Asphyxiation and the Addiction Connection

woman with belt around neck autoerotic asphyxiation
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Asphyxiation is a not uncommon outcome of certain addictions, whether it is accidental or self-inflicted. Asphyxiation, also known as asphyxia, broadly speaking is the term used to describe the loss of consciousness or death due to the lack of oxygen.

Asphyxiation may be caused by suffocation, smothering, strangling, choking, drowning, Injury, exposure to noxious gases (such as carbon monoxide), or such medical conditions as sleep apnea, acute respiratory distress syndrome (ARDS), or congenital central hypoventilation syndrome (CCHS).

Within the context of addiction, we tend to associate asphyxiation with a drug overdose or alcohol poisoning. A less common cause is the intentional self-infliction of strangulation, known as autoerotic asphyxiation.

Drugs and Alcohol

There are several different ways that drug or alcohol use directly or indirectly cause asphyxiation death. One way is through pulmonary aspiration, in which the inhalation of vomit into the lungs directly blocks the flow of oxygen. Unless interventions are made to clear the air passages, a person can literally choke to death on his own vomit. Sometimes the aspirated material can get into the lungs leading to pneumonia.

Alcohol, in particular, has a tendency to produce large amounts of liquid vomit. When intoxicated, people are not only less in control of their motor and mental functions, many of their natural reflexes—including the pharyngeal reflex (a.k.a. gag reflex)—are immobilized by the depressive effects of alcohol. This was the cause of death for rock legend Jimi Hendrix and Bon Scott, the lead singer of the rock band AC/DC.

According to the research from the National Programme on Substance Abuse Deaths in London, 23% of all overdose deaths are caused by asphyxiation, second only to direct acute overdose (drug poisoning).

Another type of asphyxiation occurs when an overdose of a drug like heroin causes a person's respiration to drop to where it can no longer sustain life. What ultimately starts with respiratory depression (hypoventilation) eventually become respiratory arrest (the complete termination of breathing).

Others cease breathing as a result of a seizure during drug or alcohol withdrawal. This is most likely to occur outside of a substance abuse treatment center or in the absence of the appropriate medical care.

Risk Factors

According to data from the National Institute of Drug Abuse, the rate of drug overdose deaths in the United States has climbed dramatically in recent years, increasing from just over 20,000 deaths in 2002 to 70,237 deaths in 2017. Alcohol poisoning, for which asphyxiation is a common feature, accounts for an additional 2,200 deaths each year.

Age also plays a role in the risk of death. Drug overdose deaths tend to occur mostly between the ages of 15 and 44, affecting male, female, and racial populations equally. By contrast, most people who die of alcohol poisoning are mainly white males between the ages of 35 and 64.

By and large, opioid drugs remain the leading cause of substance induced deaths in the United States, accounting for roughly 65% of overdose deaths each year.

Moreover, while 52% of drug overdose deaths are attributed to a single pharmaceutical or illicit drug, 26% involved two drugs and 22% involved three or more drugs. The combination of certain drugs are known to increase the risk of death, according to the statistics from the Centers for Disease Control and Prevention (CDC) between 2010 and 2014:

  • 18% of all deaths methadone deaths involved Xanax.
  • 20% of all metamphetamine deaths involved heroin.
  • 20% of all overdose deaths involved heroin and cocaine.
  • 23% of all oxycodone deaths involved Xanax.
  • 26% of hydrocodone deaths involved Xanax (alprazolam).
  • 37% of all cocaine deaths involved heroin.
  • Between 12% and 22% of all overdose deaths involved alcohol.

Top 10 Drugs Linked to Overdose Death

The 10 drugs most commonly linked to drug overdose death in the United States (by order of reported deaths in 2014) are:

  1. Heroin (10,863)
  2. Cocaine (5,856)
  3. Oxycodone (5,417)
  4. Alprazolam (4,217)
  5. Fentanyl (4,200)
  6. Morphine (4,022)
  7. Methamphetamine (3,728)
  8. Methadone (3,495)
  9. Hydrocodone (3,274)
  10. Alcohol (2,221)

Autoerotic Asphyxiation

Autoerotic asphyxiation (AEA), alternatively known as asphyxiophilia and breath control play, is the intentional and sometimes self-inflicted restriction of breathing for the purpose of sexual arousal. By restricting air intake, either by strangulation and hanging, the rapid buildup of carbon dioxide triggers feelings of giddiness and lightheadedness, intensifying sexual pleasure and orgasm.

Though research is lacking, current evidence suggests that death by AEA affects roughly 0.5 of every million people, translating to a rate of roughly 180 deaths per year in the United States.

AEA is classified as a feature of sexual masochism disorder (SMD) in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) issued by the American Psychiatric Association. Because of its inherent dangers, the practice was given a unique specifier in the DSM-5 and is currently classified as SMD with asphyxiophilia. AEA is considered an infrequent feature of sex addiction and is believed to be more common in men than women.

Asphyxiation by AEA is, by its very definition, accidental. People who participate often establish some sort of "escape mechanism" in the event of unconsciousness. Sometimes, however, the safety release does not work or the participants misjudge the amount of oxygen-deprived. Actor David Carradine was reported to have died this way in 2009.

Risky Practices

Many AEA deaths occur in people who self-strangulate. A common scenario involves a participant who loops one end of a belt, scarf, or rope around the neck and holds the other with his or her free hand. It is presumed that if unconsciousness occurs, the belt or loop will fall out of the participant's hand and release the tension around the neck.

Unfortunately, some deaths have occurred because the belt bar got stuck in a belt hole. Others have happened because the texture of the rope or scarf wasn't slippery enough and ended up holding rather than releasing. Drugs and alcohol only increase the risk, impairing judgment while affecting the person's blood pressure and respiration (particularly with depressants like benzodiazepines).

12 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Elizabeth Hartney, BSc, MSc, MA, PhD
Elizabeth Hartney, BSc, MSc, MA, PhD is a psychologist, professor, and Director of the Centre for Health Leadership and Research at Royal Roads University, Canada.