This post was co-authored with R. Haile Cutter, who is a Public Health Fellow with the Cortland County Health Department and Co-Chair for the SPEAK UP Cortland Suicide Prevention Coalition. You can learn more about SPEAK UP on their Facebook page.
September is a busy month for many reasons, summer is winding down, children are going back to school, and students are returning to college. September also hosts a number of observances, namely Recovery Month, and Suicide Prevention Awareness Month. There is a lot of overlap in the conversation between recovery from a Substance Use Disorder (SUD) and that of suicide prevention.
Understanding problematic substance use:
First, let's understand what a Substance Use Disorder is. It's when a person’s drug use causes problems for them or gets in the way of them doing what they want to or need to do, and when they keep using despite those problems. This might mean they're using it too much, too often, or in ways that are harmful to their health or life. While there are clinical criteria that a person has to meet to have a diagnosed substance use disorder, people can also have problematic relationships to their substance use that don’t fit those criteria exactly. What’s important is to understand problematic substance use in a person-centered way: does the person in question think of their use as a problem?
Recovery is a process:
Recovering from a substance use disorder is about making positive changes in your life, often with the help of friends, family, and professionals. Recovery is not a one-size-fits-all process and it’s often not a neat, straight path; it's unique to each person. Some people may need therapy, support groups, or medication to aid their recovery, while others may rely on a strong support network or a change in their environment. What's crucial is that recovery is possible, and many people successfully overcome SUDs with determination and support. Even when there are setbacks, people can still move toward recovery in meaningful ways.
Recovery from mental illness (or even self harm, suicidal thoughts, or suicide attempts) follows this same pattern. Each person’s experience is different, recovery isn’t always a neat and tidy journey, and setbacks do not mean failure.
Substance Use and SUDs:
It's important to understand that not everyone with an SUD will experience suicidal thoughts or behaviors, but the risk is higher for those struggling with their substance use. Here are a few reasons why they are connected:
Mental Health: SUDs can often go hand-in-hand with mental health challenges like depression and anxiety. Substance use may be their way of self medicating their conditions. Over half (54.7%) of U.S. adults with a mental illness do not receive treatment, according to data from the Substance Abuse and Mental Health Services Administration’s National Survey. These mental health issues can increase the risk of suicidal thoughts.
Desperation: People with SUDs might feel hopeless or overwhelmed, especially if their addiction has led to negative consequences in their life. Often, people use drugs to try to manage or compensate for hard circumstances or mental health issues. These feelings of despair can lead to thoughts of suicide.
Impulsivity: Sometimes, when under the influence of drugs or alcohol, people might make impulsive decisions, including self-harm or suicide attempts. For someone who has experienced long term suicidality or has a plan in place, drugs or alcohol may give them the confidence to follow through with a planned attempt.
Stigma can have very real effects:
Substance use disorders, recovery, and suicide are all very complex, and they all have a lot of misinformation and stigma surrounding them. This stigma may keep someone who uses drugs from attending primary care visits that can diagnose mental illness, catch early signs of suicidality, or get them engaged with Medication for Opioid Use Disorder (MOUD). The shame that can come from that stigma can also keep people from reaching out for help when they need it.
The Connection Between Problematic Substance Use and Suicide
Whether someone is trying to self-medicate a mental illness or cope with difficult life circumstances, substance use is a risk factor for suicidality. Many substances lower inhibitions and can lead to a suicide attempt that might not have otherwise occurred. For example, nearly one third of those who died by suicide had alcohol in their system. It is often very difficult to determine when an overdose death was intentional. Unless there is a very large amount of opioids or other substances present or a suicide note, then it is common for these to be labeled an overdose.
Another risky scenario between suicidality and substance use occurs when someone on the path of recovery uses again (once or more than once) and faces the emotional pain or guilt of their use, paired with the altered mental status can lead to an attempt. The loss of a major source of support can also lead to an attempt, such as being kicked out of a program. If you haven’t used in a while, your risk of overdose is higher because your tolerance is lower, so the same amount that you previously took can be too much, leading to an overdose.
A return to use while in recovery is not a failure. It is a normal part of the recovery journey for many people. It can be hard and feel bad, but it does not mean that the hard work you’ve put in was wasted or that you won’t be able to reach your recovery goals. It can be a sign to find new or different resources–healthcare or treatment resources, community resources, or personal coping mechanisms–but you are still on your path to recovery.
As we observe Recovery Month and Suicide Prevention Awareness Month this September, it is vital to recognize the intricate relationship between problematic substance use, recovery, and suicide. Recovery is an attainable goal, and hope exists for those struggling with substance use disorders.
If you are struggling, there are resources in the Cortland area or virtually:
Treatment providers like Family and Children’s Counseling Services, REACH Medical, and CARS
Peer services like the Wishing Wellness Center
Community support like the SMART Recovery meetings happening at the Cortland Free Library
Call or text the 988 Suicide and Crisis Lifeline 24/7 for any sort of crisis and they can help you de-escalate, set up a safety plan, and connect to resources, often preventing a trip to the hospital.
Call the Ithaca Warm Line at (607) 210-8328, 24/7, if you are not in crisis but just need to talk to someone and get your thoughts out with no judgment, particularly useful for long nights.
The NYS HOPEline is a 24/7 number to call or text for help with addiction, substance use, and gambling. Call 1-877-846-7369 or text HOPENY (467369).
If you have a friend or family member who is struggling, there are things you can do too.
Listen to them non-judgmentally and let them know you’re there for them. It’s OK to not know what to do or have the answers (and they might not either). Don’t push them to share, but make sure they know that you’ll listen if they want to, that you won’t judge them or get upset, and that you will respect their privacy. You can also help them find or connect with resources, self-help or self-care options, or service providers.
By raising awareness, eliminating stigma, and promoting access to these valuable resources, we can make a positive difference in the lives of those affected by these challenges, fostering a community of support and understanding.