Many things can lead to suicidal thoughts, and all of them need to be addressed in different ways. However, alcohol and drug abuse have been linked to suicide, and it’s important to remember that no two people use substances for the same reason.

PTSD from trauma, military combat, or a stressful event such as an act of terrorism can all lead to alcohol abuse, as can chronic pain, childhood abuse or surviving a near-fatal accident. For many people, drugs and alcohol can dull the emotional pain from these events, but the risk is twofold; drinking can have a physical effect on the brain as well as a psychological effect, which can cause suicidal thoughts. And for those in recovery, the rush of sudden emotions and memories that can come when there is no alcohol to keep them at bay can send a person into a distressed state.

While depression and clinical disorders are the leading causes of suicide, substance abuse follows closely. According to the CDC, suicide is one of the 10 leading causes of death to those aged 10-64 years having spiked sharply in the last decade. Alcohol abuse can be a sensitive subject to broach with a loved one, but if you suspect they are drinking more than a “social” amount and appear depressed or withdrawn, there are things you can do to recognize the signs of potential suicidal behavior and help address them.

Behavior

In most cases of substance abuse, a person’s behavior will change, sometimes drastically. You might notice that they have withdrawn from friends and family or have become violent. They may sleep much more than usual or be unable to sleep. If your loved one is in school, their performance may suffer dramatically or they might display aggressive or reckless behavior. Some of these may lead to discipline from school officials or legal troubles. A suicidal person may begin to talk about harming themselves, or they might say things such as, “Everyone would be better off without me.”

Appearance

If you notice that your loved one has changed dramatically in their appearance, it may be cause for concern when coupled with any of the behaviors above. Sudden weight loss, an unkempt appearance or lack of proper hygiene habits, or a sudden disinterest in wearing makeup or clean clothing can all be warning signs.

It can be tricky to know how to approach these situations; you may be loath to make your loved one upset or offended, or you may feel that bringing up the topic of suicide might put the idea into their mind if it wasn’t already there. However, talking openly and allowing them to vent their feelings shows that you are taking them seriously and are listening to their problems, which could be exactly what they need.

It’s important to remember that where feelings of depression and suicide are concerned, there may be issues that you don’t fully understand and that’s okay. Shame should never be introduced to a person who has been having these thoughts.

Many people suffer from feelings of hopelessness, isolation, and self-loathing which can make life unbearable, and sometimes they see no other way out. While it’s perfectly okay to let them know they are not alone and that you are there for them, it is never advisable to tell a suicidal person that they are wrong for the feelings they’re having, or that they should justify their thoughts.

If the threat of suicide seems imminent, don’t hesitate; call for help. If possible, remove any items from the area that your loved one can use to cause harm to themselves. Never leave them alone.