Many people who struggle with substance use also have mental health challenges. When someone uses alcohol or other drugs, it can change the way they think and feel, sometimes making them more likely to feel hopeless or take dangerous risks. Sadly, this means that people who use substances are at a higher risk of having suicidal thoughts or attempting suicide.^[1]

Substance use affects the brain, making it harder to make good decisions. It can also make mental health problems like depression and anxiety worse. Some people use substances to cope with their pain, but over time, these substances can make things even harder.

For example, alcohol is a depressant, meaning it slows down brain and body functions. Someone who drinks to forget their sadness may actually feel worse the next day. Other substances, like stimulants, can increase anxiety, paranoia, and impulsivity, making suicidal thoughts even more dangerous.

Additionally, withdrawal from alcohol and other drugs can lead to severe mood swings, depression, and even suicidal thoughts. If someone is trying to quit without medical support, they may face intense emotional and physical distress, increasing their risk of self-harm.

This can be a scary topic to discuss, but knowing the risks and what to do can help you protect your loved one.

Why are substance use and suicide risk connected?

While research on the connection between substance use and suicide is limited, there are several reasons why individuals who use substances are at higher risk of dying by suicide.

It is very common for individuals with a substance use disorder to also have a mental health disorder, and many individuals who attempt or die from suicide struggle with their mental health.^[2] People who use substances may already be at risk of attempting or thinking about suicide, and substances might only make this worse. This is because individuals with mental health conditions may turn to alcohol or other drugs to cope.

Additionally, substance use can lead to severely impaired judgement and increased risky behavior, which can cause someone to act on existing suicidal thoughts or make a decision they wouldn’t make sober. Substances are often found to be involved in suicide attempts and deaths. For example, suicide deaths involving alcohol have increased over the past decade by at least 2%, especially among women of all age groups.^[3]

While it is difficult to separate intentional overdoses from accidental ones, at least 12% of suicide deaths reported in 2022 were a result of poisoning, most of them involving drugs.^[4] Both prescribed and illegal drugs are the leading cause of death by poisoning.^[5] During the COVID-19 pandemic, rates of suicide attempts involving drug poisoning skyrocketed amongst children and teens ages 10-19.^[6]

What are the warning signs of suicide?

If you are concerned that a loved one might be considering suicide, watch for changes in behavior and mood as well as troubling statements. Some key signs include:^[7]

• Talking about suicide, being a burden, or expressing hopelessness. Someone may bring up the topic of suicide often and say things like:
  • “I wish I wasn’t here.”
  • “Everyone would be better off without me.”
  • “Nothing will ever get better.”
• Withdrawing from others. Someone struggling with suicidal thoughts may avoid their loved ones and social activities.
• Increased risky behavior. This can include increased substance use, reckless driving, not attending school, quitting a job, or other self-destructive actions.
• Sudden changes in mood. A person considering suicide may shift between seeming depressed or sad to suddenly being happy or at peace. They may also be anxious and easily irritated.
• Changes in sleeping and eating habits. This can mean overeating or eating too much or too little or sleeping a lot or not at all.
• Someone considering suicide may start giving away meaningful possessions or write a will. If you find your loved one searching online for methods to commit suicide or ways to acquire a gun or pills, it’s time to act.

How can I talk to my loved one about suicide?

It can be difficult to have a conversation about a loved one’s suicidal thoughts. But if you ask direct and caring questions and make it known that you’re here to listen, you can help them feel supported and allow them to open up. Some questions to consider include:

• I’ve noticed you seem really down lately. What is troubling you?

• Are you feeling like you don’t want to be here anymore?

• Are you thinking about hurting yourself?

• Have you thought about suicide?

• Do you have a plan for how you would do it?(If they say yes, this is an urgent emergency.)

• What can I do to help?

What else can families do?

Listen without judgment. Avoid minimizing your loved one’s feelings or saying things like, “You have so much to live for.” Instead, acknowledge their pain: “I’m so sorry you’re feeling this way. You’re not alone, and I want to help.” Take what they have to say seriously.

Remove immediate dangers. If they have access to weapons, pills and other substances including alcohol, or other means of harming themselves, try to remove or secure them. If you have firearms in your home, strongly consider getting rid of them. Simply having access to a firearm at all can significantly increase suicide risk.^[8]

Encourage professional help.A doctor, therapist, or counselor can provide support. Many organizations specialize in treating both substance use and mental health concerns. Consider finding a therapist who specializes in co-occurring disorders.

Stay connected. People who feel alone are at a higher risk of suicide. Check in regularly, spend time together, and remind them they are loved. A strong support system can make a big difference in their recovery.

Create a safety plan. Work with them to make a plan for when they feel overwhelmed. This might include calling a trusted friend, going for a walk, or reaching out to a support hotline. A safety plan can also include a list of emergency contacts and calming strategies like deep breathing or journaling.

Educate yourself. Learn about addiction and mental health to better understand what your loved one is going through. The more informed you are, the more supportive you can be.

If your loved one seems to be at immediate risk of hurting themselves, do not leave them alone. Call emergency services for guidance or take them to a crisis center or emergency room.

Crisis Resources

• 988 Suicide & Crisis Lifeline: Call or text988 at any time of the day or night for confidential support.

• Crisis Text Line:  Text “HELLO” to 741741 to connect with a trained crisis counselor. 

• Poison control: If you suspect that someone has poisoned themselves (but is not in immediate danger), you can get immediate support by calling 1-800-222-1222 or using the tool.

• Local emergency services: Call911 if someone is in immediate danger.

Recognizing the warning signs and understanding the impact of substance use on mental health can help us protect our loved ones and provide the necessary support. If your loved one is struggling with substance use and/or their mental health and you don’t know where to turn, don’t hesitate to reach out to us for direct support.