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Suicide is on the rise. In 2011, the Centers for Disease Control and Prevention estimated there were 90 suicides a day. By 2017, the National Institute of Mental Health had raised that to 128 per day.

Overall, suicide was the tenthleading cause of death, but it’s much higher for younger people. For ages 15 to 24, it’s the third-leading cause; for ages 25-34, it’s second.

Maybe that’s why September, when many of those young people go back to school, has been designated National Suicide Prevention Month, with September 10 observed as World Suicide Prevention Day. (Confusingly, the American Association of Suicidology also sponsors National Suicide Prevention Week, Sept. 8-14.)

Mental health problems are the leading causes of suicide: depression and other mood disorders, followed by alcohol and drug abuse. Substance use disorder is a form of mental illness, too, and there is a significant overlap between people with SUD and people with mental health problems. 

Sometimes people with mental health issues take alcohol or drugs in an attempt to self-medicate. It’s called dual diagnosis or co-occurring disorders. When it occurs, both mental health and alcohol or drug use problems must be recognized and treated.

One 2018 study found the greatest risk for death by suicide was alcohol intoxication (22%) and opioids (20%). Alcohol dependence and drug use increased the risk of death by suicide 10 times or more. Some drug overdoses that were believed to be accidental may be suicides, too. 

Antidepressants can prevent suicide but paradoxically can also cause or at least allow them. Some people are too depressed to kill themselves, paralyzed into inaction. If they feel a little bit better due to antidepressants, they might have the energy to try.

So, why should SUD and suicide risk be closely linked? The U.S. Department of Health and Human Services says because:

  • They have common risk factors, such as depression, social isolation, and financial troubles. 
  • People with SUD can be impulsive and so act on temporary suicidal ideation. 

It’s not certain how many people kill themselves on an impulse. Some people who seem cheery and happy seem to suddenly take their own life, but that doesn’t mean it was a sudden decision. Maybe they were planning to do so for a long time but concealed their intentions because they were afraid someone would stop them.

Some people contemplating suicide tell everyone they know they are planning to kill themselves, but not all do. Some who do may hope someone will stop them. Some aren’t serious.

Still, it’s not safe to ignore the signs of suicidal thought, including:

  • Increased alcohol or drug use
  • Talking about death, about wanting to die or kill themselves, or about being a burden to others
  • Feeling trapped, like there’s no reason to live, or feeling unbearable emotional or physical pain
  • Driving very fast or engaging in other death-defying activities
  • Withdrawing from or saying goodbye to friends and family
  • Giving away important possessions, making a will, or otherwise putting their affairs in order
  • Changes in eating or sleeping patterns
  • Increased anger or violent threat 
  • Extreme mood swings
  • Buying a gun, stockpiling medication, or looking online for ways to kill oneself

The Mayo Clinic says if you suspect someone is seriously thinking about or planning to commit suicide is to ask some direct questions. Don’t worry that you might provoke them into acting on their thoughts by asking. It’s far more likely that you will defuse the situation, relieve the pressure, by bringing it out into the open. 

Ask:

  • Are you having difficulty coping with life? Do you feel like just giving up?
  • Are you thinking about dying or hurting yourself?
  • Have you ever thought about suicide? Are you thinking about it now?
  • Have you thought about how or when you would commit suicide?
  • Do you have access to things that could kill you? Did you get them recently for that purpose?

If you know someone has attempted suicide or catch them in the act, don’t leave them alone. If they are wounded, have swallowed a lot of pills, or in some other way are in physical danger, call 911. 

If the danger is at least temporarily averted, try to persuade them to seek help, or at least call a suicide prevention hotline. The National Suicide Prevention Lifeline is (800) 273-8255. It’s free and confidential.