Substance Misuse Increases Risks of Deliberate Self Harm


Published On: October 11, 2023

New research from the journal PLOS ONE shows that young people with substance misuse problems who attempt suicide use substances for different reasons.

When their misuse is assessed, not only should the clinical team assess what has been used, but why the patient has used it.

As we will discuss in this article, alcohol and other substances such as cannabis and solvents play different roles in the lead-up to a suicide or suicide attempt.

Suicide is the Most Common Cause of Death Among Young People

A man reading in bed

Worldwide, suicide is the most common cause of death among people between the ages of 15-29. In recent years, according to the Guardian newspaper, this rate has been increasing in the UK.

While 759 young people in the UK and Ireland killed themselves in 2018, the Millennium Cohort Study showed that 7.4% of teenagers had attempted suicide by age 17.

A deliberate attempt to end one’s life has been shown in previous research to be caused by a number of factors. The ‘interpersonal suicide theory’, according to the authors of the research we look at here, suggests that suicide is the outcome of ‘thwarted belongingness’ and ‘perceived burdensomeness’.

These two concepts stem from a range of events and perceptions that lead to the person coming to the conclusion that they cannot cope any more.

Alcohol is widely understood to have an impact on suicidal ideation. A paper in the American Journal of Psychiatry showed in 2018 that someone with alcohol use disorder is 10-14 times more likely to kill themselves than a social drinker, with 22% of those found dead having alcohol in their system.

Other substances can play a role too, with 20% of those dead having opioids in their system and 10.2% with cannabis. Meanwhile, UK government research into suicide suggested that as many as 40% of those aged between  20-24 had used alcohol to excess east around the time they died.

With these issues in mind, the research team for this paper sought to understand why young people with substance misuse problems are led to suicide.   

Qualitative Study

Three people writing at a table during therapy

Qualitative research attempts to look at the whys behind an event and not just the numbers involved in that event. Through the narratives of those who go through an experience, so commonalities are looked at in an attempt to support future clinical practice.

The research that we focus on in this article looked at the case studies of seven young people aged between 16-25 who had attempted suicide, and who self-identified as having substance misuse problems.

 The research was done with the support and participation of a UK child and adolescent mental health NHS trust (CAMHS) in which seven young people were in treatment.

Six identified as being female while a seventh identified as male. As such there may be limitations in the discoveries made here as males form the greater proportion of young people’s suicides. 

The research team, led by the then trainee clinical psychologist, Rebecca Guest, ran a 40-75 minute semi-structured interview with each of the service users discussing the role of substance misuse in the lead up to their suicide attempts.

The lead researcher asked, amongst other things:

  • About the experience of the suicide attempt
  • How things had changed since their last attempt
  • Their experience of substance misuse
  • How they perceived the substances impacted their mental health.

The analysis was done through Interpretive Phenomenological Analysis (IPA) where the team began by reading and re-reading the transcripts of the interviews. The statements were coded, and superordinate and subordinate themes were identified as common to the interviews.

These were then discussed with a qualitative research peer group prior to conclusions being drawn. The next sections of this article will look at the results and conclusions.

Multiple Substances Used

Mixing Pills

All seven participants used tobacco, cannabis and alcohol, with some also using solvents, cocaine and MDMA at different times.

Looking at alcohol use, they used it to:

  • Manage emotions that they found overwhelming,
  • Self-medicate for life events
  • Self-medicate for mental health and other stressors

Some used alcohol to heighten their mood, while others used cannabis to combat anxiety. Both substances were used as what the research team referred to as a learned coping strategy.

Adverse Impact of Substances

dayquil

Not all experiences were uniform when it came to substance use. One of the participants for example found alcohol could lift their mood while cannabis could lower it. Others said that alcohol could cause suicidal ideation.

There were two ways that alcohol could lead to a suicide attempt. The first was while under the influence they found themselves in an adverse life event that would in turn lead to the attempt.

The next, commonly understood in alcohol misuse research, is that alcohol created the low mood that directly led to the attempt. Not all had been in either or both situations.

One participant described feeling high or low when intoxicated (but never anything between). Some found that there was a limit they could handle before feeling so low they would wish to harm themselves.

Suicide is an Act of Multifactorial Cause

nose

All of the service users interviewed had a range of life events that would lead to them attempting to take their own lives. One, the male, referred to burn-out where he had too much on and then it collapsed around him, leaving him with no relationship and having been thrown off his academic course.  

The females generally saw combinations of relationship breakdown, familial problems and other life events that would lead to a low mood. In these cases, it wasn’t clear as to exactly what would lead to their trying to harm themselves.  

Common to many, alcohol would either be part of the trigger leading to the attempt or they would attempt it while under the influence.

Recovery Phase

Understanding the role that the substances had played in their suicide attempt helped all of the service users interviewed in their recovery.  

The participants had all undergone Dialectical Behavioural Therapy where they had both come to understand their personal triggers and were given tools in which to use should they feel low in future.

They all learned different coping strategies to keep their urges at bay, including going to the gym, walking, mindfulness, and self-care. These helped tackle their anxiety and helped them get better control of their emotions.  

Other Conclusions

 The key suggestion for clinicians from this study was that not only should they establish what substances are being misused but why they are being misused. Some used alcohol to feel high, while others used it to numb the pain or blot out the feelings after conflict, for example.

In assessing why the substances are being misused, so the clinician can better tailor strategies to help the person deal with the underlying problems.

Essentially, in dealing with the issues that caused the substance misuse and therefore the attempt to take their own lives, so a more personal recovery pathway can be put together.

More widely, society at large has a misconception that cannabis and alcohol can somehow ‘treat’ the symptoms of a mental health issue or personal trauma. By getting ‘out of it’, so one can somehow recover from the pain of a relationship breakup or major family issue.  

In the mental health world, this is widely understood to be quite the reverse, with both alcohol and cannabis contributing to anxiety and depression.

In short, one is throwing fat on the fire with such substances as opposed to a bucket of water. Wider education in society could help tackle substance misuse-related self-harm. 

In addition, the paper notes that in countries where it is harder to get hold of alcohol due to taxation or other restrictions, such suicide rates fall. In having stricter alcohol policies, the authors suggest, more young people will survive to adulthood.

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