substance misuse is the second most common risk factor for suicide after major depression and bipolar disorder. both chronic substance misuse as well as acute intoxication are associated. when combined with personal grief, such as bereavement, the risk is further increased. substance misuse is also associated with mental health disorders. most people are under the influence of sedative-hypnotic drugs (such as alcohol or benzodiazepines) when they die by suicide, with alcoholism present in between 15% and 61% of cases. use of prescribed benzodiazepines is associated with an increased rate of suicide and attempted suicide. the pro-suicidal effects of benzodiazepines are suspected to be due to a psychiatric disturbance caused by side effects, such as disinhibition, or withdrawal symptoms. countries that have higher rates of alcohol use and a greater density of bars generally also have higher rates of suicide. about 2.2–3.4% of those who have been treated for alcoholism at some point in their life die by suicide. alcoholics who attempt suicide are usually male, older, and have tried to take their own lives in the past. between 3 and 35% of deaths among those who use heroin are due to suicide (approximately fourteenfold greater than those who do not use). in adolescents who misuse alcohol, neurological and psychological dysfunctions may contribute to the increased risk of suicide. the misuse of cocaine and methamphetamine has a high correlation with suicide. in those who use cocaine, the risk is greatest during the withdrawal phase. those who used inhalants are also at significant risk with around 20% attempting suicide at some point and more than 65% considering it. smoking cigarettes is associated with risk of suicide. there is little evidence as to why this association exists; however, it has been hypothesized that those who are predisposed to smoking are also predisposed to suicide, that smoking causes health problems which subsequently make people want to end their life, and that smoking affects brain chemistry causing a propensity for suicide. cannabis, however, does not appear to independently increase the risk. medical conditions there is an association between suicidality and physical health problems such as chronic pain, traumatic brain injury, cancer, chronic fatigue syndrome, kidney failure (requiring hemodialysis), hiv, and systemic lupus erythematosus. the diagnosis of cancer approximately doubles the subsequent frequency of suicide. the prevalence of increased suicidality persisted after adjusting for depressive illness and alcohol abuse. among people with more than one medical condition the frequency was particularly high. in japan, health problems are listed as the primary justification for suicide. sleep disturbances, such as insomnia and sleep apnea, are risk factors for depression and suicide. in some instances, the sleep disturbances may be a risk factor independent of depression. a number of other medical conditions may present with symptoms similar to mood disorders, including hypothyroidism, alzheimer's, brain tumors, systemic lupus erythematosus, and adverse effects from a number of medications (such as beta blockers and steroids). occupational factors certain occupations carry an elevated risk of self-harm and suicide, such as military careers. research in several countries has found that the rate of suicide among former armed forces personnel in particular, and young veterans especially, is markedly higher than that found in the general population. media