Effect of the Drug Abuse on Suicidal Behavior/ Ideation and Mental / Psychological Wellbeing Among Adolescents of Mardan.

Misbah Ullah ¹*, Muhammad Naveed Alam ²

Corresponding Author: Misbah Ullah, Department of Psychology, Abdul Wali University Mardan.

Copy Right: © 2022 Misbah Ullah, This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received Date: June 03, 2022

Published Date: July 01, 2022

Abstract

The present research focused on serious issue of substance addiction and its hazardous effects among adolescents which is increasing day by day. There are many effects of substance abuse but two most important are suicidal ideation and attempts and second is psychological/mental wellbeing. Sample was of adolescents was drawn from area of mardan city.  The sample was comprised of (N=400) college students from both male and female colleges(n=146) and universities(n=254). The sample was taken from Post Graduate College for males, Post Graduate College for females, Iqra School and college and University of mardan.

The present research used three scales for measuring the research variables. These scales were Drug Abuse Screening Test (DAST), SBQ-R Suicide Questionnaire-Revised, The Warwick-Edinburgh Mental Well Being Scale (WEMWBS).

The present research results show that college students scored high on mental well-being scale as compared to university students but both college and university students approximately same ratios on Warwick-Edinburgh mental well-being scale and Drug Abuse screening Test. The mean score of university students on all three variables are 47.03, 20.73 and 4.62. On the other hand, mean values of college students on all three study variables were 47.50, 40.91, and 4.83.  This result shows that drug addiction and suicide (behavior, attempt, Intentions, thoughts) ratios are same in college and university students, but mental wellbeing of college students is high as compared to college students.

Moreover, the research results show that DAST has a negative correlation with suicide and mental wellbeing but there is a positive correlation between mental wellbeing and suicidal ideation, behavior, and attempt. 

Introduction

Drug abuse is a global mental and physical health issue and is increasing day by day in adolescents regardless of their race, ethnicity, gender, sex, and background. Some people use prescribed drugs (i.e.., painkillers, sleeping pills and tranquilizers) to get relieve from pain which can be either physical like severe headache or psychological like stress and sleeping problems. But not all people abuse drugs for the same purpose, some people abuse drugs to experience recreational drugs out of their curiosity. People not only use prescribed drugs but also used illegal non prescribed drugs. In fast growing world adolescents abuse drugs to harm themselves.  As due to low psychological or mental wellbeing people took indirect methods to harm themselves and inject poison in their bodies. Drug or substance abuse is use of freaky, mind- bending and unhealthy substances such as alcohol, caffeine, cannabis, and tobacco. The use of drugs reduces mental health and play attributable role in increasing suicidal ideation.  (Segal, 2019).

Drugs

Drugs are chemical substances that change brain functioning and body dysfunction. These are of many types some are prescribed medicines, over the counter medicines like alcohol tobacco. These are illegal substances. (National Institution of  Drug Addiction ,2020)

Most used drugs are marijuana, caffeine, nicotine, heroin, cocaine, alcohol, tobacco, LSD, speed-ball, MDMA, ketamine, crystal-myth. Drugs are taken in many forms like by inhaling, through injections, orally, snorted, trans-dermal(patches), and through body orifices. 

Drug misuse

Drug use is sometimes also called drug misuse. These misuses of substances include in-taking of non-prescribed or illegal substances like cocaine, Heroin, Marijuana, and inhalants etc. It includes use of prescribed drugs which are prescribed by doctors and health care professionals but in different way like use prescribed medicines which are prescribed to someone else secondly it can also causes damage our health when we use over dose of prescribed drugs i.e.., opioid and thirdly use the medicines for some other purpose. Another aspect is misusing over the counter medicines. This can cause damage in body sometimes temporary while some time it is long lasting. (NIDA,2020)

Drug abuse

Drug abuse is associated with several risk factors, including suicidal ideation, thoughts behavior, low mental wellbeing, or psychological problems.

Drug addiction

Drug/substance addiction is about consequences of drugs used in specific frequency and amount and their effect on the user’s health. (Segal, 2019).

According to Ria Gupta (2015) most users are between 14-19 years and many students are taking drugs sold in one-gram packets in exams to kill sleep. About 5% of the adult population is using drugs in Pakistan and among them heroin users are increased.

Addiction vs abuse

Drug abuse refers to legal or illegal use of substances. These drugs are sometimes used more than regular pills, amount, or dose to get relief, feel good, reduce stress or to live in imagination because in imagination they feel themselves powerful. This drug use is habit and can be change.

Addiction is use of substances and become dependent on them and this addiction become hazardous. This dependency also has negative impact on economic conditions, health emotional and psychological problems for a person itself and also for loved ones.

Types of Drugs

Drugs are categorized in different types according to their medical and non-medical use. One most common of type of drugs are street drugs. Street drugs are illegal and addictive substances that have many names but are used as recreational purposes. These drugs are more dangerous for those who had previous history of mental and physical problems. These drugs include marijuana, alcohol, steroids, cocaine, fentanyl, hallucinogens, heroin, and many more (legacy healing center, 2019).

Hard drugs are recognized as most dangerous drugs that causes dependency such as heroin and crack cocaine. These drugs are more hazardous than soft drugs. Soft drugs that are not as dangerous as compared to hard drugs but still cause psychological dependency (dependency of mind). This means that mind feels restful when drugs are taken such as LSD, cannabis etc. (Parasuraman & Pharm, 2014)

The National Institute on Drug Abuse Blog Team (2011) published their work on drugs and its type. According to them Illicit drugs, designer drugs and club drugs are used at wide range all over the world. Illicit drugs are type of illegal drugs that doctors can’t prescribe. It varies from country to country like in western countries alcohol is legal drug while in eastern countries it is considered as illegal. Designer drugs are designed and created secretly in underground laboratories. These drugs are extracted from plants and then their chemical properties are manipulated by using the methods of chemistry. These drugs include MDMA(Ecstasy), ketamine, GHB, Rohypnol, LSD (acid), methamphetamine. These drugs are also named as club drugs when they are used in night clubs.

Recreational drugs are non-prescribed substances used for pleasure, fun and enjoyment. Many people use alcohol, tobacco for non-medical purposes. These are illegal drugs and can negatively affect social, family, and different areas of life. (Handerson,2017)

The drugs which are not widely recognized but plays important role in malfunction of brain of drug abusers are adulterants and diluents. Adulterants are used to enhance or minimize the chemical properties of drug already taken. Like amphetamine have been cut with caffeine.  On the other hand, diluents are substances added in medicines or drugs like baking soda is used to increase the bulk of drugs. (Parasuraman & Pharm, 2014)

Types of abused substances

Legal drugs are also known as prescribed drugs and over the counter drugs (OTC).  These are drugs approved by law include caffeine, alcoholic beverages nicotine and inhalants. All these drugs are not universally legal, laws for drug abuse is different in different countries.  Tranquilizers, amphetamines, benzodiazepines, barbiturates, steroids, and analgesics are drugs that can affect brain if overdose is used. Sometimes doctors or medical specialists knowingly or unknowingly prescribed overdose of these substances used in medicine purpose.

Illegal drugs are banned by law and their use is prohibited by doctors and practitioners. These drugs include morphine, marijuana, caffeine, lysergic acid diethylamide, phenylene or “angel dust”, designer and party drugs. These drugs are health hazardous that is why these are prohibited in law (Parasuraman & Pharm, 2014)

Stages of addiction

Four stages are considered as important for normal individuals to involve in drugs. The first one is experimentation and revolves around the curiosity to use drugs. Here curiosity acts as a motivator and even normal individuals can learn to trust/mistrust the drugs they use. For them “HIGH” is a new feeling. The second important stage is starting the regular use of drugs. At this stage user obsessively thinks about drug use and use the drugs when they are alone and thought that they have control over this behavior, and they can control it whenever they want to do it. The person might be confident about drug use that it will not hurt him and can involve in drug abuse due to peers. The third but hazardous stage is risky use/abuse.

The person who takes drugs tries to seek out “HIGH”. The person is confident about drug use that it will not hurt him and can involve in drug abuse just because peers’ groups uses. The last stage of drug addiction is dependency and it is most critical situation for abusers, and they can no longer get HIGH.

The avoidance of drugs may prey them to psychological and physiological illnesses and the person abuse drugs to avoid being sick. The drug abuse becomes the center of their life and their brain cannot function properly without drugs intake. (Ghazanfar, 2016)

Types of drugs-stimulants

Drugs had a stronger impact on central nervous system and increased brain activity, feeling of alertness, confidence, and energy. The people who use drugs sometimes feels lack of appetite. Once a person initiates the use of drugs is body physically and mentally becomes dependent on drugs and malfunction when a person does not intake drugs for longer time.

Cocaine is extracted from coca leaves and then crushed, chopped and/or pounded and then mixed with different solutions like alcohol, gasoline, kerosene, or some other solvents that removes the cocaine from the coca leaves and sniffed through nasal tissues and rubbed into the gums. Cocaine is most important recreational drug and has potential to irreversible damage the central nervous system. It also increases risk of heart attack(stroke), convulsions brain seizures, respiratory failures and ultimately death. overdose of cocaine also raises blood pressure and become the reason of permanent brain damage. (Gupta, 2015)

Types of drugs-depressants

According to Ria Gupta (2015) Drugs depressants cause poor co-ordination, balance, and judgment. Overdose leads to drowsiness, vomiting, coma and even death. Bobtailed substances or sniff able substances like glues, gasses, aerosols and alcohol, tranquilizers and GHB (Gama Hydroxyl-butyrate) are some examples of drugs depressants.

Effects and Consequences of drug addiction

Drug addiction had a long-lasting impact on the health of abusers. The drugs may have direct/indirect impact on health, and it depends on the amount of drug taken, the type of drug used, frequency and how they are taken. Short term consequences could be lack/increase in appetite, risks of heart attack, stroke, psychosis, and even death. These can even cause after the single use non prescribed drugs. Long term effects or consequences could be heart or lung diseases, cancer, mental illnesses HIV/AIDS hepatitis and breathing epilepsy etc. Drugs abuse changed the brain functioning. This malfunction of brain changes the perception of person to experience pleasure such as food and sex and affect their cognitive abilities. The consequences of drug vary person to person. with the passage of time person’s mind and body become shows drug dependency and person cannot stop taking drugs even he or she is aware of its negative consequences.

These are some direct consequences of drugs on heath but on the other side drugs also have indirect effects on health like drugs not only effect the users but are also dangerous for those around them. Some indirect consequences of drugs on health are poor nutrition, sleep disturbances, traumatic issues, violence, injury, and communicable diseases. The women who intake drugs in pregnancy can develop post-natal birth problems like low weight etc.  The drug use has also negative consequences in broader level just like on educational occupational academic and on family level. (National Institute of Drug Abuse [NIDA], 2017)

Signs and symptoms of drug abuse and addiction

The signs, symptoms, and effects of drugs vary from drug to drug and person to person. Common symptoms are neglecting occupational, academic/educational, or personal responsibilities like avoiding children, bunking classes or do not take interest in meetings and office work. Involving in risk taking behavior like driving when drunk, involving in illegal activities like gambling, driving while drunk or violence, and problems in relationship like intimate partner violence, misconduct with peers and with boss.

The signs of drug addiction are building tolerance for drugs means that your body demands ,more drugs than you were taking before to attain same effects caused by drug use, avoiding pain and to get relief from withdrawal symptoms like vomiting, nausea, insomnia, depression, sweating, shaking, anxiety and irritability. Other symptoms of drug addiction are loss of control over drug use, using drug despite of its harmful effects, abandoned activities and dependence on drugs. (Lawrence et al., 2019)

Risk factors of drug addiction

Lawrence (2019) and is colleagues worked from many years on events and stimulus that triggers drug addiction and explored that Vulnerability to drugs vary individual to individual. Mental health, physical health, genes, family and peers, and social circumstances play vital role in drug addiction. The risk factors that triggers drugs abuse and drug addiction are family history of addiction, abuse, neglect or traumatic experiences, low psychological well-being, psychological disorders like depression and anxiety, early use of drugs and method of administration like inhaling, injecting, and oral administration which increases potential of individual to use drugs.

Theoretical framework

During the last decade, some progresses has made in the development of theories of drug addiction, suicidal ideation, and mental/psychological wellbeing and with the passage of time these theories have become increasingly diverse complex and sophisticated. As the social sciences become increasingly sophisticated about the inadequacy of single and multiple theories about any realm of social behavior.

The researchers suggest that no single explanation covers the full range of phenomena labeled as drug addiction, suicidal ideation/intentions, and mental/psychological wellbeing. None of the literature has demonstrated that any one cause is both necessary and sufficient.

Reviewed theories about drug addiction observes that different models of various levels of analysis are organized like the layers of an onion the deep structure or inner most representing species wide evolutionary Behavioral adaption and other biological processes, the next representing sociocultural norms values and institutions.

Drug abuse is a chronic mental problem. It causes person to take drugs again and again and individual unable to notice the harm that caused by these drugs. The repeated use of drugs causes changes in brain functioning and have a greater impact on neurotransmitters and it leads to addiction. (National Institute of Drug Abuse [NIDA], 2020)

Psychological model of drug addiction

Substance addiction is not an innate behavior but a learned one which can be learned by classical conditioning and operant conditioning. In classical conditioning natural response is associated with neutral stimuli to produce an unconditioned stimulus. The craving is triggered by some external (i.e.., peer pressure) or internal stimuli(i.e.. , depression, loneliness) by the involvement of five senses(hearing, seeing, touching, smelling, or tasting) and resulted in deadly use of drugs. While in operant conditioning a person who is substance abuser is rewarded (pain and anxiety of abuser is reduced after intake of drugs) or punished by some stimuli (using aversive stimuli) to strengthen or weakens the addiction behavior. Third theory which is also a part of psychological model is social leaning theory. An abuser imitates a behavior of their models like if their parents use rugs to get relief, they start taking it. (Cavaiola,2009) Drug expectancies are another important factor which demonstrates that learn to used drugs by considering it in mind that how these will affect him. Expectancies can be positive and can be negative and vary with age. (Donovan, Molina & Kelly, 2009).

Biological model of drug addiction

The children with addictive parents are more likely develop addiction and if one of identical twin children develop addiction corcancely other have greater chances to develop that addiction due to hormonal functioning and identical genes. This hormonal functioning is sometimes due to mother’s intake of drugs during pregnancy and causes hormonal imbalance in child neurotransmitters and sometimes also cause brain dysfunction.

Addiction is caused by a physiological deficit making the person unable to tolerate the drug (George & khoob, 1992)

Cognitive model of addiction

Cognitive model is concerned with the neurobiology and psychology (cognition) aspects of substance use. There are cognitive factors behind acute drug administration to chronic drug use. In acute drug administration focuses on reason that leads someone to use drugs. From where a person learned this behavior and helps in drug-stimulus association. In chronic drug use is related to information processing theory. Whereas acute drug administration is related to learning theory. (Gould, 2010).

Psychodynamic model of drug addiction

Freud argued that people use defense mechanisms to reduce their anxiety, low confidence, regrets and get relief from pain in same way drug addicts use defense mechanisms to avoid feelings burdensome and powerlessness. Drug abusers compensate their feeling of severe emptiness with extensive drug use. Due to drug addiction a person creates his own imaginative world in which he has complete control. This situation is momentary but leaves a lifelong effect. (Freud, 1894).

Bio psychosocial spiritual model of drug addiction

Initially this model was called biopsychosocial model but later on spirituality was added because it is related with achieving higher potential of human beings. The spiritual model demonstrates that addiction is caused when a person feels disconnected with God or spiritual anchor and this vary religion to religion. Personal choices are cause of addiction. According to biopsychosocial spiritual model addictive behavior occurs when spiritual self is disconnected with physical self. Addiction is used to coped with difficulties and in achieving authentic self-image. (Horvath et al.,1995)

Moral model of drug addiction

The moral model of addiction emphasizes on superego or we can say that when a person did something wrong, he/she moves towards repressing his guilt feeling by addiction. (Horvath et al., 1995).

Temperance model of addiction

According to the temperance model substances or drugs are poison and it not only have negative impact on drug abusers but also on others and societies. Drugs like heroin or methamphetamine are more threating as compared to alcohol and tobacco. Their premises are prominent. (Horvath et al., 2016)

The opponent process model of addiction

The opponent-process model demonstrates emotional and motivational factors that leads to addiction. It also emphasizes on why drug abusers find it difficult to get rid of drugs. People use drugs to get pleasurably sensations. The opponent process model of addiction explains that a person who experience fear massively, fear will affect them less and may be situation comes when fearful situation will no longer scary. In this situation another takes the place of fear which is relief. (Barhum, Timothy & Legg., 2017)

The disease model of addictions

The disease model holds that abusers have predispositions, genes or hormones which determines whether a person will become abuse/alcoholic or not. This   model specifically describe alcohol or its effects that’s why it is also called diseases model of alcoholism. This model suggests that due to certain biological deficiencies in neurochemicals so  Ethanol affects the fluidity of cell membrane lipids  and causes dysfunction of membrane and enzymes are effected that leads to brain  dysfunction and increases craving for drugs like alcohol.( Wallace, 1990)

The personality model of addiction

Traits of a person act as risk factors of drug addiction so in turn these drugs personality dysfunction. This model emphasizes on five factor theory of personality and demonstrates that people with drug addiction like heroin, marijuana, and other substances. The people who abuse heroin/ cocaine have high Neuroticism and low Conscientiousness, particularly Competence, Achievement-Striving, and Deliberation. So, in short word’s drugs effect our personality traits. (BMC Psychiatry, 2008)

The social educational model of addiction

Social educational model of Addiction explains that behaviors are learned and can be explained by corelated actions by such components like behavior, cognition, and environment or situation. This model states that human learn behaviors like addiction either by direct experience or by indirect experience and cognition plays important role in adopting these behaviors. Drug addiction can be learned when it is reinforced by other people, environment, thoughts/feelings, and from direct exposure of drugs.

This model is also helpful in treatment of drug abusers by helping them to unlearn these behaviors. (Gary, Fisher & Roget., 2010)

The Sociocultural model of addiction

The cultural model recognizes that the cultural standards, norms, negative evaluation by culture and society on individual’s behavior leads to addiction. In some culture drug addiction is allowed but not in others. Like  people in united states are considered as modern and humorous if they drunk alcohol and are involved in drugs intoxication while in Asian countries like Pakistan and India it is considered as illegal and against societal norms.( Horvath et al., 2018)

The habitual model of addiction

The habit model proposed by Thomas Szasz questions the very concept of "addiction." He argues that addiction is a metaphor, and that the only reason to make the distinction between habit and addiction "is to persecute somebody." (Szasz, 1973)

Public health model of addiction

Public health model of addiction is made by three key factors; the agent(characteristics of drug  and its effects), the host(characteristics of the drug abuser/user) , the environment(the context in which drug is used). It focuses prevention of drug use which includes three types of preventions; primary prevention(take measures before the use of drug like awareness about its effects), secondary prevention(drug addiction is diagnosed and important steps are taken to cure it), tertiary prevention(this is given when problems become so serious that it becomes threatening for individual’s heath, economic conditions and relationships either legally or illegally and counseling is provided).(The national drug strategy, 1985)

Suicide

Joiner (2005) defines Suicide as a behavior in which individual intentionally finish his life or kill himself.

Suicidal ideation

Suicidal ideation as intentionally thoughts of death. (Orden et al., 2010). Suicide is also defined as the act that is performed consciously rather than advisedly or on anyone’s suggestion. In short suicide is acted to kill oneself, performed by individual himself consciously causes death in many cases either in direct or indirect form. (Durkheim, 1897)

Suicidal behavior

Suicidal behavior is intense feelings of hopelessness, depression, or killing oneself or ending once own life. also called Parasuicidal behavior (Kreipe, 2007)

Common terminologies used for suicide

Different terminologies are used for suicidal attempts. The terminologies used for suicide are parasuicide, cyber-suicide, copycat suicide, and anniversary suicide. Para-suicide is when a person harmed oneself but in actual do not want to die. The cyber-suicide is a pact made between two or more individuals met on internet and plans to kill themselves through social media (like on Facebook or twitter). Copycat suicide is suicide attempted by copying some well-known model whose suicidal attempt got extensive media coverage. Also known as Werther syndrome. The anniversary suicide these people attempt suicide in same day when their family member or loved one did it (Shetty, 2014)

Causes Of suicidal behavior, suicidal ideation, and plan

There are many underlying causes behind suicidal ideation and attempts. Mostly it happens when one thinks that he has no control over the overwhelming life situations. Hopelessness, depression, and any failure in life causes person to thought suicide as solution of their defeat and burdensomeness. Suicide can also be caused by genetic links as people who became succeeded in their suicidal plan may have family history of suicide. (Kennebeck et al., 2018).

Types of suicide

Durkheim’s theory which is considered as most valid theory till now defines the types of suicide that are egoistic, altruistic, and anomic. Egoistic suicide is type of suicide a person does when social interaction is low. The person feels loneliness and usually becomes self-centered. The altruistic suicide occurs when persons social interaction is high, and he had intimate relationships. Due to over integration from social circle person commit suicide. The anomic suicide is suicide which is chosen by the individual due to sudden situation like winning lottery, breakdown from society etc. the fatalistic suicide is generally due to hopelessness, lack of purpose. Generally committed by barren women, servants, and slaves. (Suhasini, 2014)

Risk factors of suicide and suicidal behavior

Risk factors that triggers suicidal behavior, ideation and plan are incarceration, poor job security or low levels of job satisfaction, history of being abused or witnessing continuous abuse, being diagnosed with a serious medical condition, such as cancer, HIV, being socially isolated or a victim of bullying or harassment, substance use disorder, childhood abuse or trauma, family history of suicide, previous suicide attempts, having a chronic disease, social loss, such as the loss of a significant relationship, loss of a job, access to lethal means, including firearms and drugs, being exposed to suicide, difficulty seeking help or support and lack of access to mental health or substance use treatment. 

Methods of suicide

Common methods of suicide are orally taking pesticide poisoning, hanging oneself with fans or other stimulus at height, firearms, using overdose of prescribed drugs or medicines, fatal injuries, exsanguinations, suffocations, and drowning. The ratios of attempting suicide are different in males and females due to difference in methods they choose to kill themselves.

Stages of suicide

Suicide do not happen all at once, but it is long process of thoughts that motivates and triggers person continuously and develop aversive negative awareness of self that motivates induvial to get escape from self who id at downhill’s.  The stages which are considered most important in attempting suicide. The first one is falling short of expectations. This happens when a person has high standards of expectations from others and do not get response according to our expectations then this raise to hopelessness and disappointment.

Second is attribution of self in which a person attributes failure internally and has positive perception of world and negative perception of self. In this situation people kept themselves isolated. Those people have self-blaming attitude and they blame themselves for the thing out of their control.

Third stage is high self-awareness and it revolves around people who are extra self-conscious about themselves and have lack of empathetic behavior towards other and cannot bother that other people ignore them.

Affect effect are at fourth stage a person is aware of his/her inadequacies. A person wants to get rid of negative self-awareness and from its associated effects. This can cause psychological pain and creates feeling of anger, anxiety, depression, disgust, and guilt.

Fifth stage is cognitive deconstruction involves setting meaningless goals, set cognitive rigidity and avoid meanings. The person prevents himself from positive self-awareness and emotions. At this stage persons cognitions failed, and temporal perception becomes so slow.

The last Stage is disinhibition in which deconstruction of cognition leads to disinhibition and irrationality. These people have meaningless and impaired thought patterns, reduced death anxiety and fear, tolerance for physical pain increases and people become more passive then dominant and feels like they are dying rather than feeling its ok. (My Fanwy Webb, 2019)

Suicidal warning signs

According to American Association of Suicidology that help us to take preventive measures to save our loved one’s life. These signs are hopelessness, rage, anger seeking revenge, involving in risky behaviors, substance abuse, social withdrawal, sleeping disturbances, mood swings, aimlessness, feelings of burdensomeness and lack of purpose in life.

Suicide and its relationship with drug abuse

Suicide is also important factor in drug abuse as people with substance abuse also have suicidal ideation or behavior or history of previously attempted suicide. About 230 million people or 5% of the world’s adult population, aged from 15 to 64 are estimated to have suicidal ideation and estimated to have used an illicit drug at least once.

Substance abuse, Suicide, and mental health

Substance abuse disorders are, or drug addiction is generally associated with psychological disorders like depression, post-traumatic stress disorders, attention, and anxiety disorders. People with mental illnesses involve in substance abuse and addiction like alcohol, tobacco, and other drugs. Depression and mood disorders are most common effects of substance abuse and withdrawal symptoms.

Suicide is also linked with substance abuse as when people try to withdraw from substance abuse and addiction the suicidal thoughts and possessions may disturb abusers’ brain because brain is relearning to function properly. (Ilgen, 2020)

Drug addiction increases risk for suicidal attempts/behavior. Early stage drug abuse causes poor judgmental abilities, poor impulse control impaired neurotransmitter functioning disinhibit ions leads to suicidal tendencies.

Alcohol use also leads to suicidal ideation. People who drink alcohol at early age have more suicidal thoughts. It is thought that people who drink alcohol has five percent more chances to attempt suicide than social drinkers. In the same way opioid related suicidal cases are increased in last 15 years. Overdose of opioid also leads to suicide. In 2015 Centers for Disease Control and Prevention reported 52,000 drugs overdose deaths out of which 63.1% were due to opioid overdose. More important is heroin also increases 13.5 times more chances of suicide then alcohol use. Not only these but all substances and drugs are a great risk of suicide in people especially at teenage. Suicidal ratios due to different drugs is different like for cocaine use 1.35, for psychostimulant use is 2.10, for benzodiazepine use 3.83, moreover for cannabis use ratio of suicide is 3.89 and 11.36 for sedative use. Independently these drugs such as marijuana, cocaine, alcohol, and cigarette smoking are leading to suicidal attempts. In recent times not a single scale can measure suicidal behavior and causes behind it. Suicidal behavior in individuals can be predict.  Several reports concluded that 83% deaths by suicide are unexpected or unavoidable. (Esang & Ahmed, 2018)

Models of suicidal behaviour, ideation and attempts

Suicide is an important and emerging problem now a days. According to WHO every year 800 000 people die due to suicide and it is the 3rd leading cause of death among teenagers age between 15-19-years. In global word 79% drugs most suicides are held in lower- and middle-income countries. One person dies in every 40 seconds. (World Health Organization [WHO], 2019)

Suicide can be defined as an act consciously attempts of killing oneself and ending one’s own life. Nonfatal thoughts or behaviour of suicide has three kinds: first is suicidal ideation or thoughts includes thinking or involving in activities which is causes serious threat to once own life. Second is Suicidal plan and it refers to adaptation of certain methods or techniques which results in intending them towards death. Third and most critical type and stage is suicidal attempt and it includes using once potential in self injurious behaviors or activities which cause death, fortunately. (Epidemiol, 2008)

Thomas joiner model of suicide

This model is based on Interpersonal-Psychological Theory of Suicide and states that suicide is composed of two psychological experiences. First is perceiving burdensomeness and second is Thwarted Belongingness. In first experience perceived oneself as burden on other and has loss of purpose in life. In second experience a person suffers from isolation and fails in social connection. The important factor ties both these experiences is capability or lack of fear of death and lacking the major human instinct to save oneself from pain. This increases the risk of suicide Moreover it does not happen all sudden but after a long term painful and provocative experiences. (Joiner, 2006)

Integrated motivational-volitional model of suicide

This model consists of 3 phases which are pre-motivational phase (consists of background factors and triggering events), motivational phase (consists of identification or intention’s information) and volitional phase (behavioral enaction). These phases describe the transition from suicidal ideation to suicidal behaviour. In pre motivational phase certain factors triggers the person and motivate him to think of suicide. Triggers can be internal(depression) and external factors (life events, Diathesis, vulnerability, and environment). The motivational phase is drives suicidal ideation towards suicidal intentions/ideation triggered by defeat and humiliation which leads to entrapment which further on causes suicidal ideation and intent, threats to self-moderators for example social problem solving, copying, memory biases and ruminative processes acts as a mediator between humiliation and entrapment while motivational factors like thwarted belongingness, burdensomeness, future thoughts, goals, norm resilience, social supports and attitudes are moderators which can enhance suicidal ideations and also reduce suicidal thoughts. The third phase which is most critical phase is volitional phase. In this phase suicidal ideation leads towards suicidal behaviour or attempt. Volitional factors like access to means, planning, exposure to suicide, impulsivity, physical pain, sensitivity, tolerances about death, imagery and past behaviour acts as moderators in volitional phase. (O'Connor & Kirtley, 2018)

Interpersonal theory of suicidal behaviour

The theory which evolved as main theory in suicidology is the interpersonal theory of suicidal behaviour (IPT) and it stated that suicidal behavior depends on thwarted belongingness and perceived burdensomeness. This theory emphasized that the individual’s capacity of suicidal behaviour is completely different from one’s desire of suicide. This is the basic reason that not every person who has thoughts to kill oneself do the same (Orden et al., 2010)

Mental/Psychological wellbeing

Mental wellbeing is viewed as intrapersonal healthy, supportive, and adaptive functioning that can include positive affiliation and attitude towards self and others. It is also related to ones’ s sense of mastery of skills, personal growth, control on negative emotions, and life satisfaction. (Burns, 2017)

Types of psychological wellbeing

Psychological or mental wellbeing is divided into two main types on which all researchers are agreed one is hedonic and second one is eudemonic. Hedonic wellbeing is related to subjective feelings of happiness and has two important elements that are affection and cognition.

Affective element or component comprises of more positive thinking, behaviour and emotions and less negative thoughts and emotions. A person feels happy when he is satisfied from his life and himself. (Carruthers & Hood, 2004). The second most important but less known type of psychological wellbeing is eudemonic that aims at purposefulness. It means that when we thought that our life has some aim, we remain hopeful and has positive psychological wellbeing. The eudemonic wellbeing which has 6 components: self-acceptance, environmental mastery, positive relationships with family and others, personal growth (both physical and mental, purpose in life and autonomy. These are explained by Carl Ruff in his model of psychological wellbeing known as carl Ruff’s model of psychological wellbeing.

Causes of low psychological/mental wellbeing

There is not only a single cause of poor psychological wellbeing but there are a lot of factors that play vital role in causing decreases in positive psychological wellbeing and helps people involving in mental illnesses like genetic, environmental factors and psychological factors. People who have previous history of mental illness have low psychological or mental wellbeing. Changes in brain functioning due to drug abuse and substance abuse leads to low psychological wellbeing and mental health illnesses. Diet, upbringing, and social exposure are other factors which are considered important for low PWB. (Psych Guides,2020)

Symptoms of low psychological wellbeing

Mental or psychological wellbeing can be raised due to certain factors and decreased due to certain factors the factors that causes change in psychological wellbeing can be emotional and physical. Emotional factors incudes changes in mood, erratic thinking, chronic anxiety, exaggerated sense of self-worth, and impulsive actions whether physical symptoms include weight loss, fatigue, and loss of libido due to depression. Moreover, it also includes malnutrition, weight loss, amenorrhea in women, or electrolyte imbalances caused by self-induced vomiting. Some psychological symptoms include anger, hopelessness, disgust, and helplessness leads to poor wellbeing. Poor mental health/state drives people to commit suicide. National Institute for Mental Health reported that 90% deaths are due to mental disorders. (Psych Guides,2020)

Models of Psychological/Wellbeing

Psychological wellbeing also called mental wellbeing and positive mental state. Happiness and satisfaction lead to positive and high psychological wellbeing. The psychological well-being has two important aspects. First aspect refers to experiencing positive emotions and feels happy and the other aspect is subjective wellbeing.

The term “Hedonic” is used for subjective well-being and it is composed of two components an affective component (high positive affect, low negative affect) and cognitive components (satisfaction with life).it is aimed at an individual experience happiness hen positive affect and satisfaction with life are both high (Carruthers & Hood, 2004). Another term used is “Eudaimonia” wellbeing which refers to meaningful living. (Diener, 2000)

Carl Ruff’s Model of psychological wellbeing

Carl Ruff’s model is a multi-dimensional model demonstrates neither on positive emotions nor on happiness but on balance in all aspects of wellbeing. This model consists of 6 categories including self-acceptance, personal growth, purpose in life, positive relation with others, environmental mastery, autonomy. This model can be used in different cultures as it was already applied in Spain and Columbia, in Sweden, and in Hong Kong. This model focuses on how one can improves his wellbeing and lives better life (Dierendonck et al., 2008).

Psychological wellbeing and suicidal ideation

Ibrahim and his colleagues (2014) explore from their research that there is a positive correlation between psychological wellbeing and suicidal ideation. Mostly it has been seen that depression is main cause of suicidal attempts and behaviour. Depression is caused due to feelings of hopelessness, failure in life and helplessness which predicts that person has poor mental health/wellbeing.

Psychological wellbeing, substance abuse and drug abuse

Visser and Leigh-Anne Routledge founded from his marvelous work on psychological wellbeing that drug addiction plays important role in the impairment of psychological wellbeing. It was concluded that people who abuse drugs have less life satisfaction. Different researchers found that teenage is most obvious age when adolescents prey to substance abuse because it is a stage when they pass through physical, emotional, and psychological development to gain their individuality and matureness. At this stage person can also are low psychological wellbeing if his mental health does not remain stable (Rajalakshmi et al., 2018)

Lively examples of suicide due to PSW

Recent case of suicide which got huge social media coverage was death of an Indian actor Sushant Singh (2020) Rajput who killed himself by hanging due to PTST. Crime Patrol actor Preksha Mehta (2020) attempted suicide by hanging from a ceiling fan She was suffering from depression, disappo