FREMONT, Neb. -- Empty beer bottles and half-smoked joints greet Lynn Miller when she visits the grave of her son, James. The litter reminds her, every time, of how James lived and how he died.
James Farrand, 19, was drunk and on antidepressants -- which he apparently stole from a friend -- the Saturday night he walked past his mother, locked the door to her bedroom, found a handgun in her dresser and shot himself.
The pressure had been building on James. Two weeks before his death, James was arrested for drinking and possession of drug paraphernalia. It was his latest in a string of drug-related arrests, and the consequences with authorities in Fremont were likely to be severe.
A girlfriend wanted to break up with him, and James threatened that he would shoot himself if she did. The night before his death, he fought with the girl's new love interest.
Breakups, violence and arrests are known to have set off teen suicide. But especially in older teens, there are few things as strongly linked to suicidal behavior as abusing drugs and alcohol.
It isn't necessarily a cause and effect. Sometimes, teens use drugs to numb the pain of depression, which is also behind the suicide attempt. Sometimes, intoxication simply robs a teen of good judgment against self-harm.
"When someone is suicidal, I see it as tunnel vision, " said Dave Miers, a Lincoln mental health services administrator and chairman of the Nebraska Health and Human Services System's suicide prevention committee. When you add to that drinking, he said, the risk of harm only increases.
Researchers at Columbia University in New York City found that 35 percent of teens who committed suicide had severe problems with drugs or alcohol. Among those ages 18 and 19, it was 62 percent.
Interviews by The World-Herald offered similar results. The newspaper asked the parents of 37 Nebraska youths lost to suicide whether their children had frequently used illegal drugs or alcohol.
The parents of 15, or 41 percent, of the youths indicated their children had used illegal drugs such as marijuana, methamphetamine or stolen prescription drugs. Eighteen, or 49 percent, said their children drank alcohol frequently. Among 11 suicide victims who were 18 or 19 when they died, all but one had abused drugs or alcohol.
The parents of 27 of the youths knew for sure whether or not their children were intoxicated when they died. The parents of seven said their children were. One of them was James Farrand.
While a friend was passed out in his room, James found a handgun in his mother's room and searched for a bullet. He found one before his mother could break through the locked door.
After the gunshot, Lynn ran outside her house and looked back through the picture window. Her son had died.
An autopsy showed twice the legal limit of alcohol in his bloodstream.
Teens abusing alcohol or drugs regularly don't have to be drunk or high to be at risk for suicide, though. When sober, drinkers and drug users can feel restless and irritable, and these withdrawal symptoms can push them to deadly decisions.
The lead researcher at Columbia, Dr. David Shaffer, said drugs and alcohol can be particularly troublesome for depressed teens who have access to firearms.
Drunken teens may have difficulty with other, more complicated means of suicide, he said. They may, for example, not have the wherewithal to gather enough pills or fashion a noose. But guns are relatively simple.
This may help explain why Nebraska's teen suicide rate is onethird worse than the nation's. A 2003 federal survey of youth behaviors found that Nebraska teens are more likely to binge drink, more likely to drive drunk and more likely to carry guns.
The same survey also found that Nebraska had the highest rate in any state of teens who had planned how they would commit suicide.
James Farrand had a turbulent upbringing. His mother gave birth as a teenager and then gave custody of James to her parents. He moved back with his mother a few months before he died.
It was an awkward setup, because Lynn didn't feel she had the right to discipline a son she hadn't really raised. She was more like a sister, even as he was making destructive choices through his increasing substance abuse.
"The alcohol and drugs on top of each other, " Lynn said, "just didn't mix."
Stop reading. Talk to a parent, friend, counselor, clergy member, or doctor. Or call the Girls and Boys Town National Hotline, (800) 448-3000, or the Hopeline Network, (800) 784-2433.