Substance Use Disorders and Suicide

doi:10.1017/9781108963763.012

Chapter 11 - Substance Use Disorders and Suicide

from Section 2 - Specific Challenges in Preventing Suicide

Published online by Cambridge University Press: aN Invalid Date NaN

Mohammed T. Abou-Saleh

Edited by

Rob Poole ,

Murad M. Khan and

Catherine A. Robinson

Show author details

Rob Poole: Affiliation:
Bangor University
Murad M. Khan: Affiliation:
Aga Khan University
Catherine A. Robinson: Affiliation:
University of Manchester

Book contents

Get access

Summary

The scope of this chapter is to provide an overview of the relationship of substance use disorders (SUD) and suicidal behaviour. The epidemiology of substance use disorders and suicidal behaviour is extensively and critically reviewed in general and clinical populations. The mediating mechanisms for this association are examined.

The findings strongly indicate that SUD is a robust risk factor for suicidal behaviour: It is remarkable that the contribution of SUD to suicidal behaviour is universal except for few variations in the association of SUD with suicidal behaviour between high-income and low-income and middle-income countries.

Keywords

alcohol use drug use mental health prevention substance suicide

Information

Type: Chapter
Information: Preventing Suicide
An Evidence-Based Approach
, pp. 137 - 153

DOI: https://doi.org/10.1017/9781108963763.012 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2026

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Book purchase

Temporarily unavailable

References

World Health Organization. Suicide in the World: Global Health Estimates. Geneva: World Health Organization; 2019.Google Scholar

Naghavi, M. Global burden of disease self-harm collaborators. BMJ. 2019 Feb 6; 364: 194.Google Scholar

World Health Organization. Mental Health Action Plan, 2013–2020. Geneva: World Health Organization; 2013.Google Scholar

Hasin, DS, O’Brien, CP, Auriacombe, M, Borges, G, Bucholz, K, Budney, A, et al. DSM-5 criteria for substance use disorders: Recommendations and rationale. American Journal of Psychiatry. 2013 Aug; 170(8): 834–51.CrossRef Google Scholar PubMed

Poznyak, V, Reed, GM, Medina-Mora, ME. Aligning the ICD-11 classification of disorders due to substance use with global service needs. Epidemiology and Psychiatric Sciences. 2018 Jun; 27(3): 212–18.CrossRef Google Scholar PubMed

Whiteford, HA, Degenhardt, L, Rehm, J, Baxter, AJ, Ferrari, AJ, Erskine, HE, et al. Global burden of disease attributable to mental and substance use disorders. Lancet. 2013 Nov 9; 382(9904): 1575–86.10.1016/S0140-6736(13)61611-6CrossRef Google Scholar PubMed

Griffin, KW, Botvin, GJ. Evidence-based interventions for preventing substance use disorders in adolescents. Child Adolescent Psychiatry Clinics of North America. 2010; 19(3): 505–26.10.1016/j.chc.2010.03.005CrossRef Google Scholar PubMed

Afuseh, E, Pike, CA, Oruche, UM. Individualized approach to primary prevention of substance use disorder: Age-related risks. Substance Abuse Treatment, Prevention and Policy. 2020; 15: 58.CrossRef Google Scholar PubMed

Abou-Saleh, MT, Tarter, RE, Salloum, IM. Substance use disorders. In Mezzich, J, Botbol, M, Christodoulou, G, Cloninger, C, Salloum, I, eds., Person Centered Psychiatry. Springer: Cham; 2016.Google Scholar

Fruhbauerova, M, Comtois, KA. Addiction counselors and suicide: Education and experience do not improve suicide knowledge, beliefs, or confidence in treating suicidal clients. Journal of Substance Abuse Treatment. 2019 Nov; 106: 29–34.CrossRef Google Scholar PubMed

United Nations Office on Drugs and Crime/World Health Organization. International Standards on Drug Use Prevention, 2nd updated ed. Vienna: United Nations; 2020.Google Scholar

Ferrari, AJ, Norman, RE, Freedman, G, Baxter, AJ, Pirkis, JE, Harris, MG, et al. The burden attributable to mental and substance use disorders as risk factors for suicide: Findings from the Global Burden of Disease Study 2010. PLoS One. 2014 Apr 2; 9(4): e91936.10.1371/journal.pone.0091936CrossRef Google Scholar PubMed

Nock, MK, Hwang, I, Sampson, N, Kessler, RC, Angermeyer, M, Beautrais, A, et al. Cross-national analysis of the associations among mental disorders and suicidal behavior: Findings from the WHO World Mental Health Surveys. PLoS Med. 2009 Aug; 6(8): e1000123.CrossRef Google Scholar PubMed

Breet, E, Goldstone, D, Bantjes, J. Substance use and suicidal ideation and behaviour in low- and middle-income countries: A systematic review. BMC Public Health. 2018 Apr 24; 18(1): 549.CrossRef Google Scholar PubMed

Carvalho, AF, Stubbs, B, Vancampfort, D, Kloiber, S, Maes, M, Firth, J, et al. Cannabis use and suicide attempts among 86,254 adolescents aged 12–15 years from 21 low- and middle-income countries. European Psychiatry. 2019 Feb; 56: 8–13.10.1016/j.eurpsy.2018.10.006CrossRef Google Scholar PubMed

Conner, KR, Bridge, JA, Davidson, DJ, Pilcher, C, Brent, DA. Meta-analysis of mood and substance use disorders in proximal risk for suicide deaths. Suicide and Life Threatening Behavior. 2019 Feb; 49(1): 278–92.10.1111/sltb.12422CrossRef Google Scholar PubMed

Lynch, FL, Peterson, EL, Lu, CY, Hu, Y, Rossom, RC, Waitzfelder, BE, et al. Substance use disorders and risk of suicide in a general US population: A case control study. Addiction Science and Clinical Practice. 2020 Feb 21; 15(1): 14.10.1186/s13722-020-0181-1CrossRef Google Scholar

Wasserman, D, Rihmer, Z, Rujescu, D, Sarchiapone, M, Sokolowski, M, Titelman, D, et al. The European Psychiatric Association (EPA) guidance on suicide treatment and prevention. European Psychiatry. 2012 Feb; 27(2): 129–41.10.1016/j.eurpsy.2011.06.003CrossRef Google Scholar PubMed

Mishara, BL, Chagnon, F. Why mental illness is a risk factor for suicide: Implications for suicide prevention. In O’Connor, RC, Pirkis, J, eds., The International Handbook of Suicide Prevention, 2nd ed. Hoboken: Wiley; 2016: 594–608.10.1002/9781118903223.ch34CrossRef Google Scholar

Wasserman, D, Carli, V, Iosue, M, Javed, A, Herrman, H. Suicide prevention in psychiatric patients. Asia Pacific Psychiatry. 2021 Feb 18: e12450.CrossRef Google Scholar

Norström, T, Rossow, I. Alcohol consumption as a risk factor for suicidal behavior: A systematic review of associations at the individual and at the population level. Archives of Suicide Research. 2016 Oct–Dec; 20(4): 489–506.CrossRef Google Scholar PubMed

Khemiri, L, Jokinen, J, Runeson, B, Jayaram-Lindström, N. Suicide risk associated with experience of violence and impulsivity in alcohol dependent patients. Scientific Reports. 2016 Jan 19; 6: 19373.10.1038/srep19373CrossRef Google Scholar PubMed

Brignone, E, George, DR, Sinoway, L, Katz, C, Sauder, C, Murray, A, et al. Trends in the diagnosis of diseases of despair in the United States, 2009–2018. BMJ Open. 2020 Nov 9; 10(10): e037679.10.1136/bmjopen-2020-037679CrossRef Google Scholar PubMed

Kim, AM. Alcohol consumption and suicide rate. Psychiatry Research. 2021 Jan; 295: 113553.CrossRef Google Scholar PubMed

Harris, EC, Barraclough, B. Suicide as an outcome for mental disorders. British Journal of Psychiatry. 1997 Mar; 170: 205–28.CrossRef Google Scholar

Darvishi, N, Farhadi, M, Haghtalab, T, Poorolajal, J. Alcohol-related risk of suicidal ideation, suicide attempt, and completed suicide. PLoS One. 2015 May 20; 10(5).10.1371/journal.pone.0126870CrossRef Google Scholar PubMed

Blow, FC, Serras, AM, Barry, KL. Late-life depression and alcoholism. Current Psychiatry Reports. 2007 Feb; 9(1): 14–19.CrossRef Google Scholar PubMed

Hulse, GK, Saunders, JB, Roydhouse, RM, Stockwell, TR, Asso, MR. Screening for hazardous alcohol use and dependence in psychiatric in-patients using the AUDIT questionnaire. Drug and Alcohol Review. 2000; 19: 291–8.10.1080/713659373CrossRef Google Scholar

McCloud, A, Barnaby, B, Omu, N, Drummond, C, Aboud, A. Relationship between alcohol use disorders and suicidality in a psychiatric population. British Journal of Psychiatry. 2004 May; 184: 439–45.10.1192/bjp.184.5.439CrossRef Google Scholar

Ilgen, MA, Conner, KR, Roeder, KM, Blow, FC, Austin, K, Valenstein, M. Patterns of treatment utilization before suicide among male veterans with substance use disorders. American Journal of Public Health. 2012 Mar; 102(suppl 1): S88–92.CrossRef Google Scholar PubMed

Crump, C, Edwards, AC, Kendler, KS, Sundquist, J, Sundquist, K. Healthcare utilisation prior to suicide in persons with alcohol use disorder. British Journal of Psychiatry. 2020 Dec; 217(6): 710–16.10.1192/bjp.2020.122CrossRef Google Scholar PubMed

Edwards, AC, Ohlsson, H, Sundquist, J, Sundquist, K, Kendler, KS. Alcohol use disorder and risk of suicide in a Swedish population-based cohort. American Journal of Psychiatry. 2020 Jul 1; 177(7): 627–34.CrossRef Google Scholar

Kõlves, K, Chitty, KM, Wardhani, R, Värnik, A, de Leo, D, Witt, K. Impact of alcohol policies on suicidal behavior: A systematic literature review. International Journal of Environmental Research and Public Health. 2020 Sep 25; 17(19): 7030.10.3390/ijerph17197030CrossRef Google Scholar PubMed

Charlson, FJ, Baxter, AJ, Dua, T, Degenhardt, L, Whiteford, HA, Vos, T. Excess mortality from mental, neurological, and substance use disorders in the Global Burden of Disease Study 2010. Epidemiology and Psychiatric Sciences. 2015 Sep 25; 17(19): 7030.Google Scholar

Poorolajal, J, Haghtalab, T, Farhadi, M, Darvishi, N. Substance use disorder and risk of suicidal ideation, suicide attempt and suicide death: a meta-analysis. Journal of Public Health (Oxford). 2016 Sep; 38(3): e282–91.10.1093/pubmed/fdv148CrossRef Google Scholar

Martins, SS, Sampson, L, Cerdá, M, Galea, S. Worldwide prevalence and trends in unintentional drug overdose: A systematic review of the literature. American Journal of Public Health. 2015 Nov; 105(11): e29–49.CrossRef Google Scholar PubMed

Esang, M, Ahmed, SA. Closer look at substance use and suicide. American Journal of Psychiatry Residents. 2018; 13(6): 6–8.10.1176/appi.ajp-rj.2018.130603CrossRef Google Scholar

Wilcox, HC, Conner, KR, Caine, ED. Association of alcohol and drug use disorders and completed suicide: An empirical review of cohort studies. Drug and Alcohol Dependence. 2004 December; 76: S11–19.CrossRef Google Scholar PubMed

Ilgen, MA, Bohnert, ASB, Ganoczy, D, Bair, MJ, McCarthy, JF, Blow, FC. Opioid dose and risk of suicide. Pain. 2016; 157: 1079–84.10.1097/j.pain.0000000000000484CrossRef Google Scholar PubMed

Bohnert, ASB, Ilgen, MA. Understanding links among opioid use, overdose, and suicide. New England Journal of Medicine. 2019 Jan 3; 380(1): 71–9.CrossRef Google Scholar PubMed

Rockett, IRH, Caine, ED, Connery, HS, D’Onofrio, G, Gunnellm, DJ, Miller, TR, et al. Discerning suicide in drug intoxication deaths: Paucity and primacy of suicide notes and psychiatric history. PLoS One. 2018 Jan 10; 13(1): e01902.10.1371/journal.pone.0190200CrossRef Google Scholar PubMed

Oliva, EM, Bowe, T, Manhapra, A, Kertesz, S, Hah, JM, Henderson, P, et al. Associations between stopping prescriptions for opioids, length of opioid treatment, and overdose or suicide deaths in US Veterans. BMJ. 2020 Mar 4; 368: 283.Google Scholar PubMed

Connery, HS, Taghian, N, Kim, J, Griffin, M, Rockett, IRH, Weiss, RD, et al. Suicidal motivations reported by opioid overdose survivors: A cross-sectional study of adults with opioid use disorder. Drug and Alcohol Dependence. 2019 Dec 1; 205: 107612.10.1016/j.drugalcdep.2019.107612CrossRef Google Scholar PubMed

Oquendo, MA, Volkow, ND. Suicide: A silent contributor to opioid-overdose deaths. New England Journal of Medicine. 2018 Apr 26; 378(17): 1567–9.10.1056/NEJMp1801417CrossRef Google Scholar PubMed

Fornili, K. The opioid crisis, suicides, and related conditions: Multiple clustered syndemics, not singular epidemics. Journal of Addictions Nursing. 2018 Jul/Sep; 29(3): 214–20.10.1097/JAN.0000000000000240CrossRef Google Scholar

Harrison, C, Abou-Saleh, MT. Psychiatric disorders and substance misuse psychopathology. In Hussain, RG, ed., Dual Diagnosis: Substance Misuse and Psychiatric Disorders. Oxford: Blackwell; 2002.Google Scholar

Abou-Saleh, MT, Janca, A. The epidemiology of substance misuse and comorbid psychiatric disorders. Acta Neuropsychiatrica. 2004 Feb; 16(1): 3–8.10.1111/j.1601-5215.2004.0075.xCrossRef Google Scholar PubMed

Abou-Saleh, MT. Substance misuse and comorbid psychiatric disorders. CPD Bulletin in Psychiatry. 2000; 2: 61–7.Google Scholar

Appleby, L, Kapur, N, Shaw, J, Ibrahim, S, Turnbull, P et al. The National Confidential Inquiry into Suicide and Safety in Mental Health. Annual Report: England, Northern Ireland, Scotland and Wales. 2019. Manchester: University of Manchester.Google Scholar

Abou-Saleh, MT. Dual diagnosis: Management within a psychosocial context. Advances in Psychiatric Treatment. 2004; 10(5): 352–60.10.1192/apt.10.5.352CrossRef Google Scholar

Lowe, AL, Abou-Saleh, MT. The British experience of dual diagnosis in the National Health Service. Acta Neuropsychiatrica. 2004 Feb; 16(1): 41–6.10.1111/j.1601-5215.2004.0060.xCrossRef Google Scholar PubMed

Abou Saleh, MT, Crome, I. National Institute for Health and Clinical Excellence (NICE) Guideline: Psychosis with coexisting substance misuse. Addiction. 2012 Jan; 107(1): 1–3.10.1111/j.1360-0443.2011.03542.xCrossRef Google Scholar PubMed

Myhre, MØ, Kildahl, AT, Walby, FA. Suicide after contact with substance misuse services. British Journal of Psychiatry Open. 2020 May 7; 6(3): e45.CrossRef Google Scholar PubMed

Hesse, M, Thylstrup, B, Seid, AK, Skogen, JC. Suicide among people treated for drug use disorders. BMC Public Health. 2020; 20(1): 146.10.1186/s12889-020-8261-4CrossRef Google Scholar PubMed

Suzuki, T, Comtois, KA, Dickens, H, Bagge, CL. Motivations for suicide attempts amongst psychiatric inpatients. Psychiatry Research. 2021 Jan; 295: 113574.10.1016/j.psychres.2020.113574CrossRef Google Scholar PubMed

Meltzer, H, Griffiths, C, Brock, A, Rooney, C, Jenkins, R. Patterns of suicide by occupation in England and Wales: 2001–2005. British Journal of Psychiatry. 2008; 193: 73–6.10.1192/bjp.bp.107.040550CrossRef Google Scholar PubMed

Abou-Saleh, MT. Doctors’ impaired fitness to practise for health issues: The pivotal role of psychiatrists. Arab Journal of Psychiatry. 2020; 23(1): 17–24.Google Scholar

Dutheil, F, Aubert, C, Pereira, B, Dambrun, M, Moustafa, F, Mermillod, M, et al. Suicide among physicians and health-care workers: A systematic review and meta-analysis. PLoS One. 2019 Dec 12; 14(12): e0226361.CrossRef Google Scholar PubMed

Braquehais, MD, González-Irizar, O, Nieva, G, Mozo, X, Llavayol, E, Pujol, T, et al. Assessing high risk of suicide amongst physicians and nurses in treatment. Psychiatry Research. 2020 Sep; 291: 113237.10.1016/j.psychres.2020.113237CrossRef Google Scholar PubMed

The National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH). Suicide by Female Nurses: A Brief Report. Manchester: University of Manchester; 2020.Google Scholar

Molodynski, A, Lewis, T, Kadhum, M, Farrell, SM, Lemtiri Chelieh, M, Falcão De Almeida, T, et al. Cultural variations in wellbeing, burnout and substance use amongst medical students in twelve countries. International Review of Psychiatry. 2021 Feb–Mar; 33(1–2): 37–42.CrossRef Google Scholar PubMed

Sathanandan, S, Abrol, E, Aref-Adib, G, Keen, J, Gerada, K. The UK Practitioner Health Programme: 8-year outcomes in doctors with addiction disorders. Research and Advances in Psychiatry. 2019; 6(2): 43–9.Google Scholar

World Health Organization. Preventing Suicide: A Global Imperative. Geneva: World Health Organization; 2014.Google Scholar

Fleischmann, A, Arensman, E, Berman, A, Carli, V, De Leo, D, Hadlackzy, G, et al. Overview Evidence on Interventions for Population Suicide with an Eye to Identifying Best-Supported Strategies for LMICs. Cambridge: Global Mental Health (Cambridge); 2016.10.1017/gmh.2015.27CrossRef Google Scholar PubMed

UK Department of Health. Preventing Suicide in England: A Cross-government Outcomes Strategy to Save Lives. London: Department of Health; 2012.Google Scholar

Royal College of Psychiatrists. Self-Harm and Suicide in Adults, Final Report of the Patient Safety Group CR229. London: Royal College of Psychiatrists; 2020.Google Scholar

Public Health England. Alcohol Treatment in England 2013–2014. London: Public Health England; 2014.Google Scholar

Hegerl, U, Heinz, I. Reflections on causes of suicidal behaviour. Epidemiology and Psychiatric Sciences. 2019 Oct; 28(5): 469–72.10.1017/S2045796018000562CrossRef Google Scholar PubMed

Hegerl, U, Wittenburg, L, Arensman, E, Van Audenhove, C, Coyne, JC, McDaid, D, et al. An optimizing suicide prevention programs and their implementation in Europe (OSPI Europe). BMC Public Health. 2009 Nov 23; 9: 428.10.1186/1471-2458-9-428CrossRef Google Scholar PubMed

Ayuso-Mateos, JL. Suicide prevention: Towards an evidence-based policy. Epidemiology and Psychiatric Sciences. 2019 Oct; 28(5): 468–8.10.1017/S204579601900012XCrossRef Google Scholar PubMed

Zalsman, G, Hawton, K, Wasserman, D, van Heeringen, K, Arensman, E, Sarchiapone, M, et al. Suicide prevention strategies revisited: 10-year systematic review. Lancet Psychiatry. 2016; 3: 646–59.10.1016/S2215-0366(16)30030-XCrossRef Google Scholar PubMed

Hawton, K, Witt, KG, Taylor Salisbury, TL, Arensman, E, Gunnell, D, Hazell, P, et al. Pharmacological interventions for self-harm in adults. Cochrane Database of Systematic Reviews. 2015; 6(7): CD011777.Google Scholar

Hawton, K, Witt, KG, Taylor Salisbury, TL, Arensman, E, Gunnell, D, Hazell, P. Psychosocial interventions for self-harm in adults. Cochrane Database Systematic Reviews. 2016; 12(5): CD012189.Google Scholar

Platt, S, Niederkrotenthaler, T. Suicide prevention programs. Crisis. 2020 Mar; 41(suppl 1): S99–124.CrossRef Google Scholar PubMed

Hofstra, E, van Nieuwenhuizen, C, Bakker, M, Özgül, D, Elfeddali, I, de Jong, SJ, et al. Effectiveness of suicide prevention interventions: A systematic review and meta-analysis. General Hospital Psychiatry. 2020 Mar–Apr; 63: 127–40.CrossRef Google Scholar

Padmanathan, P, Hall, K, Moran, P, Jones, HE, Gunnell, D, Carlisle, V, et al. Prevention of suicide and reduction of self-harm among people with substance use disorder. Comprehensive Psychiatry. 2020 Jan; 96: 152135.CrossRef Google Scholar PubMed

Nunes, EV, Levin, FR. Treatment of depression in patients with alcohol or other drug dependence: A meta-analysis. JAMA. 2004; 291: 1887–96.10.1001/jama.291.15.1887CrossRef Google Scholar PubMed

Hunt, GE, Siegfried, N, Morley, K, Sitharthan, T, Cleary, M. Psychosocial interventions for people with both severe mental illness and substance misuse. Cochrane Database of Systematic Reviews. 2013; 10: CD001088.Google Scholar

Voss, WD, Kaufman, E, O’Connor, SS, Comtois, KA, Conner, KR, Rie, RK. Preventing addiction related suicide. Journal of Substance Abuse Treatment. 2013; 44: 565–9.10.1016/j.jsat.2012.10.006CrossRef Google Scholar PubMed

Comtois, K. Preventing Addiction Related Suicide (PARS). 2018. https://clinicaltrials.gov/study/NCT03166709?cond=Suicide&term=Comtois%20&viewType=Card&rank=1.Google Scholar

Simon, RI. Suicide risk: Assessing the unpredictable. In Simon, RJ, Hales, RE, eds., The American Psychiatric Publishing Textbook of Suicide Assessment and Management, 1st ed. Washington, DC: American Psychiatric Publishing; 2006.Google Scholar

Little, V, James, MC. Commentary on substance use disorders and risk of suicide in a general us population. Addiction Science and Clinical Practice. 2020 Jun 29; 15(1): 21.10.1186/s13722-020-00195-6CrossRef Google Scholar

Accessibility standard: Unknown

Why this information is here

This section outlines the accessibility features of this content - including support for screen readers, full keyboard navigation and high-contrast display options. This may not be relevant for you.

Accessibility Information

Accessibility compliance for the PDF of this book is currently unknown and may be updated in the future.