By Peg Rosen (Medical Reviewer Stacia Alexander, PhD, LPC-S)

Suicide and addiction. Too often, we hear these words in the same breath.

At face value, the connection feels logical. Think of celebrities who die by suicide—often there’s the implication, if not outright fact, of a struggle with substance misuse.

At the most basic level, “what suicidality and addiction share is the desire to escape from pain and distress,” says Michael Groat, Ph.D., director of psychology at Silver Hill Hospital in New Canaan, CT. It’s pain that often draws from a shared landscape of suffering that includes childhood trauma and abuse, economic hardship, chronic physical pain, and mental health issues such as bipolar disorder and depression.

But what exactly is the link? And can suicidality or addiction actually lead to the other?

Not everyone with addiction issues contemplates suicide. And not everyone who contemplates or attempts suicide struggles with addiction. Often, however, the paths converge and feed a loop of misery.

“Someone may turn to an addictive substance or behavior as a way to cope with pain in their life. But addiction then creates its own negative cascade,” says Groat.

A person struggling with addiction may eventually lose their job, their relationships, and their home as their habit takes over their life. As their addiction deepens, the pain they feel may grow stronger. As a result, they may begin to see suicide as their only way to escape.

“If you talk to people who have reached the point of considering suicide, many don’t actually want to die. They want relief from their suffering,” Groat says.

STATISTICS ———————————–

Hard Facts About Substance Use Disorder and Suicide

Under the distorting and disinhibiting influence of addictive substances, people in their most desperate hours may then be more likely to take impulsive action. Indeed, acute alcohol intoxication is present in 30% to 40% of suicide attempts, according to the Substance Abuse and Mental Health Services Administration, and opioids are present in about 20% of people who die by suicide.

Next to depression and other mood disorders, substance use disorder is the top risk factor for suicide, according to SAMHSA. People who abuse alcohol and/or drugs attempt suicide six times more often than those in the general population.

While all substance use disorders are associated with heightened suicide risk, alcohol and opioid abuse are clear standouts, increasing a person’s likelihood of dying by suicide by 10 and 14 times, respectively, per a 2018 study published in American Journal of Psychiatry Residents’ Journal. Male deaths by suicide outnumber female by almost four to one generally, says SAMHSA.

Gambling, Sex Compulsion, and Suicide Risk

It’s not just addiction to substances that’s at issue. Addictive behaviors are strongly associated with suicide, too.

“A lot of people don’t think of problem gambling as an addiction because a person isn’t using a substance. But the effects of gambling addiction can be devastating,” says Shane W. Kraus, Ph.D., assistant professor of psychology at the University of Nevada, Las Vegas. Among those who seek treatment for problem gaming, as much as 30% report having made suicide attempts.

Even stronger links have been found between suicide and compulsive shopping and compulsive sexual behavior. Problem gaming, such as playing video games online, is a likely cause of suicidality as well, but more research is needed to be certain.

“People often drink excessively or use drugs to escape their problems. Addictive behaviors also provide a kind of distraction,” says Groat. “When you win while gambling or buy something new, it delivers that excitement, that needed hit of dopamine. In the short term, you don’t have to think about your issues. You don’t have to deal with your unhappiness. But over time, behavioral addictions make problems worse.”

Addiction, Mental Illness and Suicide

People have increasingly accepted evidence showing that mental illness is a disorder of the brain, not a personal frailty.

Addiction—specifically substance use disorder—falls under the umbrella of mental illness. As with other psychiatric disorders, a person’s risk of developing an addiction can be influenced by their genes, their own physical makeup, and their environment.

“Unfortunately, some people still believe addiction has to do with people’s moral failings. That’s why there’s still so much stigma around it and why a lot of people don’t seek help,” says Kraus.

Now consider these realities about the dangerous and common collision of addiction with other mental health disorders:

• 90% of people who die by suicide have one or more psychiatric disorders. Risk is highest among patients with mood disorders like bipolar, depression, schizophrenia, and substance use disorders.
• People with psychiatric disorders are also at much higher risk of addiction. Among people with a mood disorder, 32% are found to also have a substance use disorder. In the absence of effective treatment or before an illness is even identified, many self-medicate, “often turning to substances or engaging in activities like gambling as a way to find relief from their negative feelings,” says Groat.
• When mood disorder and substance use disorder coexist (called “comorbidity”), the risk for suicide escalates considerably. For instance, men with both depression and alcohol use disorder have the highest long-term risk of suicide of all groups, around 16%.

Other Risk Factors for Addiction and Suicide

Not everyone who struggles with addiction and becomes suicidal starts out with a diagnosable mental health issue.

For example, “a lot of young people might begin using drugs or gaming intensively as a way to cope with feeling lonely, sad, or anxious,” says Groat.

Poverty and abuse can also lead a basically healthy person to seek escape through addictive behaviors. Peer pressure, easy access to addictive substances, and exposure to family members with addiction issues can raise a person’s risk of turning to drugs, alcohol, and addictive behaviors, too.

Many people are able to dip into potentially destructive coping behaviors and eventually move past them. Or they avoid them all together.

“There are plenty of high-achieving people who come from a history of trauma and pain,” says Groat.

There are also people who get by with low-level substance use or compulsive behavioral disorders that detract from their life but don’t reach crisis levels. Think of functional alcohol misusers, who nip into the bottle throughout the day yet still manage to keep a job. Or a long-time gambler who might have had a nicer house or paid for his kids’ college had he not blown so much on craps.

But others may be more vulnerable and find it harder to control their use or behavior, probably by some combination of genetic vulnerability and environmental factors.

“They then get into a spiral that creates its own problems. And people who didn’t start out with a mental health issue may end up with one because of their addiction,” Groat says.

If left untreated and allowed to spiral, that combination of addiction and comorbid mental illness can then lead a person to a desperate point. And in many cases, that point can be thinking about or attempting suicide.

TREATMENT ———————————–

The Challenge of Finding Treatment for Suicidality and Addiction

Considering how closely linked addiction and suicide are, one might assume that treatment options are plentiful.

To some extent, that’s true for people who have suicidal ideation and are also struggling with behavioral addictions like gambling. Guided by a licensed practitioner, talk therapies like cognitive behavioral therapy can teach skills to reduce urges and help people replace unhealthy thoughts with positive or adaptive ones.

While there are currently no FDA-approved medications that specifically target addictive behaviors, emerging research has shown that some drugs can effectively reduce addictive urges. There are also peer-led support groups and treatment programs that specifically target behavioral addictions.

The same cannot be said, however, for suicidality and substance use disorder, despite how commonly these two issues co-occur.

Certainly, there are places and professionals that treat patients who are at risk of suicide. And there are counselors, peer-led support groups, and rehab facilities that deal with substance use disorder, increasingly with the help of medications that ease recovery by blocking cravings and eliminating withdrawal symptoms.

But people struggling with both suicidality and substance dependence too often find themselves “in a murky gray area,” says Groat.

Someone may be referred to a mental health provider for their suicidal ideation and to a substance abuse counselor to address their addiction. This may work in some cases, but often care can be fragmented and patients receive mixed messages and conflicting advice from their different providers.

What’s more, some mental health specialists and facilities require potentially suicidal individuals to first deal with their substance dependence before coming on as patients. But many inpatient and outpatient rehab facilities will not take patients who are actively suicidal.

The tragic result: Families trying to help loved ones with alcohol or drug and suicidal ideations may not know where to turn at their most desperate time.

“It’s a huge limitation of the mental health field and a symptom of our broken mental health care system,” says Groat.

What You Can Do ———————————–

The Best Approach to Co-Occurring Suicidality and Addiction

This doesn’t mean help can’t be found. It just means you have to know how and where to look for a facility or specialist that treats dual diagnoses or provides what’s called “co-occurring care.”

If matters aren’t immediately life threatening, you can see a primary care provider, emphasize that addiction and suicidality are both at issue, and ask for a referral to a place or person that provides co-occurring care.

If you don’t have or want to see a physician, call the National Suicide & Crisis Lifeline at 988, describe what’s going on, and ask for a referral to a place or specialist who can treat dual diagnoses.

Whichever way you go and whatever possibilities you find, “you need to ask questions,” says Groat. Ask what their experience is with comorbid suicidality and addiction. Ask if they take a dual approach to treatment and what that approach entails.

“There unfortunately isn’t a way that I know of to quickly identify who is most likely to provide this kind of care. But I find that many therapists who specialize in suicidal ideation are also used to working with people who have substance use issues,” says Groat. “I also find that a lot of people and places that treat bipolar disorder are accustomed to treating substance abuse and suicidality because both are relatively common among people with BPD.”

Psychology Today’s website has a directory of therapists who specialize in bipolar disorder, as well as directory of therapists who specialize in suicidal ideation. There’s also a directory of licensed therapists who specialize in substance use disorder. All can provide helpful leads.

It may take some effort to find it, but there is support out there that can help you deal with the vicious cycle of addiction and suicidality.

“If you are able to find someone who can listen and understand how bad you feel … a therapist who ‘gets’ you and doesn’t judge you for your addiction … and effective medication … it can change the course of your life,” says Groat.

If you or someone you care about is in immediate crisis and is actively planning to hurt themselves or attempt suicide, call 988, go to an emergency room, or call 911.

Notes: This article was originally published July 7, 2023 and most recently updated July 24, 2023.