Week 4 – Substance Use Disorders and Suicide

Drugs and Suicide

There is an established association between substance use disorders and suicide, but little is known about the underlying psychological mechanisms. The dysregulation of the neurotransmitter serotonin has been linked to depression, suicidal behaviour, and substance abuse. Particularly, lower levels of 5-hydroxyindoleactic acid, a principal metabolite of serotonin, have been associated with increased suicide and suicidal behaviour. Although researchers are examining many other potential neurobiological and genetic mechanisms of suicide, such discussion is beyond the focus of this article (Page 3).

Drug use increases the risk of suicidal behaviour through both acute and chronic effects. Acutely, drug use distorts judgment, weakens impulse control, and interrupts neurotransmitter pathways. With longer periods of use, cognitive and behavioural control is impaired, subsequently leading to an increase in impulsive and aggressive behaviours. Physiological and metabolic stress resulting from use of substances can also lead to neurotoxic damage and severe medical consequences, especially among elderly individuals. Additionally, addiction induces negative emotional states, since it causes financial strain, social stigma, isolation, and difficulties at school (Page 3).

Lifetime prevalence of suicide attempts among individuals with alcohol use disorder is high, with heavy drinkers having a five-fold greater risk than social drinkers. About 40% of those seeking treatment for alcohol use disorder report at least one suicide attempt during their lifetime (Page 3).

Tobacco use is one of the main preventable causes of death and contributes to an increased suicide risk proportional to the number of cigarettes smoked per day. Cessation has a positive impact, although former smokers will always carry a suicide risk higher than that of non-smokers (Page 4).

A suicide assessment identifies static (unchangeable) and dynamic (modifiable or treatable) risk and protective factors that facilitate diagnosis, treatment, and safety management. To our knowledge, no single assessment method has been tested for reliability and validity; thus, emphasis should be placed on identifying and modifying dynamic risks. Common modifiable risk factors are medical illness, psychiatric symptoms, active substance abuse, current life crises, unemployment, lack of social support, and access to firearms. Static risk factors help stratify the level of risk but are typically of little use in treatment. Dual diagnoses are often overlooked but should be identified due to an association with poor prognosis: patients with dual diagnoses are at greater risk for a suicide attempt than those with a single diagnosis (Page 5).

Reference: Saeed Ahmed, M.D., and Cornel N. Stanciu M.D. (2017). Addiction and Suicide: An Unmet Public Health Crisis. American Journal of Psychiatry Residents Journal · December 2017. Dartmouth–Hitchcock Medical Center, USA. Page 3 – 5.