Addiction and suicide: Montreal study challenges assumptions

Montreal researchers’ review of 25 studies reveals that the likelihood of suicidal tendencies preceding substance-use disorders is as high as previous assumptions that addiction led to suicidal behaviours in young people

A study conducted at Sainte-Justine children’s hospital and Université de Montréal reveals that suicidal tendencies can often precede substance-use disorders, not simply be caused by them.

The idea that alcohol, cannabis, and other drug abuse and dependence disorders lead to suicidal tendencies in adolescents and young adults is being challenged by the results of a new meta-analysis in the Public Library of Science Journal (PLOS ONE).

“For the first time ever, our meta-analysis reveals that the likelihood of suicidal tendencies preceding substance-use disorders is equally high,” said study first author Charlie Rioux, a graduate of the doctoral program in psychology at UdeM.

Adolescence is often a time of great vulnerability, discovery and search for autonomy, when some young people turn to substance use, and find themselves struggling with suicidal thoughts and behaviours. Problematic substance-use and associated disorders among youth have multiple negative physical and psychological consequences while suicidal tendencies, typically emerging and peaking in adolescence, often reflect other mental health problems.

Several studies have shown that the link between substance use and susceptibility to suicidal ideation in adolescent and adult populations could be explained developmentally by four hypotheses, and the research team focused on two of them: that substance-use disorders lead to suicidal tendencies through increased psychological distress and impulsivity or substance-induced depression; and that of self-medication or substance use to gain peer acceptance to cope with suicidal ideation.

“Although a number of meta-analyses on the association between substance use and suicidal tendencies have been conducted recently, none examined how both influence each other,” said Natalie Castellanos-Ryan, associate professor at UdeM’s School of Psychoeducation and CHU Sainte-Justine researcher.

The meta-analysis reviewed 25 published studies of these associations and highlights a research bias that ignores the fact that young people may use substances as a response to suicidal thoughts. The study also highlights the fact that research models in the vast majority of current studies fail to specify how substance-use disorders and suicidal tendencies can develop together.

According to psychiatry and addiction professor and researcher Jean Séguin, “If the young person in distress is to be diagnosed and treated appropriately and effectively, it is essential to clarify these issues. Clinically, providers tend to focus on one problem or another because mental-health and addiction services are often not well integrated into emergency or primary care.”

The study suggests that associated disorders should be assessed and treated together and that clinicians should be vigilant about substance-use initiation in young patients with suicidal thoughts or attempts. “A better understanding of the developmental and two-way association between substance use and suicidal tendencies and how these may change over developmental periods will allow for improved prevention and intervention programs by age group,” said Rioux.

The study was funded by the Monique Gaumond Fund for Research in Affective Diseases, Canadian Institutes of Health Research, Fonds de recherche du Québec – Santé, American Foundation for Suicide Prevention, and Réseau québécois sur le suicide, les troubles de l’humeur et les troubles associés.

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