts is limited, but simultaneous treatment for substance use disorders and depression is effective. Abstinence is associated with decreased feelings of depression after treatment, according to a review published in Psychiatric Annals.

If depression continues after prolonged abstinence, individuals should seek treatment for depression. The same is true for individuals with suicidal thoughts. They should continue to seek mental health counseling after receiving treatment for addiction.

“There have been at least one or two studies that have looked at whether suicidal risk goes down with addiction treatment,” Ilgen said. “It looks like the rates of making a suicide attempt are lower following addiction treatment than prior to that. But they’re certainly still not at zero. Addiction treatment is important, but for many people it’s not sufficient [for resolving suicidal thoughts].”

Like relapse into alcohol or drug use, relapse into suicidal thinking can occur after treatment. Continued aftercare, love and support are crucial to mental wellbeing. Access to education, employment and other future-oriented opportunities are also important. But friends and family members should always be aware that relapse is possible.

“The challenge with protective factors is you don’t want people to develop a false sense of security,” Ilgen said. “Protective factors do matter a lot. Unfortunately, when someone becomes suicidal, they develop, in some ways, a kind of tunnel vision around suicidal thinking and planning and can lose sight of protective factors.”

The association between suicide and substance abuse is complicated. Alcohol and other drugs don’t necessarily cause suicidal thoughts, and people who commit suicide aren’t always under the influence. But each factor can contribute to the other and result in devastating consequences.

If you’re struggling with addiction and you’ve considered ending your life, know that recovery is possible. It can be difficult to envision a life without alcohol or other drugs when you’re in active addiction, but millions of people in the United States are in recovery from substance use disorders. Sobriety is possible with treatment, hard work and faith.

group of people with their hands in a circle

Suicide Prevention Resources

Individuals in crisis can reach out to emergency services, suicide prevention hotlines or online chats for professional help. Several organizations provide 24/7 crisis services. The groups also provide resources, tools and information for friends and family of those with suicidal thoughts.

National Suicide Prevention Lifeline Logo

National Suicide Prevention Lifeline

The National Suicide Prevention Lifeline provides 24/7 access to support online and over the phone. Individuals in crisis can start an online chat with a mental health professional by going to the National Suicide Prevention Lifeline website, or they can speak to someone on the phone by calling 1-800-273-8255.
Veterans Crisis Line Logo

Veterans Crisis Line

The Veterans Crisis Line is a specialized crisis service for veterans facing a mental health crisis. Veterans can access around-the-clock support by starting an online chat at the Veteran Crisis Line website or by calling 1-800-273-8255 and pressing 1.
Suicide Prevention Resource Center Logo

Suicide Prevention Resource Center

The Suicide Prevention Resource Center is funded by the federal government to improve the nation’s suicide prevention strategy. It provides assistance and training to suicide prevention practitioners and those serving individuals at risk for suicide.
Suicide Awareness Voices of Education Logo

Suicide Awareness Voices of Education

Suicide Awareness Voices of Education is dedicated to preventing suicide by equipping communities with tools and information about mental illness. The group strives to reduce stigma and support those affected by suicide.

American Foundation for Suicide Prevention Logo

American Foundation for Suicide Prevention

The American Foundation for Suicide Prevention fosters a community of support for individuals affected by suicide. It supports research, education and advocacy initiatives by funding a variety of projects across the United States.

Medical Disclaimer: aims to improve the quality of life for people struggling with a substance use or mental health disorder with fact-based content about the nature of behavioral health conditions, treatment options and their related outcomes. We publish material that is researched, cited, edited and reviewed by licensed medical professionals. The information we provide is not intended to be a substitute for professional medical advice, diagnosis or treatment. It should not be used in place of the advice of your physician or other qualified healthcare provider.

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