With addiction, there’s always the risk of possible overdose or injury. What is sometimes overlooked is an underlying issue, and in some cases it is related to mental illness. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), “Nearly 40,000 people in the United States die from suicide annually, or 1 person every 13 minutes. This exceeds the rate of death from homicide and AIDS combined. More people die by suicide than from automobile accidents.” So what does this mean for people who struggle with mental illness and addiction? Is there truly a connection between suicide and substance abuse?
The Connection Between Substance Abuse and Mental Health Issues
According to the National Alliance for Mental Illness (NAMI), “About a third of all people experiencing mental illnesses and about half of people living with severe mental illnesses also experience substance abuse. These statistics are mirrored in the substance abuse community, where about a third of all alcohol abusers and more than half of all drug abusers report experiencing a mental illness. Men are more likely to develop a co-occurring disorder than women. Other people who have a particularly high risk of dual diagnosis include individuals of lower socioeconomic status, military veterans and people with more general medical illnesses.” Those statistics are staggering, and to many, this is a surprise. Here are some common symptoms of mental illness in someone struggling with substance abuse disorder:
- Hopelessness
- Worthlessness
- Panic
- Fear
- Anxiety
- Fatigue
- Irritability
- Racing thoughts
- Suicidal thoughts
Unfortunately, untreated mental illness and substance abuse can ultimately lead to death by overdose or suicide. This is why it is so important that if you believe yourself or a loved one is struggling with both addiction and mental illness, it’s imperative they be diagnosed and treated together.
Substance Abuse and Common Co-Occurring Disorders – a Double Threat
As we discussed, mental health issues and substance abuse often go hand in hand. Sometimes the mental illness pushes people to use drugs in order to self-medicate. In others, chronic substance abuse leads to changes in the brain that can trigger symptoms of mental illness. Here are some common co-occurring disorders that are diagnosed alongside substance abuse disorders:
- ADHD
- Anxiety
- Bipolar disorder
- Depression
- Eating disorders
- Obsessive compulsive disorder (OCD)
- PTSD
- Trauma
When it comes to properly treating a co-occurring disorder, diagnosis is essential. A good rehabilitation team will complete an evaluation to better tailor treatment. Treatment options may include therapies like: cognitive-behavioral therapy, medications, group therapy, detox, and individual psychotherapy. Addictions can derail the treatment of mental health issues. It’s important to stop the negative pattern of self medication to relieve mental health symptoms. So why do people self medicate?
Self Medicating Mental Illness with Alcohol or Drugs is a Dangerous Thing
Some people use substances to reduce the physical or emotional pain caused by mental illness. This, however, can cause a bad pattern that exacerbates both the mental illness and addiction. Although taking a substance can reduce the immediate discomfort, once the substance wears off, the user has to deal with possible withdrawal symptoms in addition to the mental illness. One feeds the other, and eventually, the substances offer no relief. Instead, the user has to take more and more drugs or alcohol to feel “better.” Here are some common ways people suffering from mental illness self medicate:
- Stimulant drugs (cocaine, methamphetamine) or Attention Deficit Disorder (ADD) medications (Adderall, Ritalin) to increase attention, focus, and energy levels. This relieves symptoms of depression and activates pleasure centers in the brain.
- Depressants that affect the central nervous system (alcohol, benzodiazepines, prescription sleeping medications) can decrease anxiety, sleeplessness, elevate mood, increase sociability and escape reality.
- Opioid drugs (heroin, fentanyl, morphine, Vicodin, OxyContin) relieve symptoms of pain, depression and reduces anxiety.
Again, consistent self-medicating can lead to an addiction. At its worst, it can cause an overdose and can exacerbate mental illness which in turn can lead to suicidal ideation. It is indeed a slippery slope once someone starts using substances to mask symptoms of mental illness.
Suicidal Ideation: What Can Happen When You Don’t Treat Mental Illness in an Addict
Suicidal ideation is when someone has thoughts of suicide that can include detailed plans for killing oneself or fleeting consideration of self-harm. Most people who have suicidal thoughts do not commit the act. Research entitled “Predictors of High Rates of Suicidal Ideation Among Drug Users” states that, “Several studies have found that the prevalence of SI and attempts are linked with severity and frequency of substance use (Fowler et al., 1986; Garlow, 2002; Garlow et al., 2003; Marzuk et al., 1992; Rich et al., 1998). For example, the 1990 Youth Risk Behavior Survey found that young adults who engaged in drug use or sexual activity were more likely to report suicidal behavior than young adults not engaged in such behavior. In particular, the strongest association between suicidal behavior and drug use was found among cocaine users (Burge et al., 1995; Garlow et al., 2003). Furthermore, Cornelius et al. (1998) found that SI was more prevalent in depressed alcoholics who also used cocaine compared with depressed alcoholics not using cocaine. There are some factors that can lead addicts to become suicidal. If your loved one is experiencing any of these life events, be sure to follow up with them and make sure they are not in danger of suicide:
- Death or illness of relative or friend
- Divorce, separation or a breakup
- Loss of job, home, money, self-esteem or personal security
- Increased alcohol or drug abuse
- Depression that can be masked with acting out
How to Intervene When a Loved One is Struggling With Thoughts of Suicide
It can be extremely difficult to interact with someone who is struggling with addiction and suicidal ideation. There is a real fear of possible death. If a loved one is threatening or talking about their death or suicide, here are a few things you can do to keep them safe:
- If they are an immediate risk, call 9-11. There is no time to lose here.
- Understand what’s going on. Someone going through a real suicidal episode feels one or more of the following: they believe no one cares if they die, they feel hopeless, or they feel they are unburdening others by dying. Any of those thoughts are red flags that require immediate intervention.
- Encourage your loved one to get assessed. If possible, take them to an emergency room or immediate care and have them evaluated.
- Listen and ask questions. Believe it or not, your loved one may be ready to talk about what they are going through. They may be waiting for someone to ask.
What To Do When Hope is Lost – Rehabilitation for Addicts Contemplating Suicide
According to Psychology Today, “Substance abuse not only increases the likelihood that a person will take their own life, but it is also used as a means for committing suicide. Roughly one in three people who die from suicide are under the influence of drugs, typically opiates such as oxycodone or heroin, or alcohol. Poisoning is the third-leading method used in suicide deaths, and drugs make up 75 percent of suicide deaths due to poisoning.” So what is the next step in recovery when you have realized you or a loved one is ready to get help? First, find a recovery program that works for you. Specifically, find one that focuses on the co-treatment of specific mental health disorders and addiction. It’s extremely important to find a program that treats specific mental illnesses since all mental health disorders are not treated the same way. Depending on the mental disorder, treatment can be complex and take many years to treat beyond overcoming substance abuse. Detox programs often run for 30 days while recovering from a traumatic experience. Anxiety, for example, can be something that needs to be worked on with a medical professional for years to come. Secondly, encourage your loved one to begin practicing some healthful habits and disassociate themselves from others that misuse substances. Some healthy habits include eating better, getting more sleep, completely stop using drugs (under doctor supervision), join a support group, hang out with positive people, avoid situations that can trigger trauma or substance abuse, and spend time with family (if it’s not a trigger). These kinds of activities can help build habits that will benefit while in recovery and well after treatment is completed. It’s the key to lifelong recovery for both substance abuse and mental illness. Not sure if your loved one is just suffering from mental illness and not addiction? Take this quiz to see if you need to get them help.