Substance Abuse and Suicide

  • Youssef Mahfoud
  • Michael Ignatowski


The complex relationship between suicide and substance abuse has been observed in most nations worldwide. Research has revealed that the majority (90%) of those who do complete suicide have received a diagnosis of mental illness, substance abuse disorder, or both, throughout their treatment. Of the individuals that are suffering from a substance abuse disorder compared to the general population, men are twice as likely to die from suicide, while women are six times as likely. Advancing age, co-occurring affective disorders, and multiple attempts are just a few of the important risk factors to be noted for this specific population. Notably, patients with alcohol use or other substance use disorder should be screened for suicide risk and ideation and be offered appropriate medication management as well as psychological treatment. The emphasis of this chapter will be placed on alcohol, opioid, and cocaine use and their individual and perplexing relationship with suicidality in individuals.


Substance use disorder Mood disorder Alcohol use Opioid use Cocaine use Suicide 


  1. 1.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5). 5th ed. Arlington: American Psychiatric Publishing; 2013.CrossRefGoogle Scholar
  2. 2.
    Center for Behavioral Health Statistics and Quality. Results from the 2015 National Survey on Drug Use and Health: detailed tables. Rockville: Substance Abuse and Mental Health Services Administration; 2016.Google Scholar
  3. 3.
    Sacks JJ, Gonzales KR, Bouchery EE, Tomedi LE, Brewer RD. 2010 national and state costs of excessive alcohol consumption. Am J Prev Med. 2015;49(5):e73–9.CrossRefPubMedGoogle Scholar
  4. 4.
    National Drug Intelligence Center. National drug threat assessment. Washington, DC: US Department of Justice; 2011.Google Scholar
  5. 5.
    Harris EC, Barraclough B. Suicide as an outcome for mental disorders: a meta-analysis. Br J Psychiatry. 1997;170:205–28.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Mościcki EK. Epidemiology of completed and attempted suicide: toward a framework for prevention. Clin Neurosci Res. 2001;1(5):310–23.CrossRefGoogle Scholar
  7. 7.
    Conwell Y, Duberstein PR, Caine ED. Risk factors for suicide in later life. Biol Psychiatry. 2002;52(3):193–204.CrossRefPubMedGoogle Scholar
  8. 8.
    Nelson AR, Stith AY, Smedley BD, editors. Unequal treatment: confronting racial and ethnic disparities in health care (full printed version). Washington, DC: National Academies Press; 2002.Google Scholar
  9. 9.
    Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry. 1999;56(7):617–26.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Maloney E, Degenhardt L, Darke S, Mattick RP, Nelson E. Suicidal behaviour and associated risk factors among opioid-dependent individuals: a case–control study. Addiction. 2007;102(12):1933–41.CrossRefPubMedGoogle Scholar
  11. 11.
    Darke S, Ross J, Lynskey M, Teesson M. Attempted suicide among entrants to three treatment modalities for heroin dependence in the Australian Treatment Outcome Study (ATOS): prevalence and risk factors. Drug Alcohol Depend. 2004;73(1):1–10.CrossRefPubMedGoogle Scholar
  12. 12.
    Ilgen MA, Harris AH, Moos RH, Tiet QQ. Predictors of a suicide attempt one year after entry into substance use disorder treatment. Alcohol Clin Exp Res. 2007;31:635–42.PubMedGoogle Scholar
  13. 13.
    Borges G, Walters EE, Kessler RC. Associations of substance use, abuse, and dependence with subsequent suicidal behavior. Am J Epidemiol. 2000;151(8):781–9.CrossRefPubMedGoogle Scholar
  14. 14.
    Wilcox HC, Conner KR, Caine ED. Association of alcohol and drug use disorders and completed suicide: an empirical review of cohort studies. Drug Alcohol Depend. 2004;76:S11–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Schneider B. Substance use disorders and risk for completed suicide. Arch Suicide Res. 2009;13(4):303–16.CrossRefPubMedGoogle Scholar
  16. 16.
    Preuss UW, Schuckit MA, Smith TL, Danko GP, Buckman K, Bierut L, et al. Comparison of 3190 alcohol-dependent individuals with and without suicide attempts. Alcohol Clin Exp Res. 2002;26(4):471–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Ries RK, Fiellin DA, Miller SC, Saitz R, editors. Principles of addiction medicine. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2014.Google Scholar
  18. 18.
    Kraepelin E. Psychiatrie: ein Lehrbuch für Studirende und Aerzte. 6. vollständig umgearbeitete Auflage. Zweiter Band, Klinische Psychiatrie; Verlag von Johann Ambrosius. Leipzig: Barth; 1899.Google Scholar
  19. 19.
    Menninger KA. Man against himself. New York: Harcourt, Brace; 1938.Google Scholar
  20. 20.
    Roy A, Linnoila M. Alcoholism and suicide. Suicide Life Threat Behav. 1986;16:244–73.CrossRefPubMedGoogle Scholar
  21. 21.
    Sher L, Zalsman G. Alcohol and adolescent suicide. Int J Adolesc Med Health. 2005;17:197–203.PubMedGoogle Scholar
  22. 22.
    Anderson BA, Howard MO, Walker RD, Suchinsky RT. Characteristics of substance- abusing veterans attempting suicide: a national study. Psychol Rep. 1995;77:1231–42.CrossRefPubMedGoogle Scholar
  23. 23.
    Roy A. Distal risk factors for suicidal behavior in alcoholics: replications and new findings. J Affect Disord. 2003;77:267–71.CrossRefPubMedGoogle Scholar
  24. 24.
    Murphy GE, Wetzel RD. The lifetime risk of suicide in alcoholism. Arch Gen Psychiatry. 1990;47:383–92.CrossRefPubMedGoogle Scholar
  25. 25.
    Inskip HM, Harris EC, Barraclough B. Lifetime risk of suicide for affective disorder, alcoholism and schizophrenia. Br J Psychiatry. 1998;172:35–7.CrossRefPubMedGoogle Scholar
  26. 26.
    Barraclough B, Bunch J, Nelson B, Sainsbury PA. Hundred cases of suicide: clinical aspects. Br J Psychiatry. 1974;125:355–73.CrossRefPubMedGoogle Scholar
  27. 27.
    Rich CL, Ricketts JE, Fowler RC, Young D. Some differences between men and women who commit suicide. Am J Psychiatry. 1988;145(6):718–22.CrossRefPubMedGoogle Scholar
  28. 28.
    Duberstein PR, Conwell Y, Caine ED. Age differences in the personality characteristics of suicide completers: preliminary findings from a psychological autopsy study. Psychiatry. 1994;57(3):213–24.CrossRefPubMedGoogle Scholar
  29. 29.
    Conwell Y, Duberstein PR, Cox C, Herrmann JH, Forbes NT, Caine ED. Relationships of age and axis I diagnoses in victims of completed suicide: a psychological autopsy study. Am J Psychiatry. 1996;153(8):1001.CrossRefPubMedGoogle Scholar
  30. 30.
    Kolves K, Värnik A, Tooding LM, Wasserman D. The role of alcohol in suicide: a case-control psychological autopsy study. Psychol Med. 2006;36(7):923–30.CrossRefPubMedGoogle Scholar
  31. 31.
    Lester D. Alcoholism, substance abuse, and suicide. In: Maris RW, Berman AL, Silverman MM, editors. Comprehensive textbook of suicidology. New York: The Guilford Press; 2000. p. 357–75.Google Scholar
  32. 32.
    Rihmer Z, Belsö N, Kalmár S. Antidepressants and suicide prevention in Hungary. Acta Psychiatr Scand. 2001;88:238.Google Scholar
  33. 33.
    Lester D. Alcohol availability, alcoholism, and suicide and homicide. Am J Drug Alcohol Abuse. 1995;21:147–50.CrossRefPubMedGoogle Scholar
  34. 34.
    Razvodovsky YE. Beverage-specific alcohol sale and suicide in Russia. Crisis. 2009;30:186–91.CrossRefPubMedGoogle Scholar
  35. 35.
    Pompili M, Serafini G, Innamorati M, Dominici G, Ferracuti S, Kotzalidis GD, et al. Suicidal behavior and alcohol abuse. Int J Environ Res Public Health. 2010;7(4):1392–431.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Gossop M. Alcohol in suicide attempts and completions. Psychiatr Ann. 2005;35:513–21.Google Scholar
  37. 37.
    Hufford MR. Alcohol and suicidal behavior. Clin Psychol Rev. 2001;21:797–811.CrossRefPubMedGoogle Scholar
  38. 38.
    Cherpitel CJ, Borges GL, Wilcox HC. Acute alcohol use and suicidal behavior: a review of the literature. Alcohol Clin Exp Res. 2004;28(Suppl):18–28S.CrossRefGoogle Scholar
  39. 39.
    May PA, Van Winkle NW, Williams MB, McFeeley PJ, DeBruyn LM, Serna P. Alcohol and suicide death among American Indians of New Mexico: 1980–1998. Suicide Life Threat Behav. 2002;32:240–55.CrossRefPubMedGoogle Scholar
  40. 40.
    Pirkola S, Isometsa E, Heikkinen M, Lonnqvist J. Employment status influences the weekly patterns of suicide among alcohol misusers. Alcohol Clin Exp Res. 1997;21:1704–6.CrossRefPubMedGoogle Scholar
  41. 41.
    Brent DA, Perper JA, Allman CJ. Alcohol, firearms, and suicide among youth. JAMA. 1987;257(24):3369–72.CrossRefPubMedGoogle Scholar
  42. 42.
    Simon TR, Swann AC, Powell KE, Potter LB, Kresnow MJ, O’Carroll PW. Characteristics of impulsive suicide attempts and attempters. Suicide Life Threat Behav. 2001;32(Suppl):49–59.CrossRefPubMedGoogle Scholar
  43. 43.
    Sher L. Alcohol consumption and suicide. QJM. 2006;99(1):57–61.CrossRefPubMedGoogle Scholar
  44. 44.
    Koller G, Preuss UW, Bottlender M, Wenzel K, Soyka M. Impulsivity and aggression as predictors of suicide attempts in alcoholics. Eur Arch Psychiatry Clin Neurosci. 2002;252:155–60.CrossRefPubMedGoogle Scholar
  45. 45.
    Sher L, Oquendo MA, Li S, Huang Y, Grunebaum MF, Burke AK, et al. Lower CSF homovanillic acid levels in depressed patients with a history of alcoholism. Neuropsychopharmacology. 2003;28(9):1712.CrossRefPubMedGoogle Scholar
  46. 46.
    Sher L, Oquendo MA, Galfalvy HC, Grunebaum MF, Burke AK, Zalsman G, et al. The relationship of aggression to suicidal behavior in depressed patients with a history of alcoholism. Addict Behav. 2005;30:1144–53.CrossRefPubMedGoogle Scholar
  47. 47.
    Tiet QQ, Ilgen MA, Byrnes HF, Moos RH. Suicide attempts among substance use disorder patients: an initial step toward a decision tree for suicide management. Alcohol Clin Exp Res. 2006;30:998–1005.CrossRefPubMedGoogle Scholar
  48. 48.
    Conner KR, Ilgen MA. Substance use and suicidal behaviour. In: O’Connor R, Platt S, Gordon J, editors. International handbook of suicide prevention. Chichester: Wiley-Blackwell; 2001.Google Scholar
  49. 49.
    Conner KR, Duberstein PR, Conwell Y. Domestic violence, separation, and suicide in young men with early onset alcoholism: reanalyses of Murphy’s data. Suicide Life Threat Behav. 2000;30:354–9.PubMedGoogle Scholar
  50. 50.
    Burnette ML, Ilgen M, Frayne SM, Lucas E, Mayo J, Weitlauf JC. Violence perpetration and childhood abuse among men and women in substance abuse treatment. J Subst Abus Treat. 2008;35(2):217–22.CrossRefGoogle Scholar
  51. 51.
    Chermack ST, Murray RL, Walton MA, Booth BA, Wryobeck J, Blow FC. Partner aggression among men and women in substance use disorder treatment: correlates of psychological and physical aggression and injury. Drug Alcohol Depend. 2008;98(1):35–44.CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Ilgen MA, Burnette ML, Conner KR, Czyz E, Murray R, Chermack S. The association between violence and lifetime suicidal thoughts and behaviors in individuals treated for substance use disorders. Addict Behav. 2010;35(2):111–5.CrossRefPubMedGoogle Scholar
  53. 53.
    Ilgen MA, Chermack ST, Murray R, Walton MA, Barry KL, Wojnar M, et al. The association between partner and non-partner aggression and suicidal ideation in patients seeking substance use disorder treatment. Addict Behav. 2009;34(2):180–6.CrossRefPubMedGoogle Scholar
  54. 54.
    Badawy AA. Alcohol, aggression and serotonin: metabolic aspects. Alcohol Alcohol. 1998;33:66–72.CrossRefPubMedGoogle Scholar
  55. 55.
    Gross-Isseroff R, Biegon A. Autoradiographic analysis of [3H]imipramine binding in the human brain postmortem: effects of age and alcohol. J Neurochem. 1988;51:528–34.CrossRefPubMedGoogle Scholar
  56. 56.
    Chen HT, Casanova MF, Kleinman JE, Zito M, Goldman D, Linnoila M. 3H-paroxetine binding in brains of alcoholics. Psychiatry Res. 1991;38:293–9.CrossRefPubMedGoogle Scholar
  57. 57.
    Dillon KA, Gross-Isseroff R, Israeli M, Biegon A. Autoradiographic analysis of serotonin 5-HT1A receptor binding in the human brain postmortem: effects of age and alcohol. Brain Res. 1991;554:56–64.CrossRefPubMedGoogle Scholar
  58. 58.
    Sher L, Milak MS, Parsey RV, Carballo JJ, Cooper TB, Malone KM, et al. Positron emission tomography study of regional brain metabolic responses to a serotonergic challenge in major depressive disorder with and without comorbid lifetime alcohol dependence. Eur Neuropsychopharmacol. 2007;17(9):608–15.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Sher L, Oquendo MA, Grunebaum MF, Burke AK, Huang YY, Mann JJ. CSF monoamine metabolites and lethality of suicide attempts in depressed patients with alcohol dependence. Eur Neuropsychopharmacol. 2007;17(1):12–5.CrossRefPubMedGoogle Scholar
  60. 60.
    Foster T, Gillespie K, McClelland R. Mental disorders and suicide in Northern Ireland. Br J Psychiatry. 1997;170(5):447–52.CrossRefPubMedGoogle Scholar
  61. 61.
    Sublette ME, Carballo JJ, Moreno C, Galfalvy HC, Brent DA, Birmaher B, et al. Substance use disorders and suicide attempts in bipolar subtypes. J Psychiatr Res. 2009;43(3):230–8.CrossRefGoogle Scholar
  62. 62.
    Skog OJ. Alcohol and suicide: Durkheim revisited. Acta Sociol. 1991;34(3):193–206.CrossRefGoogle Scholar
  63. 63.
    Magne-Ingvar U, Öjehagen A, Träskman-Bendz L. Suicide attempters with and without reported overconsumption of alcohol and tranquillizers. Nord J Psychiatry. 1997;51(6):415–21.CrossRefGoogle Scholar
  64. 64.
    Platt S, Robinson A. Parasuicide and alcohol: a 20 year survey of admissions to a regional poisoning treatment centre. Int J Soc Psychiatry. 1991;37(3):159–72.CrossRefPubMedGoogle Scholar
  65. 65.
    Berglund M, Thelander S, Salaspuro M, Franck J, Andréasson S, Öjehagen A. Treatment of alcohol abuse: an evidence-based review. Alcohol Clin Exp Res. 2003;27(10):1645–56.CrossRefPubMedGoogle Scholar
  66. 66.
    National Institute on Drug Abuse. Overdose death rates. 2015. Accessed 25 Nov 2016.
  67. 67.
    Home Office. Home Office statistical bulletin: statistics of drug addicts notified to the Home Office, UK, 1993. London: Government Statistical Service; 1994.Google Scholar
  68. 68.
    Frischer M, Bloor M, Goldberg D, Clark J, Green S, McKeganey N. Mortality among drug injectors and notified addicts. J Epidemiol Community Health. 1993;47(4):336.CrossRefPubMedPubMedCentralGoogle Scholar
  69. 69.
    Kwon M, Yang S, Park K, Kim DJ. Factors that affect substance users’ suicidal behavior: a view from the Addiction Severity Index in Korea. Ann General Psychiatry. 2013;12(1):35.CrossRefGoogle Scholar
  70. 70.
    Sheehan CM, Rogers RG, Boardman JD. Postmortem presence of drugs and method of violent suicide. J Drug Issues. 2015;45(3):249–62.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Caplehorn JR, Dalton MS, Cluff MC, Petrenas A. Retention in methadone maintenance and heroin addicts’ risk of death. Addiction. 1994;89(2):203–7.CrossRefPubMedGoogle Scholar
  72. 72.
    Connock M, Juarez-Garcia A, Jowett S, Frew E, Liu Z, Taylor RJ, et al. Methadone and buprenorphine for the management of opioid dependence: a systematic review and economic evaluation. Health Technol Assess. 2007;11(9):1.CrossRefPubMedGoogle Scholar
  73. 73.
    Stotts AL, Dodrill CL, Kosten TR. Opioid dependence treatment: options in pharmacotherapy. Expert Opin Pharmacother. 2009;10(11):1727–40.CrossRefPubMedPubMedCentralGoogle Scholar
  74. 74.
    Fiellin DA, Friedland GH, Gourevitch MN. Opioid dependence: rationale for and efficacy of existing and new treatments. Clin Infect Dis. 2006;43(Suppl 4):S173–7.CrossRefPubMedGoogle Scholar
  75. 75.
    Walley AY, Xuan Z, Hackman HH, Quinn E, Doe-Simkins M, Sorensen-Alawad A, et al. Opioid overdose rates and implementation of overdose education and nasal naloxone distribution in Massachusetts: interrupted time series analysis. BMJ. 2013;346:f174.CrossRefPubMedPubMedCentralGoogle Scholar
  76. 76.
    Centers for Disease Control and Prevention. CDC wonder: multiple cause of death 1999–2014. 2016. Accessed 17 May 2016.
  77. 77.
    Pilotte NS. Neurochemistry of cocaine withdrawal. Curr Opin Neurol. 1997;10(6):534–8.CrossRefPubMedGoogle Scholar
  78. 78.
    Mulvaney FD, Alterman AI, Boardman CR, Kampman K. Cocaine abstinence symptomatology and treatment attrition. J Subst Abus Treat. 1999;16(2):129–35.CrossRefGoogle Scholar
  79. 79.
    Sofuoglu M, Dudish-Poulsen S, Brown SB, Hatsukami DK. Association of cocaine withdrawal symptoms with more severe dependence and enhanced subjective response to cocaine. Drug Alcohol Depend. 2003;69(3):273–82.CrossRefPubMedGoogle Scholar
  80. 80.
    Narvaez JC, Jansen K, Pinheiro RT, Kapczinski F, Silva RA, Pechansky F, et al. Psychiatric and substance-use comorbidities associated with lifetime crack cocaine use in young adults in the general population. Compr Psychiatry. 2014;55(6):1369–76.CrossRefPubMedGoogle Scholar
  81. 81.
    Friedman AS, Terras A, Zhu W, McCallum J. Depression, negative self-image, and suicidal attempts as effects of substance use and substance dependence. J Addict Dis. 2004;23(4):55–71.CrossRefPubMedGoogle Scholar
  82. 82.
    Marzuk PM, Tardiff K, Leon AC, Stajic M, Morgan EB, Mann JJ. Prevalence of cocaine use among residents of New York City who committed suicide during a one-year period. Am J Psychiatry. 1992;149(3):371.CrossRefPubMedGoogle Scholar
  83. 83.
    Carroll KM, Nich C, Petry NM, Eagan DA, Shi JM, Ball SA. A randomized factorial trial of disulfiram and contingency management to enhance cognitive behavioral therapy for cocaine dependence. Drug Alcohol Depend. 2016;160:135–42.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Opioid Treatment ProgramCWRU School of Medicine, Cleveland Louis Stokes VA Medical CenterClevelandUSA
  2. 2.CWRU School of Medicine, Cleveland Louis Stokes VA Medical CenterClevelandUSA

Personalised recommendations