Youth, Drugs, Suicide: Statistics Tell a New Story

He’s 25 and, most likely, white. Eight or nine years ago, as a teen-ager, he started using drugs or alcohol. Probably both. His drug of choice was likely marijuana or cocaine.

For a long time--three or four years, at least--he didn’t seem to have a drug problem. When he was stopped for speeding and reckless driving when he was 17, his parents shrugged it off as misdirected youthful exuberance. After high school, the drug-taking continued--always apparently in moderation.

But six months ago, his girlfriend left him, in part because he was getting loaded with greater and greater frequency. Friends recall that she worried about the effect of her departure but said at the time she couldn’t tolerate the way his life was going.

Afterward, his behavior changed radically. The drug use went completely out of control and severe depression overwhelmed him. He talked about taking his own life. Then, one day, he put a gun to his head and fired a 9-millimeter slug into his brain.

He has no name because he doesn’t actually exist. He is a statistical construction that, according to researchers here, personifies what is emerging as an explanation for dramatic shifts in the demographics of suicide in the last two decades.

It is a trend brought to national attention by increases in suicide rates among adolescents. But researchers involved in the San Diego Suicide Study, one of the most elaborate studies of trends in suicidal behavior ever conducted, say perhaps there have been more devastating increases in suicide among people in their 20s. Deaths among teens--though they make headlines when they occur in clusters across the country--still are comparatively rare, they say.

According to Dr. Richard Fowler, originator of the federally funded project based at UC San Diego and the State University of New York at Stony Brook, the research has disquietingly confirmed what generations of spouses and close friends of potential victims have instinctively feared. This reality is that, in situations where alcohol or drugs have destabilized a life, the departure of a spouse or live-in mate, the loss of a job or some other sudden disruption--an event psychiatrists call a stressor --can easily become the cause of an actual suicide.

According to Fowler, a former UC San Diego psychiatry professor now in private practice here, among 133 young suicide victims in San Diego, 40% had experienced the loss of a spouse or an intense interpersonal conflict shortly before they killed themselves. An additional 30% had experienced economic problems.

In fact, the study found that significant numbers of suicides by drug users upset by stressful developments occur in one to six weeks after the disruption. It is a window of time, Fowler said in an interview, in which young drug abusers must somehow be persuaded to enter treatment programs or face a serious risk of death at their own hands.

“There are a heck of a lot of people out there who are married to alcoholics or drug abusers and who are miserable but afraid to leave because of something like this happening,” Fowler said. “And, indeed, it’s a possibility that, if they were to leave, their spouse would get into more trouble and end up taking the life. That’s a helluva guilt trip for anyone to have to live with.

“I would wish nobody to be in that position. (But if they are), the safest way to proceed is to do what they can to get the loved one into a treatment program and work with them in terms of maintaining sobriety. If at some future date the relationship falls apart, fine, but that’s the safest first step.

“If the individual won’t go into a treatment program and a person is really at the end of his or her rope, I think they come down to some very difficult decisions.”

Defied National Trend

The study was begun in 1981 after Fowler and Dr. Charles Rich, also then on the UC faculty but now at the State University of New York, noted that youth suicide rates, beginning in the late 1960s, had begun to defy a national trend for all ages. Suicide had been going down steadily for all age brackets except the young, which had begun to rise.

Indeed, before the late 1970s, suicide had generally been thought to be a phenomenon of the old. But since 1965, according to the federal government’s National Center for Health Statistics, the rate of youth suicides has increased almost exponentially.

In 1965, there were four suicides per 100,000 people 15 to 19, and 8.4 per 100,000 among those 20 to 24. By 1975, the rates had reached 7.5 for 15- to 19-year-olds and 16.3 for those 20 to 24. In 1985, according to the center, the 15- to 19-year-old group had a rate of 10 per 100,000 with 15.6 in the age bracket 20 to 24.

The San Diego Suicide Study--from which the third major research report is being published today in the journal Archives of General Psychiatry--was the first attempt to look in depth at a large number of completed suicides since the late 1960s.

Differences Hard to Study

Suicide research, Fowler and other experts agreed, is uniquely complicated because there is evidence that most people who attempt suicide but don’t actually kill themselves are different from those who die, in terms of psychiatric problems, personality makeup and immediate motivation. But since the so-called “completers” are dead, Fowler said, extensive psychiatric evaluation is impossible.

The situation necessitates costly and time-consuming research techniques. Thus in the San Diego study--financed by the Veterans Administration--Rich, Fowler and Dr. Deborah Young investigated the personal backgrounds of all 133 people under 30 who killed themselves in San Diego County between late 1981 and mid-1983. The young suicide victims were compared to 150 others, all of whom were over 30.

Specially trained interviewers sought out friends, relatives and acquaintances. Extensive medical data was obtained from hospital and coroner’s office sources, so observations about drug use, in particular, could be determined with precision.

In a telephone interview, Dr. George Murphy, a suicide expert at Washington University in St. Louis, said the San Diego study has established that the relationship between drugs and suicide in the young--widely suspected among mental health professionals--may be even more pronounced than previously thought.

Definitions Cloud Picture

He cautioned that drugs do not, alone, explain all of the trends in suicide demographics of the last decade, either. He said that recent changes in the ways psychiatric diagnoses are arrived at has tended to define “drug abuse” more liberally, sometimes making it difficult to determine the extent of the role of drugs in a young person’s behavior.

Despite those reservations, Murphy said, “There is nevertheless an increase in substance abuse and, yes, it does have something to do with suicide.

“Half of alcoholics have an experience like that in a year,” he said. “The people who did themselves in were bereft of other resources. They had gotten to the point where their spouse or girlfriend was the last person to relate to them. They have lost all of their social supports.”

The San Diego researchers found that the local young suicide victims studied had used a wide variety of drugs, including sedatives, opiates, cocaine, amphetamines, PCP, LSD and marijuana, in addition to alcohol. Fowler said, however, that no single drug was identified as having greater potential to influence suicidal behavior.

General Portrait Emerged

Many of the victims were found to have engaged in binge drinking, drinking every day, drinking in the morning, blacking out or losing friends because of their substance abuse in the weeks or months before they killed themselves. About half had had previous psychiatric treatment. Nearly three times as many young men killed themselves as young women and only 17% were married, compared with 43% of victims over 30.

More of the young people had histories of suicide attempts and 88% were white. Only 8% of the young victims lived alone, compared with 34% of the older ones. Nearly half shot themselves, while 16% used drug overdoses and 17% hanged themselves. The rest used other means.

A total of 53% of the young victims were given principal psychiatric diagnoses of substance abuse. Typically, the drug users turned out to have been involved with chemical substances an average of nine years.

Most frequently, depressive symptoms noted in drug users who killed themselves included low mood, decreased appetite, weight loss, sleep problems, agitation and being withdrawn. Thoughts of death had been expressed by 57%. And 37% to 44% of the victims--depending on whether they were drug users only or also had other psychiatric illnesses--had talked about suicide shortly before their deaths.

Study Confirmed Suspicions

Fowler said that before the San Diego Suicide Study began, researchers suspected that drugs might be playing a significant role.

But while the study confirmed the suspicion, Fowler said it is still impossible to say with certainty whether young people who kill themselves have personality disorders because they have been using drugs, or whether they used drugs because they were already ill or had a high potential for becoming ill.

It is, he concedes, a chicken-and-egg question in which mental health researchers and professionals are intensely interested but for which there is not yet a clear answer.

Researcher Young said that, while the link between drugs and suicide is hardly surprising to anyone who has treated psychiatric patients, the study was able to quantify and statistically confirm the relationship to an extent never achieved before.

Problems From Many Directions

“Drug abuse ruins people’s lives,” she said. “The problems come from so many different directions that somebody using drugs for a long time is in a terrible spot in terms of trying to pull themselves together.”

Fowler added that drug abuse and drinking among potential suicide victims is seldom a subtle phenomenon--at least to a trained observer. But he said loved ones and close friends may overlook even the most overt behavior.

“One way of dealing with a drug or alcohol problem in your midst is really to deny there’s a problem,” he said. Even more difficult, he said, is trying to predict what drug-using behavior among teen-agers portends eventual suicidal deterioration several years later.

What is clear, he said, is that suicide among drug users is the end result of a chronic disease that has a slow, natural progression over as long as 10 years.