Substance Misuse and Suicide

An analysis of primary care and coroner service records in Northern Ireland shed light on the relationship between substance misuse and suicide. The authors suggest that (1) we should not underestimate the importance of other risk factors (e.g., personality traits, adverse life events, and mental health problems) that contribute to suicide among those with substance misuse problems given that a substantial proportion of people with a history of substance misuse are not intoxicated when they die by suicide, and (2) health and behavioral health services need to more effectively address substance misuse and suicide risk given that a substantial proportion of the sample had sought help for substance misuse problems at some point during their lives.

In the sample of people who had died by suicide, 33 percent had sought help for alcohol misuse, and 22 percent for drug misuse, from a general practitioner (GP) at some point in their lives. In the 12 months prior to their death, 24 percent had sought help for alcohol misuse, and 13 percent for drug misuse.

An examination of coroner reports revealed that 52 percent of the sample screened positive for blood alcohol at the time of the suicide. Of those that screened positive, 39 percent were over the legal blood alcohol content (BAC) limit for driving, which the authors took as an indication of intoxication. Of those over the BAC limit for driving, 47 percent had visited a GP for an alcohol-related problem at some point in their life, as had 25 percent of who were not over the limit. Of the 38 percent of the sample who screened positive for drug misuse, 34 percent had sought help for a drug-related problem over their lifetime, as had 24 percent of those who did not screen positive.

Eighty-two percent of the sample had visited a GP during the 12 months prior to their death. Seventy-one percent of those who had consulted a GP had done so for a mental health concern. However, 41 percent of the sample had never been diagnosed with a mental health problem.

The authors also found that “people with a recorded history of help-seeking for drug misuse…were more likely to be screened” and people who died by drug overdoses were more likely to be screened for alcohol and drugs during the coroner’s inquest. The likelihood of toxicology screening decreased with age, although there was no difference in the rate of positive screens by age.

Galway, K., Gossrau-Breen, D., Mallon, S., Hughes, L., Rosato, M., Rondon-Sulbaran, J., & Leavey, G. (2015). Substance misuse in life and death in a 2-year cohort of suicides. British Journal of Psychiatry, 208(3), 292-297.