Regarding potential underlying mechanisms that may explain how, when, and to what extent risk and protective factors interact, to increase or decrease the likelihood of suicidal and substance use behavior, it is clear that multiple factors are involved in a developmental-transactional framework. One possibility is that stressful life events trigger suicidal or substance use behaviors in an attempt to relieve or reduce stress (Goldston, 2004; Goldston et al. 2008). For instance, some adolescents report that they attempt suicide or engage in self-harm in an effort “to get relief ” or “to escape” (Boergers et al. 1998; Hawton et al. 1982; Kienhorst et al. 1995) or to “stop bad feelings” (Nixon et al. 2002; Nock and Prinstein, 2004). Furthermore, the relationship between suicidal behavior and substance use may result from a desire to escape problems or to “self-medicate” (Hufford, 2001; Khantzain, 1997). This “relief/escape” mechanism may result in the co-occurrence of suicidal and substance use behaviors. For example, suicidal ideation is associated with high levels of stress, and the anxiolytic or euphoric effect of particular substances may reduce stress (Light et
