Substance Use Disorders and Suicide

Available with English captions and subtitles in Spanish.

Hilary S. Connery, MD, PhD, McLean Hospital, presents as part of the 2022 Suicide-Focused Assessment and Treatment: An Update for Professionals course.

Addiction and Suicide

Suicide risk is elevated in connection to substance misuse. In this talk, Connery expresses the importance of integrating treatment for substance use disorders with that for other mental health conditions. She offers considerations clinicians should make when working with people who struggle with addiction to drugs and alcohol.

Watch now to learn more about:

  • Why substance use disorder patients are at a high risk of suicide
  • Why suicide deaths may be misclassified as overdoses
  • How clinicians can prevent and treat suicidal behavior in patients who struggle with addiction

Connery works with a very high-risk population of alcohol use disorder, opioid use disorder, and stimulant use disorder patients. “Many of them have severe substance use disorder, but they’re also quite hopeless and despairing, and are at significantly elevated suicide risk,” she states.

Substance use disorder patients, and particularly opioid use disorder patients, are at very high risk for suicide overall.

Connery shares, “We may have a significant portion of the deaths in the so-called accidental drug overdose category that are actually misclassified suicides.”

She explains that the suicidal thoughts a person who uses opioids may be experiencing can be dimensional.

For example, someone may appreciate that there’s a risk of death, but does not think it is likely they’re going to die because they’re misusing opioids. Someone else may be ambivalent: sometimes wanting to die, and sometimes not wanting to die. Or a person can be in a hopeless state and think, ‘Today I’m going to die because my life is pointless.’

Connery discusses research she and colleagues conducted with patients who were in withdrawal. Patients were asked how strongly they wanted to die before the overdose, and if they were trying to kill themselves. Of those surveyed, 20% indicated having a desire to die, and 5% stated that they were actively trying to kill themselves.

All substance misuse is significantly associated with increased risk for suicidal thoughts and behaviors. People with alcohol use disorder and opioid use disorder have 10 to 15 times higher rates of suicide deaths compared to the general population.

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People who misuse substances also have elevated suicide risk, even during periods of abstinence in which they are not using substances. Intoxication is associated with more lethal suicidal behaviors, even in people who do not necessarily have addiction disorders.

“Substance use disorder and substance intoxication are significantly associated with impulsive behavior, which is a major risk factor for suicidal behavior,” Connery explains. “Substance use disorder has high rates of depressive disorders and grief, each of which can elevate suicide risk.”

She also points out the current climate, where so many people know somebody who has died from an opioid overdose poisoning.

“The frequent exposures to premature mortality may desensitize to death, and increase an individual’s acquired capacity for self-harm behavior,” she states.

Connery discusses how clinicians can conduct safety planning with patients who have substance use disorders. Peer support systems, including 12-step groups and SMART Recovery, are also important.

She covers the importance of means reduction, such as when family members can remove alcohol and drugs from the home whenever possible. She also describes harm reduction, which can help people who are not willing to give up substances altogether.

Connery concludes her talk by emphasizing that medication (agonist, partial agonist, or full agonist) for opioid use disorder—is suicide prevention.

“These are lifesaving medications, so why are we still not using medications to treat opioid use disorder? And the answer to that is that illicit drug use disorder remains the number one stigmatized health condition globally. I encourage you to learn more about the power of these medications.”


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About Hilary S. Connery

Dr. Hilary Connery is the clinical director of McLean Hospital’s Division of Alcohol, Drugs, and Addiction and an assistant professor of psychiatry at Harvard Medical School.

Her current research efforts are directed toward public health prevention strategies for addressing self-injury mortality, and patient-focused investigation regarding suicidal motivations contributing to drug overdose. Dr. Connery actively advocates for more effective responses to the drug overdose and suicide epidemics.