Substance abuse doesn’t sit in a neat little package, tied
up with a bow, waiting for treatment. Instead, imagine this little box...with
octopus tentacles coming out of it. That’s addiction: it may start as overuse
of a substance, but then it spreads to all areas of an addict’s life – family,
career, and the way an addict sees him- or herself in the world. One area to
which addiction spreads is the addict’s concept of self-worth. As we’ve known
(and as you probably could have guessed), addiction
increases suicide risk.

An article
just published in the Journal of
Affective Disorders looks inside this overall risk to discover what it is,
exactly, inside addiction that puts people at risk for suicide. The study
interviewed patients at a drug abuse treatment center and found that 68 percent
of patients had major depressive disorder; 28 percent had attempted suicide
within the last year. Here are the characteristics that predicted which
patients had attempted suicide:

1. Alcohol/Marijuana
as First-Used Drugs

Patients who dove into heroin or methamphetamines were less
likely to be suicidal than patients who had started with alcohol or marijuana.
Also, suicide risk was highest when people who started with alcohol moved to
marijuana and when people who started with marijuana moved on to cocaine. The
researchers suggest that perhaps people who start with alcohol or marijuana may
also be most likely to use these substances (as opposed to others) in the
attempt to self-medicate for depression, or as a result of depression, and that
it is this association with depression and not characteristics alcohol/marijuana
themselves that push suicide risk past that of other drugs. 

2. Depression Before
Addiction

Depression is a risk factor for substance abuse. When
depression comes first, addiction also comes with increased suicide risk. When
substance abuse acts like a symptom of depression, it is essential to treat the
underlying cause of depression along with the addiction.

3. Suicide Before
Addiction

This finding is fairly intuitive: patients who had attempted
suicide before becoming addicted were also more likely to attempt suicide
during addiction.

4. Family Drug Abuse History

Addicts who came from families that included addicts were at
higher risk for depression and for suicide attempts. But why? Is it because
growing up in an environment that included an addicted family member might not
have provided the kindest childhoods for patients in the study? Or is it due to
a genetic component of addiction and/or depression in which an addicted family
member meant that patients in this study were more likely to have genes that
predispose them to addiction and depression, and thus suicide?

All these factors taken together seem to mean that a
person’s history before becoming addicted is as important as the addiction
itself in predicting major depression and suicide attempts. This underscores
the need to treat depression and other conditions along with addiction –
addiction may be one of many symptoms of an underlying condition. Addiction
certainly doesn’t help a person prone to depression avoid suicide attempts, but
treating the addiction by itself may leave tentacles of depression or other
co-occurring conditions – these tentacles may be the factors putting addicts
most at risk for suicide.  

**

Richard Taite is founder and CEO of Cliffside Malibu,
offering evidence-based, individualized addiction treatment based on the Stages
of Change model. He is also co-author with Constance Scharff
of the book Ending
Addiction for Good.