Suicide and Co-Occuring Disorders

Categories: DeathSuicide

Suicide is a problem that all substance abuse counselors will encounter during their career and need to be able to address in a correct and safe manner. Clients who struggle with both substance abuse and mental disorders are at a higher risk for suicide ideations. A counselor should continue to increase their knowledge about suicide and mental health while understanding the importance of each individual, their needs, the warning signs, and the legality of confidentially and their limits. Even with much training there are still many issues in regards to identifying and preparation of a client with suicide ideations.

This paper will help to understand these complications and give guidance to continue to grow in knowledge about suicide.

First, let’s begin with a counselor should be comfortable when addressing and speaking to clients about suicide. A client will sense the instability of a counselor and could possible feel like the counselor isn’t really available to help them emotionally. You should build your comfort level by being strong in your knowledge and this means updated correct and accurate information that will help the client not hinder the client.

A consensus panel for TIP 50: Addressing suicidal thoughts and Behaviors in Substance Abuse Treatment (TIP 50, 2009) recommends several steps that will help a counselor grow and be stable in their practice and ease the process of suicide ideations with a client.

The first step is to “Be Direct” (Tip 50, 2009) the panel discusses that being direct can save a life. By being unsure of how to handle the situations or asking about suicide, a counselor could be avoiding the situation and result in confusion on both ends.

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The second step is to increase your knowledge. This is the best way to become more comfortable in the subject and understanding what could cause these ideations, what types of warning signs are there, even what to ask a client if you have suspensions of suicide ideations. It is important and imperative to never stop learning.

The third step that the panel suggests is to “Do what you do Best.”. That is to be the best counselor you already are. As counselors we are built to be empathetic, warm, supportive, and we trust our own experiences and intuition. (Tip 50, 2009) As a counselors we need to stay focused and grounded to our path of being understanding, forthcoming, caring and non-judgmental. Stay apprehensive and be objective to those clients and follow your training as you would for just substance abuse disorders.

Understanding that practice is important step along the way. Nothing is learning overnight and we just have to continue to grow and learn from our experiences. Counselor will find their groove and niches that work for them and help them to help guide their clients. Along with practice having good clinical supervision is very important. Here is where you can gain new knowledge and skills that will help you be more comfortable and successful in your practice.

The last two steps go hand in hand with each other. Just like you would work with substance abuse clients on collaboratively with treatment plans you would do the same with suicidal clients. The need to involve them in their own path for suicide prevention is imperative to their safety and goals to heal. A counselor should always know their limitations of confidentiality and that this should be informed to the client. There are principles of ethics and legal reasoning’s that should be protected for the client and the counselor. The client should understand these laws and guidelines and be aware of the crisis situations that a counselor would need to break the confidentiality contract.

Research shows that those who suffer with alcohol use disorder are ten times more likely to die by suicide and those who inject drugs are fourteen times more likely to die by suicide. (Association of Alcohol and drug use disorders and completed suicide: empirical review of cohort studies, 2004). They also share that their research showed that 40% of patients seeking substance abuse treatment have reported a least one suicide attempt.

This research is important to understand that as substance abuse counselors we need more clinical and research attention going to suicide in our education and in working in our field. Clients whom are entering treatment often are going to be more at an elevated risk for suicide attempts by these research numbers.

There are many stressors that can be caused and impel them to think that this is their only way. These stressors can cause serious depression and anxiety in the clients. They can include but are not limited to: relationships, lack of employment, lack of home, health and financial issues. Counselors should make sure to help clients empower these negative life events to help a client see the positive in life.

There are behavioral indicators that a person who may have suicide ideations that a counselor should be aware of. These could be along the lines of depression with aggression and impulsivity. Introversion and neuroticism are indicators for someone who has a substance abuse problem with alcohol, cocaine and opiates. (Sher, 2005) These behavioral indicators are signs that a counselor should be more in tune to their client’s needs. This can give a counselor warning signs that a client may be more adept to commit suicide. Externalizing psychopathology defined as co-occurring anti-social personality disorder, impulsivity, aggressiveness and substance dependence can also predict suicide. (Verona, Aschs-Ericson, Joiner, 2004)

External factors are a high risk for suicide attempts. These can include sexual assault, addiction, previous attempted suicides, and childhood abuse. There was a study by a gentleman named Davidson and his colleagues that share that someone with a history of sexual assault were a 15% that attempted suicide. They state in their study that woman who were sexually abuse before the age of 16 were 3-4 times more risk to commit suicide. (Davidson, 1996) These subjects can be very difficult to handle and open up with. This is an important time to be empathic and continued patience with clients to hide behind their security mechanisms. A person who has lost the part of them that is control of their own body can find it even more difficult to share whom they open and give their inner thoughts and concerns.

Post-traumatic stress disorder (PTSD) and substance abuse are commonly co-morbid and each of them alone are at a higher risk for suicide. They are even more at a higher risk of suicide attempts and completions of suicide. (Rojas, 2014) Rojas also found that depression and substance use were the most frequent psychiatric disorders co-occurring with PTSD is suicide victims.( Rojas, 2014) Their analysis demonstrated that almost 80% of individuals who had suicidal ideations and met diagnostic criteria for lifetime PTSD and substance use disorder had attempted suicide.

There are no correct answers when working with clients that may have attempted suicide or that may have suicide ideations. The center for Substance Abuse Treatment has developed the TIP 50 to help guide counselors and address the issues of suicide with proven assessments and is a resource that all counselor should have access to. This resource helps guide counselors with helping them to understand the risk factors, gain a full understanding of warning signs that a client might be expressing. It also helps to address the steps that can help to enhance the knowledge and encourage to speak about coping with suicidal thoughts.

I also believe that every counselor should feel that they are prepared for dealing with suicide and suicidal ideation behavior. PARS offers training on suicide prevention. It is proven that substance abuse, co-occurring disorders, and negative life stressors can enhance suicide behaviors, all clients who are being assessed for substance abuse should also be evaluated for suicide ideations. They should be assessed throughout their treatment as well. Though with stability through treatment and growth with less of life stressors the risk lessons. A suicide safety plan should be put in place early in treatment. The integration of mental health assessment and addiction treatment will help with stabilizing and supporting a person with a risk of suicide.


  1. CSAT, C.f.S.A.T., Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment. 2009, SAMHSA: Rockville, MD>
  2. Wilcox HC, Conner KR, Caine ED. Association of alcohol and drug use disorders and completed suicide: an empirical review of cohort studies. Drug Alcohol Depend. 2004; 76 : S11-S19
  3. Sher L, et al. The relationship of aggression to suicidal behavior in depressed patients with a history of alcoholism. Addict Behav. 2005; 30 : 1144-1153
  4. Davidson JR, et al. The association of sexual assault and attempted suicide within the community. Arch Gen Psychiatry. 1996; 53 : 550-555
  5. Verona E, Sachs-Ericsson N, Joiner TEJ. Suicide attempts associated with externalizing psychopathology in an epidemiological sample. Am J Psychiatry. 2004; 161: 444-451
  6. Rojas, SM, et al. Understanding PTSD comorbidity and suicidal behavior: Associations among histories of alcohol dependence, major depressive disorder, and suicidal ideation and attempts. J Anxiety Disord. 2014 ; 28: 318-325

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Suicide and Co-Occuring Disorders. (2021, Apr 23). Retrieved from

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