Alcohol use disorder has an enormous impact on relationships, generating ambivalence and anger. According to Wasserman [219], many suicidal persons with alcohol dependence have borderline personality disorder. They have contradictory affective reactions and are often confused as to whether others love or hate them and whether they love or hate others. They have difficulty in distinguishing between the good and evil impulses in themselves and other people.
Other Substances, Multiple Substance Use, and Suicide
Moreover, students participating in a national survey in 2001–2002 were 1.25× more likely to meet DSM-IV criteria for an alcohol use disorder relative to an age-matched cohort not attending college (Blanco et al., 2008). Because alcohol use disorder is a well-established risk factor for suicidal behaviors (Hufford, 2001), its heavy use on campuses may play an important role in the suicidal behaviors that occur there. Figure 1 indicates the impact of alcohol abuse and misuse on suicide risk and the importance of the detection and treatment of alcohol use disorders for suicide prevention. Therefore, suicide prevention should focus on the diagnosis and treatment of alcoholism [63] and other substance-related disorders. In view of the strong link between alcoholism and suicide, there is a clear need to provide public health education regarding sensible drinking. The well-established heritability of alcohol consumption and the interaction of genes with social and environmental factors [274] should also be taken into account when dealing with alcohol use as related to suicidal behavior.
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
To save this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Google Drive account.Find out more about saving content to Google how to force yourself to pee for a drug test Drive. To save this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you used this feature, you will be asked to authorise Cambridge Core to connect with your Dropbox account.Find out more about saving content to Dropbox.
Alcohol and suicide
Both longitudinal and cross-sectional aggregate-level studies usually report a significant and positive association between alcohol consumption and suicide [91–93]. Norstrom [94] reported that the estimated alcohol effect was stronger in Sweden (13% per liter) than in France (3% per liter). Furthermore, our analyses identified simple domains of alcohol misuse, such as others’ concerns about drinking, which can be readily understood by the public and targeted, perhaps through motivational interviewing,40 to reduce risk of future suicidal behaviour.
- Comparisons of continuous variables (AUDIT and PHQ Scores) used two-tailed independent t-tests and categorical comparisons used Chi-square tests.
- Results from time-series analyses on aggregate level data from several European countries indicates a stronger effect of alcohol consumption on suicide in low consumption countries than in high consumption countries [54–58].
- There was no clear pattern based on levels of consumption, as there were not consistent differences in suicide attempt and self-harm risk between people with light, moderate, and hazardous drinking consumption.
- The guidelines also recommend incorporating promising, but underused, strategies into current programs where possible, expanding suicide prevention efforts for adolescents and young adults, introducing screening programs, and evaluating the prevention programs.
- The cultural and biological underpinnings of alcohol use may have a preeminent place in this effort.
Study sample
Because suicide is a complex problem, no single approach is likely to contribute to a significant, substantial decline in suicide rates. Clinical studies of suicide prevention are hindered by methodological and ethical problems, especially since many people at risk do not have contact with clinical services. Knowledge solution based treatment & detox about who is at risk of suicide is crucial, and a number of interventions show promising effects. Future research must focus on the development of suicide-prevention based on specific assessment and treatment protocols. The high rate of suicide among adolescents and young adults is a challenge for prevention.
How alcohol misuse relates to death by suicide.
Environmental stressors act on a genetically-determined and environmentally-modulated physical structure that in turn impacts psychological well-being and may cause a psychiatric illness that affects the person’s inner world and paves the way for suicide. Alcohol abuse is a means of easing one’s psychological stress but, at the same time, impacts on all other factors, rendering suicide more likely. Bartels et al. [255] reported that alcohol use was also correlated with depression and suicidal behavior, and depression alone accounted for over 80% of the explained variance in suicidal behavior. Alcohol use alone and the correlation between depression and alcohol use accounted for only small amounts of variance. Several countries have established national suicide prevention strategies which include specific targets for the reduction of suicide. Suicide prevention strategies are targeted at both high-risk groups (selective or indicated) and general population (universal interventions) [226].
Women were more likely to have committed suicide during an acute exacerbation of the illness. Alcoholism was most common among middle-aged men (45%), whereas middle-aged women had a high rate of depressive symptoms (88%). Prior studies of AUA and suicidal behavior have failed to consider that the circumstances and motivations for drinking prior to suicidal behavior may differ in key ways. For example, although seldom considered, alcohol may be used deliberately prior to suicidal behavior in order to remove psychological barriers by increasing courage and numbing fears; anesthetizing the pain of dying18,19; or to make death more likely (e.g., “I mixed alcohol with pills”). Although the use of alcohol for the purpose of facilitating suicidal behavior has rarely been examined, a large case series estimated that approximately one quarter of suicide attempters with AUA fit this pattern,22 suggesting it is common. Assessments of the role of AUA in suicide attempts should begin with establishing if AUA occurred and estimating the amount of alcohol consumed.
Given the high prevalence of alcohol/opioid use alongside escalating rates of suicide, there is a compelling need for attention to their cooccurrence. Although not specifically indicated for suicidal ideation or behavior, SSRIs have been used with some success in decreasing suicidal ideation alongside other depressive symptoms, and reducing alcohol misuse in depressed alcohol users [101, 117–119]. SSRIs consistently produce a modest 15–20% reduction in alcohol consumption [120], however intra-individual reductions in alcohol gallstones and alcohol intake range widely from 10 to 70% [120]. In addition to SSRIs, tricyclic antidepressants are thought to mitigate depressive-like alcohol withdrawal symptoms [121] and may be effective for co-occurring depression and AUD [122, 123]. Double-blinded, randomized, placebo-controlled trials for co-occurring MDD/dysthymia and AUD indicate that antidepressants—particularly non-SSRIs—outperform placebo in the treatment of depression [122], while SSRIs only demonstrate efficacy when restricted to participants without AUD [124].
The interaction indicated that global impairment was an important predictor only among students with minimal alcohol problems scores. Some of these studies have found significant correlations between suicidal ideation and excessive alcohol use (Arria et al., 2009; Lamis et al., 2014, 2016), but others have not (Garlow et al., 2008; Gauthier et al., 2017). Indeed, one study found a significant negative relationship between frequency of alcohol use and the likelihood of seriously considering suicide (Kisch et al., 2005).
Research is needed on whether alcohol use (and degree of use) and suicidal ideation (and degree of ideation) covary generally. Such event-based analysis of drinking and suicidal thoughts and behavior would inform theory and prevention efforts targeting alcohol-involved acts of suicide. Suicide deaths involving heavy alcohol use have increased significantly among women in recent years, according to a new study supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Previous research has shown that alcohol is a risk factor for suicidal behavior and that women have a higher risk than men do for suicide while intoxicated. And in the two decades leading up to 2018, suicide death rates in the United States increased, with the rate among women increasing faster than the rate among men.