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, 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 addition, 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, commonly associated with sex addiction.

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 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.

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 reggae legend Jimi Hendrix and Bon Scott, the lead singer of the rock band ACDC.

According to the research from the National Programme on Substance Abuse Deaths in London, 23 percent 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 72,306 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 39, 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 drug or alcohol abuse deaths in the United States, accounting for roughly 65 percent of overdose deaths each year.

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

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

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