The Effects of Substance Abuse and Self-Harm

Substance abuse is a risk factor for self-harm, or self-injury.1 Drinking alcohol or doing drugs while engaging in self-harm increases the likelihood of more severe injury, according to the National Alliance on Mental Illness (NAMI).2 Both substance abuse and self-harm are also risk factors for suicide.3,4

What Is Self-Harm?

Self-harm words

Self-harm, sometimes called self-injury, means hurting yourself intentionally.2 Forms of self-harm include:1, 2

  • Cutting yourself with a knife or other sharp object.
  • Biting yourself.
  • Burning yourself with cigarettes or candles/matches.
  • Pulling out your hair.
  • Picking at scars to reopen them.
  • Hitting yourself or other things such as a wall.

Self-harm is a behavior, not a disorder, but it may be a symptom of an underlying mental health disorder (though self-harm can occur in the absence of mental illness).2 Mental health disorders commonly associated with self-harming behaviors include:2

Some people who self-harm do so in an attempt to cope with overwhelming emotional distress, to feel something if they’re experiencing emotional numbness, or to punish themselves. NAMI states that those most at-risk of self-harm include victims of trauma, abuse, or neglect.2

Is Self-Harm a Suicide Attempt?

Self-harm is not the same as a suicide attempt, and most people who self-harm do not intend to die; however, while self-harm and suicide are different, self-harm indicates a level of emotional distress that needs to be taken seriously.2  In some cases, someone who self-harms may be attempting to show others they need help.1

Though the behaviors themselves may be distinct, in some cases self-harm and suicide may be associated with each other. In such instances, self-harming behaviors may predate or be risk factors for later suicidal thoughts or behaviors.3 In fact, self-harm is one of the strongest predictors of completed suicide.5

Signs of Self-Harm

Signs that someone is engaging in self-harming behaviors include: 1,2,6

  • Having frequent unexplained injuries such as cuts or bruises or often wearing bandages.
  • Having sharp objects around without reason.
  • Always wearing pants or long-sleeved tops, even in very hot weather.
  • Avoiding situations that would require exposing certain body parts that are affected (e.g., swimming).
  • Lying about where injuries came from.
  • Depressed or anxious mood.
  • Mood swings.
  • Loss of interest in hobbies.
  • Withdrawal and isolation.
  • Bald spots/patches that would indicate hair-pulling.
  • Signs of drug or alcohol abuse (see below).

Self-Harm and Substance Use

Self-harm and substance abuse share many common risk factors, often co-occur, and have the potential for serious harmful outcomes. The combination of self-harm and drug abuse can be a very dangerous one and could increase the likelihood of more severe health consequences in the longer-term.

Shared Risk Factors

Substance abuse and self-harm share many of the same risk factors. These include:7–11

  • Trauma.
  • Physical abuse.
  • Sexual abuse or assault.
  • Emotional abuse.
  • Neglect.
  • Bullying.
  • Parental/familial substance abuse.
  • Mental health disorders, such as depression, anxiety disorder, or eating disorder.
  • Loss of one or both parents.

Risk in Adolescents

Research has shown a strong link between self-harming behaviors and substance use in adolescence.5

Also, those who self-harmed during their adolescence were found to be at increased risk of abusing substances or becoming substance-dependent in adulthood.5

Early Mortality Risk

Self-harm may result in accidental death, and substances may increase this risk since intoxication could result in more severe, self-inflicted injury than intended.2 As substance abuse is also a risk factor for suicide, those who abuse drugs or alcohol may be more at risk than those who only self-harm.

Overall, abuse of drugs or alcohol has been shown to contribute to a large degree to disease and early mortality of those who self-harm.5

Signs of Substance Abuse 

a young woman showing signs of substance abuse

Some warning signs of drug or alcohol abuse include:12–14

  • Decline in hygiene and a lack of attention to grooming/appearance.
  • Bloodshot eyes.
  • Unusual smells on the body, breath, or clothes.
  • Acting more secretive than usual.
  • Problems at work or school.
  • Change in friend groups or hobbies.
  • Lack of interest in activities once enjoyed.
  • Sleeping more or less than usual.
  • Eating more or less than usual.
  • Displaying mood changes such as seeming more depressed or hostile than usual.
  • Experiencing sudden shifts in mood.
  • Acting more talkative or energetic than usual.
  • Saying things that don’t make sense.
  • Seeming paranoid or fearful with no reason.
  • Acting withdrawn.
  • Increased conflict with loved ones.
  • Engaging in risky behavior such as having unprotected sex.
  • Legal problems related to substance use, such as DUIs.

Though not always specific to substance use, some of the above changes could suggest that a friend or family member is struggling with drugs or alcohol. If they’re displaying signs of both self-harm and substance abuse, they may be at very serious risk of severe injury. They may also be suffering from a mental health disorder such as depression. There are numerous treatment programs that understand the interplay between drug use and mental health and are able to treat both at once.

To discuss options for co-occurring disorder treatment at Laguna Treatment Hospital, call us today at . Our admissions navigators are available around-the-clock to help you decide on an appropriate program and discuss our admissions process.


  1. U.S. National Library of Medicine. (2016). Self-Harm.
  2. National Alliance on Mental Illness. (2015). Self-Harm.
  3. Whitlock, J., Minton, R., Babington, P., & Ernhout, C. (2015). The relationship between non-suicidal self-injury and suicide. The Information Brief Series, Cornell Research Program on Self-Injury and Recovery. Cornell University, Ithaca, NY.
  4. U.S. Department of Health and Human Services. (2008). Does alcohol and other drug abuse increase the risk for suicide?
  5. Moran, P., Coffey, C., Romaniuk, H., Degenhardt, L., Borschmann, R., & Patton, G. C. (2015). Substance use in adulthood following adolescent self-harm: a population-based cohort studyActa psychiatrica Scandinavica131(1), 61–68.
  6. Australian Government Department of Health. (2019). Self-harm.
  7. Whitesell, M., Bachand, A., Peel, J., & Brown, M. (2013). Familial, social, and individual factors contributing to risk for adolescent substance useJournal of addiction2013, 579310.
  8. Centre for Suicide Prevention. (n.d.). Self-Harm and Suicide.
  9. Mental Health Foundation. (n.d.). The Truth About Self-Harm.
  10. Hamdan, S., Melhem, N. M., Porta, G., Song, M. S., & Brent, D. A. (2013). Alcohol and substance abuse in parentally bereaved youth.The Journal of clinical psychiatry74(8), 828–833.
  11. DeCamp, W., & Bakken, N. W. (2016). Self-injury, suicide ideation, and sexual orientation: differences in causes and correlates among high school studentsJournal of injury & violence research8(1), 15–24.
  12. National Institute on Drug Abuse. (2014). What are signs of drug use in adolescents, and what role can parents play in getting treatment?
  13. National Institute on Drug Abuse. (n.d.). What are some signs and symptoms of someone with a drug use problem?
  14. Tennessee Department of Mental Health & Substance Abuse Services. (n.d.). Warning Signs of Drug Abuse.


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