Guest Opinion: Substance abuse, suicide on rise in CA

  • by Marcel Gemme
  • Wednesday June 15, 2022
Share this Post:
Marcel Gemme. Photo: Courtesy
Marcel Gemme. Photo: Courtesy

Substance use disorder and suicide are on the rise in California. We often see the two mental health issues co-occurring, each with potentially deadly outcomes. The link between substance abuse and suicide hasn't always been known and still isn't completely understood. But we can now say with certainty that substance misuse significantly increases the risk of suicide.

It is not hard to imagine why this connection exists. People who become addicted to drugs often see no way out and become desperate. Similarly, people who are suicidal may use substances to self-medicate or even to commit the act and intentionally overdose.

Other evidence also makes this connection obvious. When we examine alcohol, we find that 22% of deaths by suicide in the U.S. involve alcohol intoxication. And opioids, the drug responsible for the current epidemic, are involved in at least 20% of American suicide deaths.

California traditionally has a low annual rate of suicide deaths. But with the drug epidemic growing feverishly amid the COVID-19 pandemic, things began to change. Fentanyl, the deadly synthetic opioid making headlines across the country, has begun showing up more and more in California, including San Francisco. And with this wave of opioid addiction has come higher rates of mental health issues, suicide, and drug overdoses.

California saw more than 10,000 reported drug overdose deaths from 2020 to 2021. That's more than an 18% jump from the previous year, when totals were already elevated. This spike was linked to the stress and isolation of the COVID pandemic and its effect on our day-to-day lives. The stress of the pandemic led many people to self-medicate, often with addictive substances, to cope. Overdose rates skyrocketed nationally, leading to the deadliest year for addiction America has ever seen.

And while drug overdose rates were skyrocketing, so were rates of mental health issues. Physicians reported dramatic increases in emergency department visits for all mental health emergencies, including suspected suicide attempts. And these increases were in addition to already unprecedented rates from before the pandemic.

For example, between 2018 and 2019, 4.5% of adults in California reported having serious thoughts of suicide within the previous year. Also, more than 15% of adolescents in California reported experiencing a major depressive episode the year before the pandemic began, which was more than twice that rate of adults in the state at that time. And we know that since then, things have not improved.

Furthermore, these public health problems significantly impact California's LGBTQ community, representing close to 5% of the state's population.

Statistically, LGBTQ individuals often enter treatment with more severe substance use disorders. In addition, suicide rates are two to six times higher. According to the Trevor Project, a West Hollywood-based nonprofit that works with LGBTQ young people, LGBTQ and questioning students are more than four times as likely to attempt suicide compared to their straight and cisgender peers.

One of the reasons alcohol and drug abuse significantly affects suicide rates, as reported by, is its effect on the mind. Drug use changes how the brain functions and reduces inhibitions, making people more prone to behave impulsively or emotionally. For example, acute alcohol intoxication is present in about 30%-40% of suicide attempts. Completed suicides have been found in 7% to 8% of people with alcohol use disorder, with rates seven to 20 times higher than in the general population.

According to the federal Substance Abuse and Mental Health Services Administration within the Department of Health and Human Services, while multiple factors influence suicidal behaviors, substance use is a significant factor linked to many suicides and suicide attempts. Inversely, suicide is one of the leading causes of death among people who misuse alcohol and drugs. So, where we see high rates of substance abuse or drug overdoses, we often find similarly high suicide and suicidal ideation rates.

Suicide is the 10th leading cause of death in the U.S., claiming more lives each year than motor vehicle crashes. It is the second leading cause of death for Americans ages 18 to 45, right below fentanyl poisoning, which jumped to the top of the list in 2021. Addiction and suicide are undeniable public health concerns for every state, including California.

The link between substance abuse and suicide is no longer a theory or a vague connection. The data is clear, showing what we all believed was true. Both the person reaching for drugs and the person who no longer wants to live are struggling mentally and emotionally. They want to escape the pain and feel they have no other solution.

Solutions exist in the form of treatment. There's no more time to waste. We've been quick to tackle viruses like COVID, often at the expense of our mental health. But mental health, which includes substance abuse and suicide, must become a priority at least on par with the physical health of society. And it must happen soon.

Marcel Gemme, a straight ally, is the founder and CEO of, and a drug and alcohol treatment specialist who has been helping people struggling with substance abuse for over 20 years. His primary focus is threefold: education, prevention, and rehabilitation.

Help keep the Bay Area Reporter going in these tough times. To support local, independent, LGBTQ journalism, consider becoming a BAR member.