Suicide

Suicide is defined as intentional death by one's own hand. According to the World Health Organization, approximately 1 million people die by suicide worldwide each year. In the United States, suicide is the 11th leading cause of death; according to the Centers for Disease Control and Prevention, more than 30,000 people commit suicide each year. The suicide rate in the United States is approximately 1.5 times the rate of homicide deaths and twice the rate of HIV/AIDS-related deaths.

Other terms have been used to describe various nonlethal self-harming behaviors. Attempted suicide, for example, is any act in which an individual intends to take his or her own life but survives. Suicidal ideation involves thoughts about killing oneself and can range from passive thoughts about one's own death to more active planning for a suicide attempt. Suicidal ideation can also be limited to a particular time in a person's life, or it can persist through several years. Approximately 1,900 emergency department visits are made each day in the United States to treat self-inflicted injuries.

Drug and alcohol use play a major role in many nonlethal suicide attempts and suicide deaths. According to the Department of Health and Human Service's National Strategy for Suicide Prevention program, between 40% and 60% of individuals who die by suicide are intoxicated, and up to 66% have some alcohol in their system at the time of death. Approximately 1% to 6% of alcohol-dependent individuals will die by suicide. That number jumps to 50% to 75% of individuals who have concurrent alcohol dependence and depression. Further, alcohol use frequently immediately precedes suicide attempts, suggesting that alcohol plays a causal role in suicide. Less is known about illicit drug use or abuse and suicide, but having a substance use disorder does significantly increase one's risk of suicidal ideation, suicide attempt, and death by suicide. As in the general [Page 886]population, substance-abusing men are about 3 times more likely to die by suicide than are substance-abusing women, and substance-abusing women are approximately 3 times more likely to attempt suicide than are substance-abusing men.

Risk of suicide is also elevated among adolescent substance abusers. Suicide is the third leading cause of death among U.S. teens and young adults ages 15 to 24. According to the Youth Risk Behavior Survey, approximately 8.8% of high school students attempt suicide each year. Although research on substance use and suicide in teens is sometimes inconsistent and the exact relationship is not yet known, several studies have demonstrated a relationship between suicidality and use of various substances among adolescents. The 2000 National Survey on Drug Use and Health found that one quarter of illicit substance-using adolescents (ages 12–17 years) contemplated or attempted suicide compared with only 9% of non-substance-using adolescents.

The exact nature of the association between substance use disorders and suicide is unclear, and the evidence for a common etiology of substance use disorders and suicide risk remains elusive. There may be a genetic vulnerability to suicide risk that is more prevalent in substance-dependent individuals, or these individuals may be at greater risk because of the inherent stress associated with addiction. Although more prospective studies of suicide risk have been conducted recently, it remains unclear whether suicide risk precedes substance use or substance use precedes suicide risk. Three possibilities have been proposed: (1) Substance use is a precipitant of later suicide risk; (2) individuals use drugs and alcohol to self-medicate because they are suicidal and experiencing severe distress; or (3) some other factor (e.g., early trauma, depression) is a common cause of both suicide and substance use disorder. The evidence to date suggests that there may be more than one trajectory for suicide risk and addiction and that the various risk factors may have reciprocal influence on each other.

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