People with harmful use of alcohol and other drugs (AOD)

What does the evidence tell us about the link between people with AOD concerns and suicide?

Alcohol and other drug (AOD) use has been shown to significantly increase risk for suicidal thoughts and behaviours, often presenting in people who have died by suicide.^1,2

There are a range of factors associated with AOD use and increased risk of suicide. Alcohol intoxication can increase impulsive behaviours, impact on an individual’s ability to self-regulate and can worsen negative coping behaviours. These factors can elevate the risk of suicidal thoughts and suicidal behaviour in people with acute alcohol intoxication as well as chronic alcohol use or dependence.² Like alcohol use, psychoactive substance (drug) use can increase the risk of dying by suicide. The use of drugs (both acute use and intoxication as well as chronic use) can impact on a person’s cognition, perception, or moods, which can increase risk of suicidal thoughts and behaviours.³ Toxicity (also commonly referred to as overdose) from AOD use can also be associated with suicide deaths in Australia.

In the Australia Bureau of Statistics (ABS) Causes of Death data 2022, acute alcohol use and intoxication was recorded as a factor in 16.1% of suicides, and chronic alcohol abuse disorders as a factor for 12.5% of suicides. Data released by the Australian Institute of Health and Welfare (AIHW) from the National Suicide and Self-Harm Monitoring System in 2023 highlights that AOD use is one of the top three contributing risk factors to years of healthy life lost due to suicide and self-harm in both males and females. Illicit drug use contributed to 23% of healthy years of life lost due to suicide and self-harm in males and 11% in females, with alcohol use contributing to 22% of healthy years of life lost due to suicide and self-harm in males.

AOD use and mental health concerns often have a two-way relationship with suicide risk further increased if an individual experiences both mental health concerns or mental illness, and harmful use of AOD. Research conducted in Australia in 2016 found that at least 55% of people who were experiencing an AOD use disorder also had a co-occurring mental health condition (for example depression, anxiety, psychosis) and 60% of people with a mental illness were also experiencing AOD dependence.⁴ It is also widely understood that AOD concerns can be linked with the prevalence of other factors that contribute to the risk of suicide. This includes impacts on physical health, relationships, education, employment, and social participation. Stigmatising attitudes from others can also negatively impact on a person experiencing AOD concerns help-seeking behaviour.⁵

Factors that may increase risk of suicide

For people experiencing AOD concerns, some additional factors associated with higher risk of suicide include:

• Adverse childhood experiences (ACEs) including child maltreatment²
• Loss of employment and unemployment⁴
• Social exclusion and isolation²
• Presence of mental illness or a mental disorder, or an increase in symptoms associated with mental illness⁶
• Experiences of stigma and discrimination⁴
• Relationship issues²
• Reduced inhibitions and decision-making processes due to AOD use²
• Financial distress²
• Insecure housing or homelessness²
• Chronic pain or illness.²

Factors that may protect against risk of suicide

For people experiencing AOD concerns, some factors that may be protective and reduce the likelihood of suicide includes:

• Social support and connectedness
• Maintaining positive relationships with family and friends
• Community involvement
• Engaging in treatment and accessing help and support.

Protective factors for young people include⁷:

• Social and emotional competence
• Parental supervision and communication
• Participation in supervised leisure activities
• Connection to community, school and family
• Sense of belonging
• Parental supervision and communication.

What does this mean for policy and practice?

Preventative policies and practices must focus on reducing risk factors and strengthening protective factors of those who have AOD concerns to reduce the associated increased risk of suicide. The relationship between AOD use and mental health concerns is two-way, therefore policies and practices need to target both issues. These policies and practices should:

• Prioritise programs aimed at reducing harmful AOD use among young people including school-based interventions and community-led programs.⁸
• Government policies on alcohol accessibility, taxation and zero tolerance AOD driving.
• Integrate approaches across sectors including prevention, early intervention, treatment and management.
• Include harm reduction practices.
• Aim to reduce stigma to increase help-seeking behaviour and ensure people are accessing appropriate care.

Acknowledgement

This page was developed with the support of The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney.