A known risk factor for suicide globally is substance use. Despite being public health problems across the globe, research on the association between suicide and substance use have often ignored the socio-cultural context in which these behaviors play out. This qualitative study examines bereaved persons’ perception of the roles of substance use in the lifestyles and the suicides of their deceased relations. We conducted an in-depth qualitative interview with between two to seven close relations of nine men who killed themselves in Ghana in the period 2014 and 2015. A qualitative content analysis of bereaved persons’ accounts shows three themes: Behavioral changes connected with substance use, Consequences of substance use and misuse, and Alcohol presence in the suicide act. Thus, novel and excessive alcohol or drug use followed economic, financial, or relational stressors faced by the men. Personal disruption and social disintegration occurring as consequences of continued substance use triggered suicidal behaviors, which in turn appeared to have shaped in particular, use of alcohol as ingredients or tools in the suicide acts itself in some of the suicides. Contextual nuances shaping a dynamic interrelationship between substance use and suicide calls attention to viewing substances as ingredients with shifting functions during the suicidal process. We propose that encouraging emotional disclosure, supporting men with problem-solving skills, and regulating the availability and use of substances through effective alcohol and drug policies may be vital for an integrative public health approach towards suicide prevention in Ghana.
