Substance Use and Suicide Risk
Submitted by Sarah Brummett, M.A., J.D., Suicide Prevention Commission Coordinator, Violence and Injury Prevention-Mental Health Promotion Branch, Colorado Department of Public Health and Environment

Suicide is a complex and highly personal issue. Misperceptions and fear cloud the issue and give rise to a damaging stigma for those living with mental health conditions, those who have survived an attempt, and those who have lost a loved one to suicide. What we know is that the majority of those who die by suicide are struggling with a mental health condition at the time of their death. We also know that mental health conditions are amenable to treatment. Those who have survived a nearly fatal attempt report that the desire was not so much to die, but to end unbearable pain, be it mental, emotional, physical or spiritual. A hopeful fact is the vast majority (90 percent) of those who survive an attempt recover and lead healthy lives.

Troubling Statistics
In Colorado, suicide is the 7th leading cause of death for all ages, and the 2nd for those aged 10-44. Higher suicide rates overshadow many states in the Rocky Mountain West, with Colorado unfortunately falling 7th in the nation for suicide rates. In 2014, we lost 1,058 Coloradans to suicide – more than motor vehicle fatalities, homicides and HIV deaths combined. The highest rates and numbers lost are to those aged 35-64, particularly men. Men are overrepresented in suicide death data about 4:1 when compared to women, who carry the burden when it comes to suicide attempts.

The Substance Abuse and Mental Health Services Administration recently released a brief highlighting the connection between substance use disorders and the risk for suicide and attempts.  Colorado’s data bear out this theme. Of those lost to suicide, more than a quarter had a reported problem with alcohol and 16 percent struggled with a reported problem with another substance.[1] Toxicology reports shed light on which substances appear most frequently within someone’s system: [2]

-Alcohol* present in nearly 33% of cases

-Opioid* present in nearly 16% of cases

-Marijuana* present in over 10% of cases

-Benzodiazepines* present in 9% of cases

*presence in system does not necessarily equate to intoxication

Risk Factors & Warning Signs

There is Hope

Despite the fear associated with this taboo topic, you can help. Be aware of the risk factors and warning signs below, and be willing to ask the question if you are concerned about someone, because you might be the only one who does. You don’t have to be an expert in mental health or do this alone. There are many supportive resources to help you or someone else through a difficult time.

Community Resources to be aware of:

Colorado Crisis System 1-844-493-TALK (8255), or text “TALK” to 38255
This is a unified crisis system providing 24/7 support to all Coloradans regardless of age, county, or insurance status
Click here to locate your nearest 24/7 walk-in center and to learn more about the services available

Mantherapy, help support the man in your life with therapy from the creators of pork chops and fighter jets

Colorado Office of Suicide Prevention

Suicide Prevention Coalition of Colorado

National Alliance on Mental Illness (NAMI)

Suicide Prevention Resource Center

American Foundation for Suicide Prevention

The SBIRT Connection
Screening, brief intervention, referral to treatment (also known as SBIRT) is an effective service. Patients answer brief screening questions to identify risky alcohol or drug use. Those who screen positive receive a brief intervention which is a short conversation to provide feedback and motivate a person to change use to improve health and prevent future physical and mental health consequences. Patients with more serious alcohol or drug use are connected earlier to appropriate treatment and support services to prevent long-term consequences to health and other areas of life. We know that SBIRT works but it is still not provided as a routine service in primary health care. When health professionals address alcohol and drugs routinely they send a strong message to patients and families that these issues are important and appropriate to discuss as part of health care. SBIRT offered routinely in primary health care, mental health and other settings has the potential to help decrease suicide risk because alcohol in particular is a major depressant, it can increase the risk for developing depression and make depression worse, and it also contributes to impulsivity. SBIRT should be part of suicide prevention!

[1] Violent Death Reporting System, Colorado Department of Public Health and Environment, 2009-2013.
[2] Violent Death Reporting System, Colorado Department of Public Health and Environment, 2010-2014. Toxicology available in 87.34% of cases (4,201).
[3] Please note: this is not predictive for suicide or attempts; the overwhelming majority of individuals living with mental health conditions will not die by suicide. Approximately 1 in 5 adults (43.7 million people in the United States) experience mental illness each year and 1 in 20 (13.6 million) experience a serious mental illness that substantially interferes with or limits one or more major life activities– National Alliance on Mental Illness
[4] Many suicide attempts occur with little planning during a short-term crisis. Intent isn’t all that determines whether someone lives or dies; means also matter. Reducing access to lethal means saves lives. Means Matter, Harvard School of Public Health