Addressing Suicidal Behavior in People With Addiction
Substance use disorder (SUD) is second only to depression as the most frequent risk factor for suicidal behavior, according to the National Center for Injury Prevention and Control. When a loved one threatens suicide or exhibits suicidal behaviors, it’s important to take action. But what exactly should you do?
What Should I Say If Someone Threatens Suicide?
When someone threatens suicide, or tells you they’ve thought about killing themselves, it’s important take it seriously. Don’t dismiss or try to minimize the situation. Consider getting them professional help. But one of the best things you can do is listen to them. Keith Farah, executive director at Landmark Recovery of Louisville, suggests asking someone who has threatened suicide these three questions:
- What is making you feel this way?
- How do you plan on doing this?
- When do you plan on doing this?
“These are hard and uncomfortable questions to ask, but need to be asked so you can determine whether a person has the means, the ability, and an actual plan to carry that out,” Farah says.
He also encourages you to remove any items from their home which they may use to harm themselves, such as knives, firearms, or drugs. Do not leave them alone. Make a plan to have someone be with them, or at least check in on them frequently. In situations where the person expresses an extreme urge to end their life immediately, call your local police or dial 988 to reach the Suicide and Crisis Lifeline.
In cases where you determine there is no immediate danger to their life, be compassionate and offer your support. Helpful things to say to someone considering suicide include:
- How can I support you?
- I am here for you. You are not alone.
- I know I can’t understand exactly how you feel, but I care and I want to help.
It’s best to avoid minimizing their feelings or using guilt to convince them not to go through with it. Things to avoid saying include:
- Imagine how your friends and family would feel.
- It’s just a breakup, you’ll be okay.
- You’re just going through things right now. It will get better.
Suicide and Substance Use Disorders
Suicide is one of the leading causes of death in the United States among those who suffer from a SUD. The CDC estimates that 22% of suicides involve a blood alcohol content meeting or exceeding the legal limit, 20% involve opioids, 4.6% involve cocaine, and 3.4% involve amphetamines.
“The reason people return to use very quickly is the hopelessness, the depression and the feeling that everything is horrible,” Farah says. “The likelihood of people thinking, ‘my only way out is to end it all,’ certainly increases, particularly with methamphetamines.”
This effect is a result of the extreme increase and subsequent decrease of your brain’s flow of dopamine, the neurotransmitter responsible for feelings of pleasure, motivation and satisfaction. Drugs like methamphetamine and cocaine cause the feeling of reward in your brain to increase more than ten times the natural level. The average increase in dopamine flow in your brain while eating is about 50%. With methamphetamines, the brain experiences a 1,200% increase, and with cocaine, a 300% increase. The baseline of dopamine released in your brain naturally does not increase to accommodate the new demand. This lowers the brain’s sensitivity to natural rewards, creating a deficiency and an eventual addiction to the substance responsible.
“The comedown from that makes you feel like it’s the end of the world,” Farah says. “So even when things start getting better for the first few months, it doesn’t feel like it because your brain is depleted and it takes up to a year or so for it to regulate its dopamine flow again.”
Suicidal Behavior vs. Suicidal Thoughts
Suicidal thoughts or ideation is any contemplation of suicide. This can include vocalization such as a person saying “I wish I was dead” or more detailed plans and fantasies about how people would react to them being gone. Suicidal ideations can range from an occasional fleeting thought to a continual preoccupation, and often present in a “waxing and waning manner,” meaning the extent and intensity of these thoughts can fluctuate over time. Suicidal ideation does not always lead to suicidal behavior, and most people who experience these ideations have sufficient control over them.
Suicidal behavior, or intent, is when someone has a strong desire and has made plans to kill themselves. This includes behaviors such as purchasing a gun or drugs with the intent to use them, writing a goodbye letter or making final arrangements.
“There is a big difference in me saying ‘I just don’t feel like I want to live anymore,’ and me saying ‘tomorrow morning, I’m going to walk out of my front door when the public transportation comes by then I’m going to step in front of the bus and kill myself,’” Farah says.
A study published by the Center for Behavioral Health Statistics Quality states that for every 31 Americans with suicidal ideations, one individual will attempt suicide. However, suicidal ideations can still be a precursor to suicidal behavior and should not be dismissed.
When Should I Take It Seriously?
Threats of suicide should always be taken seriously, regardless of whether you believe the person is telling the truth. Most people who commit suicide have expressed their intention to do so at some point beforehand.
Sometimes, people will make suicide threats over and over, resulting in less concern from their loved ones or a feeling that they are doing it to emotionally manipulate you. However, it’s best not to concern yourself too much with this possibility so as not to risk ignoring someone who is truly in need of help.
Suicide Warning Signs
- Having expressed feelings of hopelessness or no will to live
- Calling themselves a burden to others
- Increased use of alcohol or drugs
- Isolating themselves from loved ones
- Sleeping more or less than usual
- Loss of interest in activities, hobbies, and socializing
- Giving away their belongings
- Sudden calmness, especially after a period of numbness or depression
- Making preparations or saying goodbyes
- Reckless behavior
Will Talking About Suicide Make It Worse?
There is no evidence to suggest that talking to a person about their thoughts or threats of suicide will cause them to become suicidal. In fact, talking about it is always the better option, Farah said. A 2014 study found that acknowledging and talking about suicide can reduce ideations and improve mental health.
How Can I Help a Suicidal Person?
If someone you know is actively contemplating suicide, offer to call a suicide hotline (such as 988) or the local police and take them somewhere for treatment. If they are not cooperative, Farah says the best course of action is to ensure they are not alone. Then call the authorities to have a mental health inquest warrant sworn out on them to ensure their safety.
People are often hesitant to approach a friend or family member about their suicidal ideations or behavior out of fear of damaging the relationship, but Farah urges you to consider what could happen if you do not intervene.
“Maybe they’ll never trust you again but at least they’ll be alive,” he said.
- Landmark Recovery is available 24/7 at (888) 448-0302 for those struggling with a substance use disorder.
- National Suicide Prevention Lifeline: 1-800-273-8255. This hotline is available 24/7, 365 days a year. A separate hotline for Spanish-speaking callers is available at 1-888-628-9454. If you are deaf or hard-of-hearing, connect with a counselor 24/7 through any of the following channels:
- Online chat by clicking the chat button on this website.
- Video relay service at 1-800-273-8255.
- TTY at 1-800-799-4889.
- Voice/Caption Phone at 800-273-8255.
- Veterans Crisis Line: 1-800-273-8255. Or text 838255 or chat online through their website.
- Crisis Text Line: 741741. Services are offered 24/7.
- SAMHSA helpline: 1-800-662-HELP (4357) or TTY 1-800-487-4889. This helpline is confidential and free and available 24/7, 365-day-a-year. It is available in both English and Spanish.
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