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Coexisting Disorders


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 the time.

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. 



Associations between drug use and suicide
Those most at risk of suicide
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.
    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.
    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.
    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.
    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:

bulletPrevious suicide attempt
bulletInvolvement in the justice system
bulletMental illness (depression, schizophrenia, personality disorder)
bulletLiving in rural or remote areas (males)
bulletAboriginal people
bulletGay men and women
bulletYoung men
bulletElderly men
bulletThose 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.

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

bulletSupportive and caring network of family an friends
bulletHealthy and pleasing physical environment
bulletCommunity recreation, vocational, accommodation, health and welfare supports which should be known and available
bulletPositive school/work/recreation experiences 
bulletCreative outlets to express positive and negative emotional states

Personal Resources

bulletWell defined social identity and feelings of belonging
bulletFeelings of self-worth and contribution
bulletWell developed decision making, problem solving and life skills
bulletAbility to focus on those things which are working and functional and not just those which are problematic
bulletAbility to tolerate and manage negative emotional states, particularly those associated with loss and grief
bulletWell developed sense of meaning and purpose in life
bulletPositive view of the future


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


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 Other Client Support

Family and friends

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

bulletallow family and friends to deal with their emotional states including grief, loss and guilt
bulletto mobilise family and friends as potential supports
bulletprovide further insights and assessment for treatment

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.


Click here to download a PowerPoint presentation on youth suicide & drug use (202 KB - speaker notes not yet written).

 Related Internet Information

Click here for Hillman, Silburn, Green & Zubrick (2000) Youth Suicide in Western Australia Involving Cannabis and Other Drugs: A literature review and research report. WA Drug Abuse Strategy Office (126 pages, PDF 344 KB) 

Click here for a brief summary of suicidal behaviours, issues and possible intervention from The Homeless Handbook (Victoria). 

Click here for an overview and treatment of Suicidal Behaviour from the MERCK Manual

Click here for the more suicide links and resources from the National Youth Suicide Prevention Communication Project

Click here for a list of reviewed resources on suicide from the National Youth Suicide Prevention Project

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Introduction ] Psychiatric and Substance Use Assessment ] Symptoms ] Anxiety Disorders ] Depression ] [ Suicide ] Personality Disorders ] Schizophrenia ] Impact on Parenting ] Disability & Drugs ] Psychiatric Drugs ]

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