May 2026: Suicide and Substance Abuse

Mark had struggled with drugs since high school, and on at least one occasion, his “overdose” appeared to have been intentional. In the days leading up to his death on a sunny spring afternoon, he was struggling with financial reversals, a failed relationship, and a looming court date. Though his attorney said he was unlikely to lose at trial, he struggled with what a potential loss might mean for his future. 

So, he wrote heartfelt notes to his wife, parents, one sibling, and grandmother and then found a quiet place in the woods behind his home where he would be undisturbed, a location he had often described as his “happy place.” When his wife read the note, she knew exactly where to look and with the help of a deputy sheriff, found Mark in just a few minutes. The next days, weeks, and months were filled with questions, regrets, and anger at the 36-year-old whose life—and death—had been fueled by complex relationships and a 20-year addiction to narcotics.

Mark’s addiction started simply enough. He injured his hip playing football in high school and in the days before the drugs’ full potential were known, the physician prescribed opiates to help him function in school until surgery could be arranged. After two failed operations, the pain worsened until, at age 19, he underwent a total hip replacement. Nevertheless, the damage was done and his addiction was set. He dropped out of college and went to rehab twice. It was during his “clean and sober” period in his mid-20s that he met Samantha and she gave him a “reason to stay clean.” But weeks before Mark’s death, Samantha asked for a divorce, in part because of his repeated descent into addiction. In his notes to family members, Mark reported, “My world has collapsed.” 

Whether clinical counselor, clergy, funeral director, or bereavement group leader, Mark’s story is all-too-familiar to those who support the bereaved. We have heard the anguished tales told by parents, spouses, children, and friends who try valiantly, but whose help is ultimately insufficient to help the addicted person to stay alive. Sometimes, their deaths are accidental but all too often, like Mark’s, their death comes at their own hand. 

Individuals with heavy alcohol use are five times more likely to die by suicide than social drinkers, especially when alcohol use behaviors are accompanied by drinking from an early age and binge drinking. Opioid-related suicides have doubled in recent years; “Collectively, substance use disorders confer a risk of suicide that is 10–14 times greater than that of the general population; deaths related to substance use are highest among persons with alcohol use disorders followed by persons who
abuse opiates” (Esang & Ahmed, 2018, p. 8).

In my work with families after a substance-related suicide, I have found that there are often significant regrets and blame. In one case, parents confessed to feeling they “had not done enough” even though their daughter had been to rehab multiple times and they had dipped into retirement savings to pay the out-of-pocket costs. One mother blamed her husband, the deceased’s stepfather, at least in part, for telling her young adult son he needed to “Get the hell out of my house,” and calling him a “deadbeat” a couple of days before her son’s death. While it is widely known that it is a myth bereaved parents divorce at a higher-than-average rate, be on the lookout for marital discord that is already present, knowing that a child’s death can be the final blow to a troubled relationship.

I have also found it helpful, at least in time, to help individuals bereaved by suicide to find some important cause they can support. Often, these families are searching for ways to make some sense and meaning of an otherwise tragic, meaningless death. Pledging financial or volunteer support to an organization dedicated to stopping substance addiction can also be an important way for family members to begin the sense-making journey and often gives some sense of a “redemptive purpose” to their own suffering. Enumerable are the parents who have begun speaking to teens at high schools to make sense of their own child’s death by suicide. 

Clinical techniques of “therapeutic inquest” and “retrospective narrative” can help parents and others bereaved by suicide reconstruct the story of life and death and to help survivors grapple with unanswered questions (Gamino, 2025, pp. 151-156; Jordan, 2011). With the family’s permission, a clergyman might begin the funeral with words like, “We have gathered today with far more questions than we have answers.”

In the case of a young man who, like the first case, chose his “happy place” to die, part of my clinical work focused on helping his parents process why he chose that location; eventually, the parents determined that their son was “gracious” in the choice to die away from home, rather than in the place they lived. Working with bereaved families in the immediate aftermath of a suicide death and in long-term support, clinicians can help bereaved individuals gradually “craft” a narrative that works for them as a “good enough” explanation (Jordan, 2011, p. 182).

In the landmark work on suicide that has occupied a space on my shelf since shortly after it was published three decades ago, Shneidman (1996) suggested that at the root of most suicides is a deep “psyche-ache,” a psychological pain that is deep and pervasive. Though by no means always, sometimes that “ache in the soul” is evidenced in clinical depression. In my experience, often that psychological pain is what the abuser of substances is working to counteract in the use of the drug to begin with. It is my hypothesis that the same force that leads a person to substance use is likely the same force at work in “the suicidal mind.”

Both for bereaved individuals and the clinicians who support them, we might never fully understand the role of substance abuse and suicide, nor find explanations for what drove the deceased to his or her final, desperate act. However, by understanding the correlation and being alert to risk factors, we can go far in preventing suicide and in providing helpful counsel as families grapple with suicide’s aftermath.

References

Esang, M., & Ahmed, S. (2018). A closer look at substance use and suicide. American Journal of Psychiatry Residents’ Journal , 13 (6), 6–8. https://doi.org/10.1176/appi.ajp-rj.2018.130603

Gamino, L.A. (2025). Working with bereaved parents: A practitioner’s guide.Routledge.

Jordan, J.R. (2011). Principles of grief counseling with adult survivors. In J.R. Jordan & J.L. McIntosh (eds.), Grief after suicide: Understanding the consequences and caring for survivors (pp. 179-223). Routledge.

Shneidman, E.S. (1996). The suicidal mind. Oxford University Press.

The Author: For more than 40 years, William G. Hoy has been counseling with the bereaved, supporting the dying and their families, and teaching colleagues how to provide more effective care. After more than 17 years in hospice care, he served as Clinical Professor of Medical Humanities at Baylor University in Waco, Texas from 2012 to 2024. In his semi-retirement, he continues to write and provide resources and training seminars to colleagues who care for the bereaved. He can be reached at Bill_Hoy@baylor.edu.