According to the Centers for Disease Control and Prevention (CDC), suicide is ranked tenth among leading causes of death for people in the U.S. The government says that, in 2016 (the last year for which statistics are available), 44,965 people took their own lives. But that number may be misleading. The true number could be considerably higher.
To classify a death as a suicide, a physician or coroner must discern the intention of the deceased. Indeed, the government defines this cause of death as “intentional self-harm.” In contrast, when a doctor or coroner deems that a death is an “accident,” they define the cause as involuntary, calling it an “unintentional injury.” While some suicides and accidents are black and white – such as suicide by hanging or an automobile accident fatality – many are less obvious. Delve deeper, and it’s clear that there is a spectrum of intent that can lead to misclassifying causes of death.
Overdose: At the Crossroads of Suicide and Accidental Death
The CDC reports that, in 2016, more than 63,600 people died from drug overdoses in the U.S. Adjusted for age, that is more than triple the number of overdose deaths in 1999. This figure is stunning, and certainly reflects the opioid epidemic that is sweeping the nation. But that’s just part of the story. Remember, it’s all about intent. The CDC classifies overdoses as “drug poisoning” deaths, which encompass both intentional and unintentional overdoses.
Viewed through another lens – one that sees the whole person – an unknown but significant number of overdose deaths can be categorized as suicide. The National Institute on Drug Abuse, part of the National Institutes of Health, acknowledges that mental illness can play a role in substance abuse. For example, anxiety, depression, and stress can lead people to seek drugs in order to alleviate negative feelings; over time, drug use can become drug abuse. When those with mental health issues also have a genetic vulnerability to addiction, drug usage can accelerate.
Scientific American reports that one in six adults in the U.S. take psychiatric drugs, including antidepressants, anti-anxiety drugs, and sedatives, and that white and older adults typically access these drugs more than non-white and younger adults. This could be a result of systemic and economic barriers to accessing healthcare and mental health care, as well as increased mental illness stigma among non-white adults.
It’s logical that when people don’t have access to mental health services, they may turn to available drugs in an attempt to ease their pain. For example, prescription painkillers can do double duty, helping to alleviate physical pain as well as anxiety and depression. It’s also logical that, for some people, physical and mental health issues are inextricably intertwined. The woman who is in chronic pain is not able to actively participate in life activities. As her world becomes smaller, she spirals into depression. Her reliance on painkillers increases but her psychological pain remains unaddressed. While under the influence, she may quietly decide to take a few more pills and end her life. In the absence of evidence of intent, her death is likely to be ruled an overdose rather than a suicide. If even 15 percent of overdose deaths were reclassified as suicides, suicide would jump to the eighth leading cause of death among adults in the U.S.
The Role of Ineffective Drug Treatment Programs
Those who suffer from substance abuse and mental illness are often invisible patients within the drug treatment program construct. Addiction is too often diagnosed as the problem to be treated, rather than as a symptom of a significant, painful underlying mental health issue. When the focus is on the symptom – substance abuse – drug treatment becomes a revolving door of sobriety, relapse, and re-admittance. Along the way, the person’s underlying untreated mental illness can become a vortex of emotional distress and hopelessness that leads them to take their own life via overdose – and never be counted as a suicide casualty.
“Insanity is repeating the same mistakes and expecting different results.” Ironically, although often attributed to Albert Einstein, this sentiment first appeared in writing in a 1981 Narcotics Anonymous pamphlet. The substance abuse treatment paradigm most often used today does just that: it makes the same mistakes again and again, yet continues to expect that the outcome will be sobriety.
A Different Approach
In contrast, seeing the person as an individual rather than an addict enables a treatment approach that considers all of the factors that contribute to the person’s behavior. Rather than focusing on the patient’s character, their personality, and even their DNA, an effective treatment program begins with a correct diagnosis of the patient’s mental illness and an identification of their emotional challenges.
With a correct diagnosis, treatment can be tailored to the patient. With a personalized treatment plan, it may no longer be necessary to treat drug addiction with yet another drug. It may no longer be necessary for the patient to self-medicate or to turn to maintenance medications. It may no longer be necessary to treat drug addiction as a life sentence. Instead, we can see addiction for what it is: the symptom of a treatable underlying condition.
It’s time to shine a spotlight on invisible patients. Drug treatment programs must provide patients with a dignified path to wellness that acknowledges the role that mental illness plays in substance abuse.