Substance Abuse in Teens Linked to Greater Suicide Risk

substance-abuse-in-teens-linked-to-greater-suicide-risk_medium_smallThe Question
Are teens who inject drugs at greater risk for suicidal behavior than teens that use other methods for taking the same drugs?

Substance use can have serious health consequences for teens.  However, risk factors associated with suicidal behavior are similar for teens who use substances and teens who do not use substances. Depression, anxiety, hopelessness and impulsivity as well as substance use increase the risk for suicide among teens. Dr. Liu was curious if there were certain risk factors, related specifically to substance use, which could help identify teens who were using drugs—and might also be at increased risk for suicidal behavior.

There were previously identified substance use characteristics, which related to suicide:

  • frequency of drug use,
  • difficulty functioning in daily life
  • type of drug used
  • suicidal ideation, planning and attempts

Dr. Liu’s work is framed by the Interpersonal Theory of Suicide that suggests that suicide is the result of the person feeling like a burden and that they don’t belong, as well as capacity for suicide, including reduced fear of death and tolerance of physical pain. Dr. Liu gave particular attention to capacity for suicide.

Using this theory, Dr. Liu proposed that the use of injected substances, as opposed to other methods of using the same drugs, like smoking or inhaling, may be a marker for greater suicide risk.

The Study
The National Survey of Drug Use and Health provided a nationally representative sample of 2,095 teens ages 12 to 17 years old, who had used potentially injectable drugs regardless of whether or not they actually injected them.

Since the questions about suicidal ideation and behavior are only asked to participants who were depressed, only depressed teens were included.

Interviews about depression, substance use and suicidal ideation and behavior were conducted via personal computer (CAPI) or audio computer-assisted self-interviewing (ACASI), as these methods have been shown to be more effective in capturing personal information that may not be revealed in a face-to-face interview.

The average age of the teen respondents was 15.7 years old, 74 percent were female and 6.8 percent reported having a lifetime history of injecting a drug.

82 percent of teens reported suicidal ideation, 40 percent had a history of a suicide plan and 45 percent had made a suicide attempt. Almost 82 percent who had a plan had made a suicide attempt as some point.

62 percent of those teens who injected drugs had made a suicide attempt.

History of suicidal ideation and/or suicide plan by the teen respondents was not different between those teens who injected, and those teens who did not inject—when controlling for potentially related factors such as age, gender, ethnicity and family income.


  • The rate of suicidal ideation, suicide plans and suicide attempts is high among teens who are depressed and among teens who are using a substance.
  • A teen who is depressed and who is also injecting drugs is at a greater risk for suicidal behavior.
  • ACTION:  Getting a teen to treatment right away for their depression and substance use can save their life.

Publication from AFSP grant
Liu RT, Case BG, Spirito A. (2014) Injection drug use is associated with suicide attempts but not suicide ideation or plans in a sample of adolescents with depressive symptoms.  Journal of Psychiatric Research, 56, 65-71.

Dr. Liu is an Assistant Professor of Psychiatry and Human Behavior (Research) at Brown University. Click here to read about Dr. Liu’s Postdoctoral Fellowship.


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