Drug overdoses and suicide are both among the leading causes of death in the United States. As of late 2017, overdoses have been identified as the top killer of Americans under the age of 50. Suicide is not far behind, either, ranking in at the tenth most common cause of death (and the second most common in people ages 15-35).

Obviously, the two causes overlap in a number of deaths. It’s not uncommon for individuals to commit suicide by intentionally overdosing on heroin, prescription opiates or benzos, particularly when they’re already addicted to those substances.

Data shows that, of the 45,000 Americans who committed suicide during 2016, roughly 7,000 of them did so via intentional overdose. This number represents a 2% increase in cases of suicide by overdose since the year 1999.

But is it possible that statistics don’t account for every suicide? How can we actually be sure that only 7,000 people overdosed on purpose? Are the suicidal tendencies among addicts something that we should be paying closer attention to?

A Closer Look at Intentional Overdoses

The documented cases of suicide-by-overdose are the ones in which a note or some other tangible evidence was left behind. Those deaths of those who left no suicide letter were deemed to be accidental overdoses.

When there is no evidence to prove that an overdose was intentional, it is difficult to determine what the addict was thinking when they took their final dose. It’s hard for us to know, then, exactly how many people overdose on purpose without leaving a note behind.

What we do know, however, is that many addicts show signs of suicide risk. These signs include severe depression, financial problems and a disconnection from their loved ones. Even substance abuse itself is considered to be a risk factor. It is not impossible, therefore, to assume that at least some overdoses are undocumented suicides.

Why Would Someone Commit Suicide Without Leaving a Note?

The misconception about suicide is that it is always accompanied by a letter from the individual. We most likely get this idea from television, movies, and literature. Journalists tend to glorify the suicide notes left by musicians like Kurt Cobain and writers like Hunter S. Thompson.

In reality, though, the families affected by suicide do not usually receive a letter explaining why the act was committed. In fact, the American Psychological Association claims that only 38% of people who commit suicide leave a note. As it appears, then, it’s actually far more common for people to die without leaving a note that it is for someone to leave one.

It’s likely that this is due to the stigma around suicide. Much like drug addiction, it is often considered unspeakable in certain communities. Individuals may not be able to publicly admit to their depression even if they won’t be around to face the repercussions of doing so.

The stigmas around suicide and drug addiction could be evidence to suggest that some overdoses are intentional. It’s possible that an addict could feel so much shame around their conditions that they overdose intentionally without letting anyone know.

Understanding The Roots of Depression

Depression, suicidal tendencies, and drug addiction are all very complex topics. Although the three are not inherently linked, they do tend to appear together in a vast number of people. While only 2% of all people diagnosed with clinical depression commit suicide, roughly 45% of people with untreated substance abuse disorders contribute to the suicide rate.

It is clear, therefore, that there is some relationship between these conditions. That relationship likely stems from the similarities between the addicted brain and the depressed brain.

Although depression can be caused by a number of factors, it is generally seen as a chemical imbalance occurring in the brain and a dysfunction of the nervous system. When someone suffers from depression, it is likely because their nervous system is either too active or not active enough and their brain produces too many (or not enough) neurotransmitters.

Neurotransmitters, specifically dopamine and serotonin, are the chemicals that enable us to feel happy. When your nervous system produces an abundance or deficit of these chemicals, your mood will be affected. Clinical depression occurs in folks who are either genetically predisposed to it or whose life and environment causes their neurotransmitter levels to fall out of sync.

Where Do Drugs Come In?

As you probably know, drugs can be used to treat addiction. Prescription meds like SSRIs, SNRIs, benzos and even opioids were developed to help regulate the neurotransmitter levels in the brains of people with depression and anxiety. These drugs can work well to restore balance in the patient’s brain.

We all know, however, that not all drugs are used purely for medicinal purposes. People take all kinds of drugs for the fun of it. The reason that drugs can be pleasurable is that the provide the brain with a huge rush of neurotransmitters. While substances like heroin, cocaine, and meth each affect the brain in a distinctly different way, they each flood the brain with an enormous amount of dopamine.

You can imagine, therefore, that this effect would be appealing to people who suffer from depression. Even if someone’s condition is driven by an overproduction of neurotransmitters, drugs can provide them with a temporary relief from the overwhelming sadness they feel on a daily basis.

Depression and Addiction: A Dangerous Cycle

The problem is that drugs don’t cure depression, they simply help to manage it. While a user might feel better when they’re under the influence of a certain drug, that feeling won’t last for long.

Whether a person is taking a prescribed drug or an illicit one, they must continue taking the substance in order to feel its effects. It raises dopamine levels in the brain for a short time. Afterward, those levels will come crashing down to a lower level than they were at before. In order to get their dopamine level back up to that high point, they’ll need to take more of the drug.

If an individual uses a drug repeatedly, they can develop an addiction over time. When they’re addicted, they’ll depend on the drug to feel any pleasure at all. If they attempt to quit entirely, they’ll experience withdrawal symptoms.

Most addicts (even those without a history of clinical depression) tend to get depressed when they go through detox. For people with clinical depression or suicidal tendencies, however, the withdrawal process can be especially dangerous.

When Depression Evolves into Suicidal Tendencies (And How Drugs Can Contribute)

There isn’t any clear explanation of why a small number of depressed people are driven to suicide. However, we do know that drugs don’t make the situation any better.

Prolonged drug use can contribute in a few key ways, including:

Facilitating irrational thoughts

When someone is under the influence of drugs, they tend not to think rationally. As anyone who has ever had too much to drink knows, we are capable of doing some very irrational things when we are intoxicated.

Suicide is not exactly a rational act. Human beings are creatures that are programmed around self-preservation. All of our basic instincts and impulses are designed to help us survive for as long as possible. Ending your own life, therefore, doesn’t exactly make sense. Drugs could be the catalyst that enables a person to think that it’s their best option.

Escalating feelings of guilt

Excessive feelings of guilt or shame are a key indicator of clinical depression. Even if an individual has nothing to be guilty about, they may feel that they’re a burden on those around them.

In a recent study of suicide letters, one psychologist found that nearly all of the writers mentioned that they felt like a burden.

Drug addicts often have this feeling as well. Because drug use can lead the addict to make poor choices, they may start to resent themselves for the things they’ve done. If an addict feels that their behavior is an emotional or financial burden on their loved ones, their depression may grow worse. They may also start to feel that, as many suicide notes read, “The world will be better off without me.”

Addicts who aren’t able to forgive themselves may be driven to take drastic action against themselves.

Increased tolerance for pain

It was pointed out above that only 2% of all clinically depressed people end up committing suicide. This has led psychologists to believe that these individuals must share some common characteristic.

Some psychologists believe that the characteristic they share is a tolerance for pain and an ability to confront fear. Ending your own life, after all, would probably be a pretty scary thing to do no matter how bad the depression was. For this reason, it is suggested that people who participate in extreme sports, enjoy tattoos or body piercings and have a history of getting into physical altercations are far more likely to go through with the act.

Individuals with a history of self-harm are much more likely to commit suicide. In a sense, drugs can be considered a form of self-harm. Any addict who has been through the addiction-withdrawal cycle a few times can tell you that the experience isn’t a walk in the park. Yet many people continue to abuse drugs despite the pain it causes them.

Treatment for Co-Occurring Disorders: Reducing the Risk of Suicide

Although basic detox and rehab can be helpful for addicts with no signs of mental illness, those who suffer from depression require a more personal kind of addiction treatment. Whether the depression is a symptom or a cause of their drug abuse habit, it can contribute greatly to a relapse. In order for a depressed person to get clean and stay that way, therefore, they need to be treated for both co-occurring disorders.

“Co-occurring disorder” is the term given to the dual diagnosis of both a mental illness and a substance abuse disorder. When someone is diagnosed with co-occurring depression and addiction disorder, they are supposed to receive addiction treatment that takes their depressive tendencies into account. This includes extensive therapy to help them address the relationship between their two conditions and potentially a non-addictive anti-depressant prescription.

Why Expert Treatment is Important

Unfortunately, not all clinically depressed addicts receive proper treatment, even if they attend a professional rehab program. Studies estimate that roughly 33% of all depressed addicts relapse after leaving rehab. Even worse, they estimate that nearly 99% of depressed addicts who abstain from seeking any professional treatment relapse within two years of detoxing.

These numbers point out the importance of professional, specialized care. Rehab centers should always take into account any mental health conditions that the patient is struggling with on top of their addiction. Doing so could help not only to prevent relapses but to reduce suicide rates, as well.

Working to Fight Addiction and Depression

We may never know exactly how many overdoses are driven by the addict’s desire to end their own life. We do know, however, that depression and addiction are intimately related. There are resources that can help addicts to overcome their drug habits and help depressive people work toward a happier life.

If you or a loved one is struggling with either, or both, of these conditions, it’s crucial that you seek the proper treatment. At AspenRidge Recovery, we provide expert treatment for co-occurring disorders. Our doctors, therapists, and addiction specialists can help you to manage your depression in a healthy, drug-free manner.