|Approximately 10% of those diagnosed as 'alcoholic'
commit suicide. This figure may be higher for those addicted to
illicit drugs. In addition between a third and a half of
those carrying out suicide were intoxicated (mostly alcohol) at
As alcohol and other drug use is a know risk factor in suicide,
agencies and individuals working in the drug field need to be
proactive in initiating suicide prevention strategies including
screening procedures. All drug agencies need to develop and
monitor policies and procedures to prevent and manage suicide.
The WA Suicide Prevention Strategy includes five areas which
should form part of any comprehensive strategy:
- Promote well-being
- Early intervention and help
- Crisis support and treatment
- Support following suicide
As alcohol and other drugs are often used as a means of support
and protection against negative emotional states, caution should
be exercised if these drugs are removed without other support
mechanisms being put in place.
Associations between drug use and suicide
Those most at risk of suicide
Types of Suicidal / Self Harm / Risk-taking Behaviour
Enhance Protective Factors
Staff Training & Supervision & Support
Family and Other Client Support
Intoxication on alcohol and/or other drugs causes
short-term disinhibition and
distortion of thinking/emotional processes which increases the
likelihood of impulsive suicide. This is the most powerful
association/link to suicide.
a. Teach impulse
b. Teach the value of delaying acting on suicidal thoughts
till not intoxicated.
Longer-term drug use and
dependency increases psycho-social stressors which may lead to
suicidal thoughts and behaviour.
a. Provide human and other resources to reduce
b. Decrease or stop drug use through drug management
Psychiatric conditions such as
depression, personality disorders and schizophrenia, are at increased risk of suicide in people with
a drug-related problem.
Screen for psychiatric illness, particularly depression, personality disorders and
- Drugs as a Method of Suicide
Drugs may be used as a method to commit suicide by way of
Caution in prescribing drugs which can be lethal in
As substance use is a significant risk factor in its own right,
all clients in drug treatment should be considered at suicide
risk. In addition, the factors below are associated with
|Previous suicide attempt|
|Involvement in the justice system|
|Mental illness (depression, schizophrenia, personality
|Living in rural or remote areas (males)|
|Gay men and women|
|Those with chronic illness and/or pain|
Because alcohol and other drug use is a high risk factor in
suicide, routine questions regarding suicidal ideation and
behaviour should be routinely asked on intake. In addition, they
may be asked again during therapy if there are any indicator of
possible suicidal thought or behaviour. It's not necessary
to be depressed to suicide.
- Have you ever had thoughts or feelings that were so bad that
you didn't want to go on, or that you might kill yourself?
- Have you ever tried to kill yourself?
If the answer is 'yes' click here
for assessment of suicide risk questions (PDF 12 KB) to quantify
It's useful to distinguish different types of behaviour which
may at first appear to have similarities with suicidal ideation,
but which are categorically different. These different
categories generally require different intervention strategies.
Overt suicidal ideation and/or behaviour
Aim: to end life
Motivations: to escape emotional/physical pain; escape
from problems; get even; get attention
Aims: to harm self; to feel pain (generally, NOT to kill
Motivations: to express emotional pain; experience
feelings of release; to show others inner pain & get attention
I don't care about life risk-taking
Aims: a) enjoy benefits of risk-taking without regard
b) tempt death without making an overt decision
Motivation(s): enjoy the thrill; impress others; low
value on own life (nothing to lose); avoid making a decision about
living or dying.
I do care about life risk-taking
Aims: a) enjoy benefits of risk-taking with regard to
b) to live and not be harmed
Motivation: "We take these risks not to escape
life but to prevent life escaping us".
Explore and enhance the following factors which are likely to
be protective against suicide:
|Supportive and caring network of family an friends|
|Healthy and pleasing physical environment|
|Community recreation, vocational, accommodation, health and
welfare supports which should be known and available|
|Positive school/work/recreation experiences |
|Creative outlets to express positive and negative emotional
|Well defined social identity and feelings of belonging|
|Feelings of self-worth and contribution|
|Well developed decision making, problem solving and life
|Ability to focus on those things which are working and
functional and not just those which are problematic|
|Ability to tolerate and manage negative emotional states,
particularly those associated with loss and grief|
|Well developed sense of meaning and purpose in life|
|Positive view of the future|
How will things be different? (Or how will killing yourself
The above question acknowledges the functionality of
suicide. Subsequently, this allows the client to identify
goals and the possibility of achieving these goals through strategies
other rather than suicide.
This approach comes from Solution
Focused Brief Therapy. It is useful for those experience in
its practice. Others are advised to seek training in this
(See also: Solution-Focused
Brief Therapy Approach to Problem Drinking)
Encourage clients to delay acting on an impulse to
suicide. Suggest clients take at least 20 minutes before
acting on a suicidal impulse. During this time, they may
consider talking with someone about things, or simply put on some
music to give them a break from their thoughts.
Refer and consult
If suicide is related to depressive states or other mental
illness, referral and/or clinical consultation with a clinical
psychologist and/or a psychiatrist may be indicated.
(See bottom of this pages for other DrugNet pages on psychiatric
disorders and drug use).
Identification of staff competencies and training needs in
reference to the prevention and management of suicidal ideation
and behaviour should be undertaken.
Staff training should be linked to competencies and workplace
Comprehensive staff supervision should always be provided where
clients present with overt and high suicidal risk factors.
Support should be made available to staff in the event of
attempted or completed suicide. In the first instance, this
support should be aimed at providing emotional support to staff
via debriefing procedures. At a later date, debriefing should also
aim to identify and enhance those procedures which are working and
those which may need to be improved.
Family and friends
Particularly in the event of an attempted or completed suicide, family
involvement is essential to:
|allow family and friends to deal with their emotional states
including grief, loss and guilt|
|to mobilise family and friends as
|provide further insights and assessment for treatment|
Your client's permission must be sought prior to contacting
family/friends and confidentiality issues discussed.
While it's important to protect the confidentiality of a client
who has attempted or completed suicide, where other clients know
what has happened they will also need support to manage their
thoughts and feelings associated with the incident.
Suicidal behaviour can lead to 'copy-cat' behaviours which
should be openly discussed.
Suicidal behaviour of another client can provide an opportunity
to discuss this 'taboo' subject in managed sensitively.
to download a PowerPoint presentation on youth suicide & drug
use (202 KB - speaker notes not yet written).