Driving Under the Influence

In September 2014, Michael Phelps, the most decorated Olympic athlete of all time, received his second DUI citation. Ten years earlier he had pleaded guilty to his first DUI charge and was sentenced to probation. A requirement of his probation was to talk to high school students about alcohol. This time, Phelps was also charged with speeding and crossing a double yellow line. After that, he said he felt he was in a dark place and did not want to be alive anymore (Michael Phelps, 2015). His license was suspended, and Michael went into inpatient treatment. He was fortunate that he was once again put on probation. However, the fact that Michael Phelps considered suicide after his DUI suggests how devastating it can be. The greatest success may not be enough to counter the stigma of a DUI; indeed, status may enhance it.

Of all the legal issues, DUIs may represent the most overlooked risk factor in suicide. Little research has been done on the topic, but one finding indicates that as the rate of car accidents related to DUIs increases, so does the suicide rate (Hourani et al., 2006). In our sample, 36 cases of suicide mentioned DUIs as a precipitating event. This represented approximately 3% of our sample, but likely other cases existed where we were not aware of the DUI, because it was not mentioned in the coroner’s report or in the note. Ninety-two percent were men who ranged in age from 23 to 69. Although the average age was 46, more than two-thirds of the sample were over 40 years old. Most of the victims used guns (50%), followed by asphyxia (31%), and toxic substances (19%). Approximately two-thirds killed themselves at home.

There were blue-collar workers and professionals, including a judge, a lawyer, a retired physician, and a coroner’s office investigator. We were able to determine the motivation for all but one individual. Although a few were motivated by relationship problems (8%) or felt like a failure (3%), the vast majority were attempting to escape from legal (14%) or psychological (3%) problems or, like Eric, a multitude of problems (70%). The psychological problems were not always specified, but when they were, most individuals were reported to be depressed. They were also struggling with medical (36%), interpersonal (39%), or financial issues (20%). It is not surprising then that in their notes, they spoke of “messing things up” or being out of options. One note read:

Similarly, another individual spoke about her mess but also spoke of her exhaustion: “Please forgive me. This is the last mess of mine you will ever have to clean up… I love you & I’m sorry. Suicide is selfish and devastating act. But little by little, bit by bit, I’ve been worn out.”

For many of these individuals, the DUI was simply the last straw. Eric’s was a typical scenario. He received a DUI, which would likely lead to a career loss, financial concerns, and the possibility of prison. It was simply too overwhelming to overcome a lifelong addiction and all the consequences from the addiction. Another individual’s note read:

Others were more succinct: “I can’t fight anymore too much on my head.” In each of these notes, from the longest to the shortest, the sense of “too much” was clear. Coupled with a drinking problem and the legal issues, all of the other problems became a tidal wave of difficulty.

For at least one-third of our DUI sample, it was not their first DUI offense. One person had received two DUIs in one day while another received two DUIs within a month. One individual was in a treatment facility for his drinking. For these people, it is likely that in addition to the loss of a driver’s license, the consequences would include time in jail, prison, or a treatment facility. The coroner’s reports stated that many non–note writers had indicated to friends that they would kill themselves before going to jail. One note writer said:

In a report summarizing CDC data on over 10,000 suicide victims, approximately one-third of their toxicology tests were positive for alcohol (Parks, Johnson, McDaniel, & Gladden, 2014). About half of our DUI sample were drinking or abusing substances when they killed themselves, probably to make the task easier. Some of them had just been escorted to their homes by police and immediately killed themselves, so they were still drunk. While researchers have examined the suicides of those taken to jail, no comprehensive study exists of suicides after police have taken someone home. One recent British study observed community-based offenders on a “criminal justice pathway,” not those in jail, and found they were at increased risk of suicide (King et al., 2015).

Most individuals killed themselves within 24 hours of their arrest or shortly before their court appearances. If they did not kill themselves immediately, some may have used that time to get their affairs in order, then killed themselves before a decision could be rendered or a warrant could be issued for their failure to appear. Others may have experienced a period of mounting stress that they found they could not handle; tunnel vision may have set in. Once in jail, it becomes much more difficult to kill oneself, and the options become limited.

Given these patterns, there are obvious points of intervention. Since receiving a DUI is clearly a risk factor for suicide, one potential initial point of intervention is through the arresting officer or at the police station. A police officer would not want to tell someone who has been arrested for a DUI, and is likely drunk, that apparently a relationship exists between DUIs and suicide. Yet police could routinely provide contact information for crisis intervention options before releasing someone. In fact, police should do this routinely on all arrests. Additionally, holding an individual until he is sober or has a responsible party who will stay with him until he is sober, should be standard policy. Training police to recognize suicidal risk factors, as well as suicidal ideation and behavior, and to act as intervention teams, is practiced in some jurisdictions, but mainly in the form of pilot programs or grant programs (Draper, Murphy, Vega, Covington, & McKeon, 2015; Sareen et al., 2013). Mastrofski and Ritti (1996) found that whether police officers enforce DUI laws is more affected by supportive organizational management than by their personal attitudes. Training matters. By implication, officers trained to behave in a way attentive to suicide risk toward DUI offenders might lower the risk.

If suicide can be prevented during those first 24 hours following arrest, the focus should then shift to listening to the individual’s dialogue with others. When someone has received a DUI, particularly multiple DUIs, he or she may begin to develop tunnel vision and talk about seeing no way out of the situation. At least a third of our DUI sample—and this finding is supported by other research—made suicidal threats or expressed suicidal ideation, but these were dismissed by friends, family, and even some professionals (Parks et al., 2014). Individuals may also talk about prison and their fears related to incarceration or punishment. At this point, it is critical to break the cycle of all-or-none thinking and help the person to examine options.

Cook (2013) also found a risk of suicide among those who had recently received a DUI and suggested that prevention efforts should be broadened to include the period between arrest and arraignment. In our sample, the 48 hours before court appearances represented an especially critical period. For those who had not committed suicide immediately following the arrest, the day of or day before court appearances were the next most lethal period. Cook suggests developing assessment tools, based on already existing data, to identify individuals who come into contact with the criminal justice system and are at high risk of suicide. Once they are identified, then more interagency cooperation with mental health and substance abuse programs is needed.

In many other cases substance use or other addictions played a key role in the commission of a crime, but were not the reason for the arrest. The backdrop of substance use, abuse, and addiction can be seen in some of the following criminal cases.

Other Crimes

Norbert had a gambling problem, and his credit card debt became astronomical. When he failed to make minimum payments, he was sued by the company, resulting in garnishment of his wages. Norbert worked at a retirement community, and while helping a resident he stole her credit card. Although he was able to purchase a few things, he quit using the card before it was terminated. It was so easy he stole a second and then a third card from other residents. He was arrested and charged with three counts of theft from a vulnerable population. One day he went to his storage unit and hanged himself. In his note he said, “I’ve been carrying a big ball of guilt, shame, embarrassment hopelessness and worthlessness in my gut.”

Following interpersonal crimes and substance/addiction related crimes, the next largest category of criminal offenses involved money and property, including breaking and entering, theft and robbery (9%). Some of these crimes occurred in the context of other criminal activity or legal involvement. One man broke into his ex-wife’s home, damaged property, and then stole her jewelry. Other common crimes included assault and homicide (7%), and rape, sexual assault, child molestation, or child pornography (4%). Conviction for any of these crimes would likely result in a long prison sentence.

Some individuals, like Norbert, expressed remorse for their crimes. Others were angry at their victims. In his note, one middle-aged man spoke of his love for his fiancée, children, and grandchildren, then quoted Bible verses extensively. Intermittently his note turned bitter and vengeful as he placed fault with the victim. He stated,

A college student, charged with drunk and disorderly conduct and felonious assault on a police officer, blamed the female officer for his actions. He said,

Beyond remorse and blame, the notes were interesting in what they addressed and did not address. Most of the notes were organized, and many provided some justification for why the victims were choosing suicide. For example, one individual who committed rape left a note saying, “I’m sorry for my actions! I can’t live with myself. Please forgive me. My insides are just full of guilt!” Like the overall set of note writers, most individuals expressed love for others (77%) and many offered an apology to a specific person (58%). One woman who was charged with prescription fraud wrote, “I love you very much but I just can’t stay out of trouble and you deserve better.” They frequently talked about God (42%) and many asked for forgiveness (39%). About one-fourth of the notes absolved someone from blame or, conversely, blamed someone. Approximately a third talked about their legal problems. Some talked about justice in general. For example, a 56-year-old man closely paraphrased the King James Bible, Philippians 4:8, changing the word “virtue” in the original to “justice” in the note, “And finally whatsoever things are just, whatsoever things are true, whatsoever things are pure, whatsoever things are lovely, whatsoever things are of good report, if there be any justice, if there be any praise, think on these things. Dont cry bean it’s only trying to fix a whole in the ocean.” The last sentence was a blended quotation from a movie, El Camino de la Vida (1956), about three boys awaiting sentencing in a juvenile court, and “Glass Onion” by the Beatles on The White Album (1969).

These notes had a very different tone from those found with individuals who were motivated by interpersonal issues. It was rare to see anyone speak about being sad, lonely, or lacking joy. Unlike those suffering from physical or mental illness, no one talked about being tired or tired of living. More often the decision to commit suicide referred to the “mess” they had made which was solely or partly related to their legal involvement. Many left advice, “Don’t let Bernie grow up to be like his dad and don’t let him grow up not knowing his grandma and Grandpa Paulson. I’ve screwed up my life. I don’t need to screw his up to…This is no ones fault but mine.”

In short, most of these individuals did not seem to want to die but they simply saw no way out. For some, a chain of events resulted in a total collapse of their lives. Child support represents one of those situations.

Child Support

Jeff was 34 years old and had three children. His ex-wife, Jill, had divorced him over his substance abuse issues. He was $1600 in arrears, and if he could not pay it by the end of the month he was facing six months in jail. He had moved in with his parents and was about to have his beloved truck repossessed. Jeff had told friends that he had a terrible fear of being locked up. As the end of the month drew near, he selected a day, downed a bottle of ibuprofen with a pint of whisky, then slashed his wrists with a box cutter.

Child support begins as a civil issue in family court but can become a criminal issue when there is a failure to provide support. Jeff’s story is representative of many of the child support cases we encountered. Clearly, finances were a problem in most cases. In addition, stable employment eluded most of them, often because of their substance abuse. Finally, many were living in a transient housing situation, such as a motel or with friends or relatives, due to their financial difficulties.

Most of the individuals in our sample owed tens of thousands of dollars in child support and were facing felony charges as a result. One note writer who had been unable to work as a result of the recession in the late 1990s indicated, “I have really work in a year and they still won’t lower my support. I can’t live not noing if I am not going to Jail for it agian and freeze just paid 10,000 and they still won’t lower it.” It was mid-January when he died. Later in the same note the victim wrote, “I do love all five kids with all my heart…I will always take care of you.” In fact, it was common in these notes to find expressions of love for the children.

Inmates and Suicide

In our sample, 25 individuals committed suicide in jail and one in prison. The annual suicide rates are over three times higher in jails when compared to prisons (Cook, 2013). Hayes (2012) has suggested that two precipitating factors for suicide in jail are the environment itself and the fact that the individual is facing a crisis. The jail environment includes a “fear of the unknown, distrust of an authoritarian environment, perceived lack of control over the future, isolation from family and significant others, shame of incarceration, and perceived dehumanizing effects of incarceration” (p. 234). Furthermore, inmates facing a crisis may have numerous personal factors that predispose them to handle the situation poorly, such as a history of substance abuse or mental illness. In addition, they do not know the outcome of their trials as most will be appearing in court in the near future to learn their fates. Perhaps this is why the period before court appearances is a high-risk time for suicide. Suicide can occur any time during detainment, but a peak in suicide occurs following arrest (Cook, 2013), and a resurgence in the days prior to court appearances (Hayes, 2012). Once inmates are in prison, these factors change. This is not to suggest prison is less challenging than jail for inmates, but the environment and crises become more chronic and less acute. In some ways, the inmate may have greater perceived control and the challenge becomes more one of adaptation to the prison and loss of social support.

Consistent with a national sample, the jail inmates in our sample were an average age of 35 and male (93%), and they all hanged themselves in their cells (Hayes, 2012). At least one-third had a history of substance abuse and approximately one-fourth had a history of mental illness, including depression or multiple diagnoses. Additionally, 23% were known to have made previous suicide attempts.

When Joiner’s (2005) model of interpersonal theory of suicide was applied to jail inmates in one sample, only thwarted belongingness was associated with past or predicted future suicidal behavior (Simlot, McFarland, & Lester, 2013). In our sample, only two inmates left notes that we could examine, but neither of them spoke of perceived burdensomeness. However, during this period, detainees have limited access to writing utensils or paper so it is difficult to leave a note. Coroners’ reports indicated that at least 23% of our inmate sample had reported interpersonal problems and some were in jail on domestic violence charges (15%). These charges could have led to a perceived loss of social support and may have been the key factor for those who were in jail and considering their uncertain futures. The fact that they had not been bailed out of jail supports the notion that they had exhausted their social supports or thwarted their belongingness. Conversely, those who were out on bail spoke less of thwarted belongingness and more of causing trouble for others or creating a “mess.” Since they had been bailed out they clearly still had social support, but they may have felt they were becoming a burden.

Comparing data from 1985 to 1986 to data from 2005 to 2006 shows that suicide rates have been declining in detention facilities (Hayes, 2012). This decline could be due to the fact that screening for suicide risk has increased, as have staff trainings. Also more protocols and policies are in place for how to handle at-risk individuals and what to do when someone harms himself. Nevertheless, trainings can be inadequate and infrequent, and screenings may not always be conducted (Hayes, 2012). Much more could be done, including enhancing the safety of cells and creating a death review process when inmates do commit suicide. A death review would involve an examination of the circumstances surrounding the suicide which could provide policy recommendations (Hayes, 2012).

In spite of the fact that proportionately more suicides occur in jails than in prisons, much more research exists on suicide committed in prisons, perhaps because it is the leading cause of violent death in prisons. When prisoners who had attempted suicide were interviewed about when they formed the initial intent to commit suicide, how they planned, prepared and carried out the act, and their reflections on it, they identified many of the risk factors already presented (Rivlin, Ferris, Marzano, Fazel, & Hawton, 2013). The reasons for their self-harm were grouped into three categories: “adverse life events; criminal justice or prison-related issues; and psychiatric or psychological factors” (p. 311). Adverse life events involved interpersonal relationship issues including bereavement. The most frequently cited psychiatric or psychological factor was drug or alcohol withdrawal. However, most prisoners indicated that they had multiple reasons for their suicide attempt. Moreover, they acted impulsively, with 40% indicating they did not think about the act for more than a few minutes and another 20% considered it for three hours or less. Approximately one-third left a note while another third had told someone, usually family or mental health personnel, of their wishes to die. Prisoners were interviewed within four weeks of their attempts and, in retrospect, commonly reported their actions were “stupid.”