Suicidality & Substance Abuse

1. Suicidality & Substance Abuse Bruce Michael Cappo, Ph.D. Clinical Associates, P.A.

2. Quo Vadis • Intro • Statistics • Causality • Substance factors • Risk Factors • What we know • What to do

3. The Three Hs: • Hopelessness • Helplessness • Haplessness

4. Hopelessness • Strongest predictor of suicide • Stronger even than depression • Only people who have lost all hope kill themselves. Do whatever you can to build hope - however small it may be. They want to have hope in the future.

5. Helplessness • The person views him or herself as being absolutely unable to make any changes to the situation or to his/her life • This characteristic should signal a high risk situation for you.

6. Haplessness • These people often have very sad lives • 25% have a family history of successful suicidal behavior in a relative • Higher percentage who have histories of mental illness, depression, abuse, divorces, frequent moves and periods of unemployment in their family • Often there are multiple problems at the same time which just become too overwhelming.

7. Suicide is a tragic and potentially preventable public health problem • 8th leading cause of death in the U.S. • 10.6 out of every 100,000 persons died by suicide

8. The total number of suicides was approximately 31,000, or 1.3 percent of all deaths. • Approximately 500,000 people receive emergency room treatment as a result of attempted suicide each year

9. Substance Use and the Risk of Suicide Among Youths • Approximately 3 million youths were at risk for suicide during the past year

10. Substance Use and the Risk of Suicide Among Youths • Youths who reported past year alcohol or illicit drug use were more likely than youths who did not use these substances to be at risk for suicide

11. Substance Use and the Risk of Suicide Among Youths • Only 36 percent of youths at risk for suicide during the past year received mental health treatment or counseling

15. Underestmated Numbers? • Authorities agree that many suicides are not reported, but the National Center for Health Statistics records between 25,000 and 30,000 self-inflicted deaths in the U.S. annually.

16. Attempts vs Completions • For every death from suicide, experts estimate that eight other suicide attempts are made. Suicide is now the second leading cause of death among persons 15 to 24 years of age. It is increasingly a problem among adolescents and elderly people.

17. Statistical Indicators of Risk • Previous suicide attempts • The verbalizing of suicide threats • The giving away of prized personal possessions • The collection and discussion of information on suicide methods

18. Statistical Indicators of Risk • The expression of hopelessness, helplessness, and anger at oneself or the world • Themes of death or depression evident in conversation, written expressions, reading selections, or artwork

19. Statistical Indicators of Risk • Statements or suggestions that the speaker would not be missed if he or she were gone • Physical symptoms such as eating disturbances, sleeplessness or excessive sleeping, chronic headaches or stomachaches, menstrual irregularities, apathetic appearance

20. Statistical Indicators of Risk • Use or increased use of substances • Look for sudden changes in behavior that are significant, last for a long time, and are apparent in all or most areas of his or her life (pervasive).

21. Often occur prior to acts of self-harm • The scratching or marking of the body, or other self-destructive acts • Recent loss of a friend or a family member (or even a pet) through death or suicide; other losses (for example, loss of a parent resulting from divorce)

22. Often occur prior to acts of self-harm • Acute personality changes, unusual withdrawal, aggressiveness, moodiness, or new involvement in high-risk activities. • Sudden dramatic decline or improvement in academic performance, chronic truancy, tardiness, or running away

23. Who is at highest risk for suicide in the U.S.? • Common misperception that suicide rates are highest among the young • Elderly, particularly older white males have the highest rates • Among white males 65 and older, risk goes up with age

24. Who is at highest risk for suicide in the U.S.? • White men 85 and older have a suicide rate that is six times the national rate • White males are more deliberate in their suicide intentions • They use more lethal methods (firearms) & don’t tell of their plans • Older persons are less likely to survive attempts because they are less likely to recuperate

25. "They [researchers] cite a wide range of potential suicide triggers, from loss of employment or loved ones, to aging and physical impairment. But, in almost all cases, they agree there is an underlying psychiatric illness-primarily depression, followed by alcoholism and substance abuse.""The Mystery of Suicide," Newsweek, April 18, 1994

26. Causality • No cause-and-effect relationship between use of alcohol and/or other drugs and suicide has been established • Substances often identified as a contributing factor

27. Possible Explanations • Drinking, use of other drugs, or both may reduce inhibitions and impair the judgment of someone contemplating suicide, making the act more likely • Use may also may aggravate other risk factors for suicide such as depression or other mental illness.

28. Alcohol/other drug problem prevention in reducing suicides: • High rates of alcohol involvement have been found among suicide victims who use firearms. • Recent studies suggest that alcohol tends to be associated with impulsive rather than premeditated suicides

29. Alcohol/other drug problem prevention in reducing suicides: • Between 20 and 35 percent of suicide victims had a history of alcohol abuse or were drinking shortly before their suicides

30. Alcohol/other drug problem prevention in reducing suicides: • Nearly 24 percent of suicide victims had blood alcohol concentrations (BACs) of .10 or greater • Similarly, an analysis of 100,000 deaths in 1989 found positive BACs in 35 percent of suicide fatalities

31. Alcohol/other drug problem prevention in reducing suicides: • In one study of youthful suicide, drug and alcohol abuse was the most common characteristic of those who attempted suicide • Fully 70 percent of these young people frequently used alcohol and/or other drugs

32. Alcohol/other drug problem prevention in reducing suicides: • In 1989, the cost of providing health care for people who had attempted suicide was estimated at $116.4 million annually

33. Alcohol/other drug problem prevention in reducing suicides: • Prevention works, and preventing alcohol, tobacco, and other drug problems also can help prevent suicide.

34. Does alcohol and other drug abuse increase the risk for suicide? • A number of recent national surveys have helped shed light on the relationship between alcohol and other drug use and suicidal behavior. A review of minimum-age drinking laws and suicides among youths age 18 to 20 found that lower minimum-age drinking laws was associated with higher youth suicide rates

35. Does alcohol and other drug abuse increase the risk for suicide? • In a study of all non-traffic injury deaths associated with alcohol intoxication, over 20 percent were suicides.

36. Does alcohol and other drug abuse increase the risk for suicide? • Lower minimum-age drinking laws are associated with higher youth suicide rates • For particular groups at risk, such as American Indians and Alaskan Natives, depression and alcohol use and abuse are the most common risk factors for completed suicide

37. Does alcohol and other drug abuse increase the risk for suicide? • In a large study of adults who drink alcohol, suicidal ideation was more likely reported among persons with depression • Persons who had made a suicide attempt were more likely to have had a depressive disorder and many also had an alcohol and/or substance abuse disorder

38. Other Risk Factors • Aggressive behavior doubled suicide risk among boys • Panic attacks nearly tripled suicide risk for girls • Being a teenage runaway nearly tripled suicide risk • Perfectionism has also been linked to suicide in some studies • Substance abuse appears to be a particularly important factor when kids who have suicidal thoughts go on to make suicide attempts

39. Substance Abuse May Escalate Suicidal Ideas to Attempts in Teens • A study in the September issue of the Journal of the American Academy of Child and Adolescent Psychiatry provides important insights into the relationships between psychiatric disorders and adolescent suicide, suggesting that teens who abuse drugs or alcohol are more likely to progress from suicidal thoughts to suicide attempts

40. Substance Abuse May Escalate Suicidal Ideas to Attempts in Teens • The research assessed the links among suicidal ideas, suicide attempts, and adolescent psychiatric disorders in a random sample of nearly 1,300 children aged 9 to 17 years. Of these, • 67 had had suicidal thoughts • 42 had made suicide attempts. • Adjusted for age and gender

41. Substance Abuse May Escalate Suicidal Ideas to Attempts in Teens • suicide attempts were significantly more likely for youngsters with mood disorders (depression and bipolar disorder), anxiety disorders, and substance abuse or dependence issues.

42. In order to find it you must look • Recognition and appropriate treatment of mental and substance abuse disorders also hold great suicide prevention value • Most elderly suicide victims --70 percent -- have visited their primary care physician in the month prior to their suicides • Recognition and treatment of substance abuse and depression in medical settings can help prevent suicide in older adults

43. Risk factors among people who have completed suicide • For particular groups at risk, such as American Indians and Alaskan Natives, depression and alcohol use and abuse are the most common risk factors for completed suicide. • Substance use & abuse occurs more frequently among youth and adults, compared to older persons.

44. Alcohol and substance abuse problems contribute to suicidal behavior • Persons who are dependent on substances often have a number of other risk factors for suicide. • In addition to being depressed, they are also more likely to have social and financial problems.

45. Alcohol and substance abuse problems contribute to suicidal behavior • Substance use and abuse can be common among persons prone to be impulsive, and among persons who engage in many types of high risk behaviors that result in self-harm

46. What are the most common methods of suicide? • Firearms • For men and women • 60 percent of all suicides • Nearly 80 percent of all firearm suicides are committed by white males

47. Common Methods • The second most common method for men is hanging • The second most common method for women is self-poisoning including drug overdose

48. Common Methods • The presence of a firearm in the home has been found to be an independent, additional risk factor for suicide. Thus, when a family member or health care provider is faced with an individual at risk for suicide, they should make sure that firearms are removed from the home.

49. Male - Female Differences • More than four times as many men as women die by suicide • Women attempt suicide more often during their lives than do men • Women report higher rates of depression.

50. Why the Gender Differences? • Completed suicide is associated with aggressive behavior that is more common in men • Men and women use different suicide methods