Recovery Month and Suicide Prevention Awareness Month both fall in September. One focuses on people who struggle with addiction, and the other focuses on people we have lost to suicide and those still at risk. In most communities, they run on parallel tracks. The recovery rally and the suicide prevention walk rarely share a stage, and the people planning them don’t often sit in the same meetings.

I have worked with grief, trauma, and addiction for more than 35 years, and I’ve long suspected the two observances are talking about a lot of the same people. This summer, a group of researchers put some solid numbers behind that hunch.

What the Death Certificates Miss

In a commentary published online in July in Injury Prevention, injury epidemiologist Ian Rockett, psychiatrist Eric Caine, and their colleagues looked at U.S. deaths from 2000 through 2024. Over those years, the suicide rate rose 37.5 percent and drug poisoning deaths more than tripled. Yet the rate of drug poisoning deaths officially recorded as suicide went from only 1.3 to 1.8 per 100,000.

If overdose deaths tripled and suicides climbed by more than a third, you would expect overdose suicides to rise along with them. Rockett estimates that as many as 30 percent of overdose deaths labeled accidental or undetermined could be suicides. Part of the problem is how intent gets decided. A medical examiner or coroner has to make that call after the person has died, and when there is no note and no documented psychiatric history, the ruling usually lands on accident. Rockett put it plainly: “Most drug overdoses are the result of motivated behaviors and aren’t ‘accidents’ in the strict sense.”

To get a sense of scale, take the CDC’s latest provisional count of 67,798 overdose deaths for the 12 months ending in March 2026. The official suicide total for 2024 was 48,824. If one in ten of those overdoses was really a suicide, the national suicide count would be roughly 14 percent higher than what we report, and that uses a figure well below Rockett’s estimate. Those deaths aren’t counted as suicides when agencies decide where suicide prevention dollars and research should go.

What Survivors Tell Us

Studies of people who survive an overdose point the same way. In 2019, Hilary Connery and her team at McLean Hospital surveyed 120 adults in treatment for opioid use disorder about what they were feeling right before their most recent overdose. Just over half (58.5 percent) said they had at least some desire to die, and about 21 percent said they definitely wanted to die.

None of that surprises me. When I have asked clients about an overdose, what they’ve told me rarely fits the categories on a death certificate. I hear about exhaustion and about not caring about whether they woke up. Some used more than usual on the anniversary of a death, after losing a custody hearing, or on their first night home from jail. Intent runs along a continuum, and a lot of overdoses fall somewhere in the middle.

The link holds when you start from the other end. Lynch and colleagues (2020) compared people who died by suicide with matched controls across eight U.S. health systems. Those with alcohol, drug, and tobacco use disorders combined had about 11 times the odds of suicide death after adjusting for other risk factors. Among women with multiple substance use disorders, the odds were nearly 17 times higher.

How Big the Overlap Is

SAMHSA released its 2025 National Survey on Drug Use and Health in July. An estimated 44.6 million Americans age 12 and older had a substance use disorder in the past year. Among adults, 13.9 million had serious thoughts of suicide, 4.9 million made a plan, and 2.3 million attempted suicide. About 18.5 million adults had both a mental illness and a substance use disorder.

I think the treatment gap is the most concerning to me. Only 16 percent of people with a substance use disorder got any substance use treatment last year, which leaves roughly 38.5 million people who received no treatment or services at all. Many of them are at high risk for suicide and will never be asked about it by a clinician.

There are real reasons for hope in the numbers, too. Overdose deaths are down about 12 percent from a year earlier, and 73 percent of adults who report having had a substance use problem consider themselves in recovery. Most people do get better, and Recovery Month is a good time to remind people of that.

When Risk Is Highest

Risk tends to spike during transitions. After someone leaves detox, residential treatment, or incarceration, their tolerance is lower, and their stress is usually much higher. Binswanger and colleagues (2007) followed people released from Washington State prisons and found their risk of overdose death in the first two weeks out was about 129 times that of the general population. Those are also the weeks when people get turned down for jobs and housing, find out which relationships survived, and carry a lot of shame, all known drivers of suicidal thinking.

A return to use after time in recovery is another dangerous point. Clients often tell me a relapse proves they’ve failed, and that belief can slide into hopelessness fast. Put hopelessness together with lower tolerance and a drug supply nobody can predict, and it becomes very hard to say where an accidental overdose ends and a suicide attempt begins.

What Would Help

Emergency departments, recovery programs, and outpatient clinics that see someone after a nonfatal overdose should consider the possibility of suicidal intent and ask about intent directly, ideally with a validated screening tool. It takes a minute or two, and in my experience, people answer honestly when the question comes from someone who seems to care about the answer.

Suicide screening also belongs at every stage of addiction treatment, including intake, discharge, and after any return to use. For this population, a good safety plan includes naloxone, a conversation about access to firearms and other lethal means, and the name of a specific person to call.

On the data side, Rockett and Caine recommend a measure called self-injury mortality, which counts recorded suicides together with most deaths from drug self-intoxication. It sidesteps the problem of guessing intent after death and gives policymakers a more accurate read on how many people we are actually losing. Better training and more consistent standards for medical examiners and coroners would help as well.

Locally, the two September campaigns could simply start working together. Recovery organizations can include suicide prevention in their events, and suicide prevention coalitions can invite people in recovery to speak. Plenty of people also don’t know that the 988 Suicide & Crisis Lifeline takes calls about substance use.

A Question From My Own Practice

One of the questions I’ve relied on most in my practice is some version of, “What has kept you going this far?” In solution-focused therapy, we call this a coping question. I’ve used it with people in early recovery and with people who are thinking about ending their lives, and it tends to land with both because it turns their attention toward the ways they have already managed to survive.

The two September observances will probably keep their own logos and events, but I would like to see the people who work in each of them start asking the other’s questions. A counselor in a recovery program can ask about suicidal thoughts, and a crisis line worker can ask about drinking and drug use. Neither question takes long to ask.

If you or someone you love is contemplating suicide, seek help immediately. For help 24/7 dial 988 for the 988 Suicide & Crisis Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit the Psychology Today Therapy Directory.