Suicide, an Addictive Behavior
Robert M. Lichtman, Ph.D., LMHC, CASAC, FAPA, MAC, CRS
Phone: 914-665-8622 or 914-960-9943
‘Daniel’ was intent on killing himself. He threatened his outpatient treating team and his family, that if he did not receive a prescription for Ativan, a highly addictive anti-anxiety drug, he was going to drink himself to death. In order to prevent this, his family took him to a psychiatric emergency room, where he was hospitalized as a danger to himself. Once again, he demanded that the ward psychiatrist give him the drug Ativan. As with most chemically dependent patients receiving efficacious treatment, the drug was not prescribed. He then persuaded his family into taking him home, promising that he would not harm himself. Unfortunately, they believed him and returned to the hospital, signing him out AMA (Against Medical Advice). Once home and out of his familys’ sight, he secured the anti-anxiety drug on the street, bought a liter of vodka, rented a room in a local motor inn and successfully committed suicide. The combination of Ativan and vodka proved to be quite lethal, and he knew it would be. Following a psychological “autopsy” and a root cause analysis, it was determined that Daniel “was going to do what he was going to do,” and the culpability was his own. I have often reflected on Daniel’s case and his drive to kill himself, thinking short of: locking him up and throwing away the key,” did we do everything clinically possible to prevent that suicide? That question haunts me to this very day. The concepts of free will and self-determination are challenging when someone takes their own life.
Running on Empty
Daniel was neither religious nor spiritual. Church and self-help programs held little value for him. The central activity in his life was to remain in the altered sense of consciousness produced by the psychoactive properties of an anti-anxiety drug. When the drug was not available, alcohol took its place, but that was not his drug of choice, Ativan was. Alcohol drove him into misery and made his hunger for Ativan worse. Daniel in an alcohol intoxicated state was literally hopeless, hapless and helpless. He was running on empty, unable to fill himself, and the alcohol was a poor second place substitute. It was the lure of Ativan that kept him going. He could not tolerate the protracted withdrawal enforced by the controlled environment of a hospital ward or a locked rehabilitation program. He had gone through countless detoxification and rehabilitation programs, both inpatient and outpatient. His comfortable state was his addicted state and without the anti-anxiety drug in his system he was very uncomfortable. As with many substance dependent people, his tolerance increased exponentially to a point where he required four times the dosage indicated for someone with an anxiety disorder. Other medications were tried, all to no avail. They only made him tired and produced sleep. Once awake, the craving returned twofold. He could not live in his skin, the pain was too great. The addiction to the Ativan was now turning towards the drive towards death. He saw his life ending as the only way out of his misery and what was once an addition to the drug became an addiction to suicide.
When Ingestive Addictions Become Process Addictions
Specialists in addictive disorders usually separate behaviors that involve the administration of substances into one category and others like pathological gambling, shoplifting, exercising, the internet, and sexual compulsivity into another, hence the terms ingestive and process. They are not mutually exclusive, as people engage in both types of addictions and at times, simultaneously. I prefer to call the latter, “Addictions Without Substance,” although both have a payoff in the form of physiological, psychological and sociological reinforcement. Incidentally, I have seen a number of cases where the person’s life ended in an intentional suicide, either by design, as in Daniel’s case, or by moral deterioration, to a point where an “accident” takes the person’s life. When there is literally nothing more to live for other than seeing oneself being strangled and falling into a deeper abyss, suicide is no longer viewed as an option. The drive to die takes on all of the properties of addictive behavior, especially the obsessive and compulsive components. Suicide is not viewed as some clinicians say, “a permanent solution to an otherwise temporary problem,” it becomes the “solution” itself. The drive towards oblivion is all too powerful.
Note: The name of the case study in this article has been changed in order to maintain confidentiality.
Dr. Bob Lichtman, Ph.D., LMHC, CASAC, FAPA, MAC, CRS, is a clinical administrator at a psychiatric hospital and a professor at local colleges. He is a founding member and former president of the Addictions Division of the New York State Psychological Association and a specialist in the assessment and treatment of people who have co-occurring emotional and substance use disorders. Bob lives in the Fleetwood, a section of Mount Vernon, New York and maintains a private practice specializing in relationship counseling and addictive behaviors.
If you or anyone you know are in crisis, please know that you are not alone. You can reach out to the National Suicide Prevention Lifeline where skilled, trained counselors are available 24 hours a day, 7 days a week at 1-800-273-TALK (8255) or online at http://www.suicidepreventionlifeline.org/.