Substance use, a risk factor for suicidal behavior
Suicidal behavior is responsible for 15% of all injury-related deaths worldwide each day. According to data from the National Institute of Statistics, in 2022 there was an average of 11.2 suicides per day in Spain (74% men; 26% women).
We know that substance use is a contributing factor to suicidal behavior, and that the duration of use and the subsequent possible development of a substance use disorder (SUD) increases the likelihood of such behavior. It is estimated that the lifetime prevalence of suicide attempts in people with a substance use disorder is significantly higher compared to the general population (19-73% versus 3-5%). For example, people with an alcohol use disorder have a tenfold increased risk of suicide, and in people who inject drugs, the risk is fourteenfold (Yuodelis-Flores et al., 2015).
40% of people who have a substance use disorder and a mental disorder experience suicidal thoughts.
On the other hand, people diagnosed with dual pathology —that is, those with both a mental disorder and a substance use disorder—have a higher risk of suicide than those with only a substance use disorder or a mental disorder. In fact, it is estimated that 40% of people with dual pathology experience suicidal ideation (Arias et al., 2013).
Compulsive internet use and alcohol consumption are increasing among young people.
Several suicide risk factors have been identified in people with substance use disorder:
Personality traits
Numerous studies agree that people who exhibit suicidal behaviors and SUDs have higher rates of aggression and impulsivity in their personality profile, with borderline and antisocial personality disorders being the most commonly associated with suicidal behaviors in people with a comorbid SUD.
Environmental factors
There are higher rates of unemployment and social exclusion in the population with substance use disorders and mental health disorders. Interpersonal or family relationship problems have been described in up to one-third of people with alcoholism and completed suicide, six weeks prior to the suicide. (Arias et al., 2013).
Gender
Men have historically been described as having higher rates of substance use, abuse, and dependence; however, recent epidemiological studies suggest changes that are narrowing these differences. Regarding suicide, although men outnumber women in the general population (4:1), the association between suicide and alcohol use disorders is significantly stronger in women . A large meta-analysis of retrospective and prospective data (Wilcox HC et al., 2004) concluded that the standardized suicide mortality rate is seventeen times higher in women with alcoholism compared to only five times higher in men.
On the other hand, there are other social factors associated with gender that influence the evolution, such as stigma, social exclusion, gender violence, difficulties in reconciling family life and access to treatment itself, which gives them special vulnerability.
Substances consumed
The population that consumes alcohol consistently exhibits higher suicide rates than the general population, both in cases of alcohol dependence and acute alcohol intoxication. This could be explained by behavioral disinhibition, a loss of risk perception, and cognitive limitations in seeking alternative coping strategies during acute intoxication.
The risk of suicidal behavior or suicide intensifies during times of alcohol intoxication.
A study by the Violent Death Reporting System (NVDRS) found that alcohol was present in one-third of the 37,993 deaths studied. Although acute intoxication is not the same as a pattern of alcohol abuse or dependence, the risk of suicidal behavior or suicide increases during periods of intoxication in people with or without a substance use disorder. For the use of other substances (cocaine, opiates), suicide risk rates are nearly as high as those for alcohol use.
Luis San Molina
There are also some protective factors that should be considered when assessing suicide risk and creating a safety plan, such as:
- Resilience.
- Optimism.
- The presence of stable psychosocial support.
- The family.
- The children.
- Religious beliefs.
Thus, a strong relationship between suicidal risk and substance use disorders is demonstrated. Specific protocols and clinical guidelines exist for the assessment and management of suicidal thoughts and behaviors throughout the follow-up of individuals treated for a substance use disorder, such as the TIP 50 (Treatment Improvement Protocol), which have been shown to improve the outcomes for these individuals.
Let us also remember that substance use is one of the few modifiable risk factors that can be addressed with specific interventions (motivational interviewing, pharmacological treatment, etc.) by healthcare personnel. Therefore, training and development plans are necessary to improve the detection and care of these individuals.
Featuring
