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:

1. Promote well-being
2. Early intervention and help
3. Crisis support and treatment
4. Support following suicide
5. Research

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. 

Contents

Associations between drug use and suicide
Those most at risk of suicide
Screening 
Types of Suicidal / Self Harm / Risk-taking Behaviour
Enhance Protective Factors
Other Interventions
Staff Training & Supervision & Support
Family and Other Client Support
Related Internet Information

Associations between drug use and suicide

1. Short-term Intoxication
   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.
   Intervention
   a. Teach impulse control.
   b. Teach the value of delaying acting on suicidal thoughts till not intoxicated.

2. Dependent
   Longer-term drug use and dependency increases psycho-social stressors which may lead to suicidal thoughts and behaviour.
   Intervention
   a. Provide human and other resources to reduce psycho-social stressors.
   b. Decrease or stop drug use through drug management interventions.

3. Psychiatric Illness
   Psychiatric conditions such as depression, personality disorders and schizophrenia, are at increased risk of suicide in people with a drug-related problem.
   Intervention
   Screen for psychiatric illness, particularly depression, personality disorders and schizophrenia

4. Drugs as a Method of Suicide
   Drugs may be used as a method to commit suicide by way of overdose.
   Intervention
   Caution in prescribing drugs which can be lethal in overdose

Those most at risk of suicide

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 increased risk:

Screening 

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.

Screening Questions

1. 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?
2. 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 the risk.

Types of Suicidal / Self Harm / Risk-taking Behaviour

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

Self-harm behaviour

Aims: to harm self; to feel pain (generally, NOT to kill self)

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 for consequences
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 possible dangers
b) to live and not be harmed

Motivation: "We take these risks not to escape life but to prevent life escaping us".

Enhance Protective Factors

Explore and enhance the following factors which are likely to be protective against suicide:

Social/Environmental Factors

Personal Resources

Other Interventions

How will things be different? (Or how will killing yourself help?)

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 approach prior.
(See also: Solution-Focused Brief Therapy Approach to Problem Drinking)

Impulse control

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).

Staff Training & Supervision & Support

Staff training 

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 learning situations

Supervision

Comprehensive staff supervision should always be provided where clients present with overt and high suicidal risk factors.

Support

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 Other Client Support

Family and friends

Particularly in the event of an attempted or completed suicide, family involvement is essential to:

Your client's permission must be sought prior to contacting family/friends and confidentiality issues discussed.

Other clients

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.