What Should I do About Suicidal Thoughts?

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Anyone who has experienced addiction is familiar with the feeling of being trapped in a very lonely place. When you’re already feeling isolated, and losing hope that things can get better, just one negative life event can trigger a flood of suicidal thoughts.

No matter what else may be going on in your life, it’s important to know that thinking about the possibility of suicide is part of the human experience. Philosopher Albert Camus said, “Deciding whether or not life is worth living is to answer the fundamental question in philosophy.” If you’re living with substance use, it’s common to lose track of meaning and purpose in your life. It’s easy to wonder whether your life matters. Having thoughts about suicide can help you uncover your individual reasons to keep living. This is a critically important moment on your recovery journey!

Unfortunately, the clinical divide between Substance Use Disorder (SUD) recovery programs and mental health programs can make it difficult for people with both to get help for suicidal thoughts. Some Substance Use Disorder programs don’t deal with underlying mental health issues, and some mental health treatment programs don’t deal with Substance Abuse Disorders.

Because September is National Suicide Prevention Awareness Month, we’d like to take a closer look at the issue, and share some tips on how to get the treatment you need, when you need it.

Learn how to deal with suicidal thoughts

Suicidal Ideation is a Natural Part of Recovery

Substance use and suicidality often go hand in hand: they are both forms of risk-taking, and they both come with their own stigma or shame. A 2020 study found that just one SUD comes with an increased risk of suicide mortality, which rises with each additional substance.

Crossover between substance use and suicidality can play out in many different situations during recovery. In fact, it’s not uncommon for suicide attempts to happen in recovery centers. There’s the possibility of death by overdose, and in these cases, it can be difficult to tell if these deaths were intentional or not. When negative life events happen during treatment, like losing a loved one, or your spouse asking for a divorce, it may seem like too much to bear, and trigger a suicide attempt. After multiple stays in rehab, feeling like it’s your “last chance” to get healthy can also bring up thoughts of suicide. Finally, once someone with SUD is stabilized, they may no longer meet the criteria for the SUD treatments they need, because they are clean and sober. Without an ongoing support structure in place, they are more vulnerable to a suicide attempt.

All of these situations are normal and valid experiences that a lot of people face on the road to recovery. Dealing with the dual shame of both addiction and suicidality can make it very difficult to talk about both. It’s true that in some situations, what you say can affect the treatment you’ll receive. But if thoughts about suicide are there in the back of your mind, you have to find a safe place and time to talk about it with a professional who’s qualified to help.

Finding the Right Treatment at the Right Time

It’s common for people in SUD treatment to have some suicidal ideation, even without a dual diagnosis of a mental health condition. Social isolation, problems at work, negative life events, bullying, sexual violence, and trauma are all considered contextual risk factors for suicidality that have nothing to do with your brain or biological makeup. Unfortunately, the mention of suicide during admission can be treated as a red flag for mental health issues that need to be treated in a hospital.

What’s important to recognize is that the conversations you have at admission and during initial assessments have specific purposes. You’re not in a treatment setting yet, and the language of safety policies and admissions discussions can be confusing. Slight differences can have huge implications: for instance, the difference between suicidal ideation and suicide attempts.

Each SUD treatment center is required to have a suicide safety plan, but these aren’t always very comprehensive or sufficient. Many will have clients sign a “no harm contract” stating that one suicide attempt will result in your removal from the program or escalation to a mental health facility. When rehab centers shut down conversations about suicide, it causes patients to downplay these symptoms or ignore them because it might hurt their chances of getting the care they need. The better alternative—and  what we do at Renewal– is to create a collaborative safety plan with each patient. This means we can talk about suicide without jumping to conclusions about your mental health, and our entire staff watches out for changes in mood and behavior that might be signs of suicidal patterns.

Questions to Ask During Admission

Use the following questions to determine if a rehab facility is a safe place to talk about suicidal thoughts:

  1. What are your policies around creating suicide safety plans?
  2. Do you have any rules or guidelines about how clinicians can discuss the topic of suicide?
  3. What happens if someone mentions they have had suicidal thoughts during group therapy?
  4. What happens if someone makes a suicide attempt during treatment here?

Renewal can be a Safe Place to Talk About Suicide

There is such a thing as an SUD program that accepts and encourages full transparency about suicidal ideation. Various Renewal locations treat both substance use (including eating disorders) and mental health conditions concurrently. The reality is that suicidal thoughts cross over into all of these areas.

Onetime a client was admitted to Renewal after an overdose. During group therapy, they shared that they had made another suicide attempt. The group was able to hear this client unpack his experience and reflect on this specific pain without making any judgments about his current mental state. Discussions like this can support long-term healing for everyone involved because they expose us to important questions about why life is worth living. The bottom line is that you can’t build up the resilience to face suicidal thoughts without having a frank and honest conversation about suicide.

If you’re looking for help with substance use, and you experience suicidal thoughts, reach out to us today. Give us a call at (888) 226-7413.

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