A suicide attempt is «a non-fatal self-directed potentially injurious behavior with any intent to die as a result of the behavior» 16. A completed suicide is «a death caused by self-directed injurious behavior with any intent to die as a result of the behavior» 16. The studies reporting suicide as a general term without distinguishing between suicidal ideation, suicide attempt, or completed suicide were excluded. To investigate the association between alcohol use and our three outcomes, we conducted multivariable logistic regressions.
Data Availability Statement
In 1996, O’Carroll et al. 29 proposed a classification based on three characteristics, that is, intent to die, evidence of self-inflicted injury and outcome (injury, no injury and death). Another strong correlation is that alcohol and mind-altering substances are used as means of self-medication to cope with untreated mental health disorders, the symptoms of which are reciprocally exacerbated by substances. This causes a spiral effect of emotional decline and mental impairment that occurs with chronic alcohol and drug use and intoxication.
Association between AUDIT score risk categories and suicidal behaviour
However, more investigation is required before making any statements on the link between alcohol and suicide. Part of preventing suicide is raising awareness around the topic and bringing it into conversations. The topic of suicide is surrounded by secrecy, which is one of the barriers to getting treatment for people who need it.
The high rate of suicide among adolescents and young adults is a challenge for prevention. The CDC’s National Center for Injury Prevention and Control 259 published guidelines for the development of intervention strategies for communities interested in adolescent and youth suicide prevention programs. The strategies focus on identifying youths at risk so as to direct them to healthcare centres, defining the risk factors, and providing support to manage stressful life events. The guidelines recommend making sure that suicide prevention programs are strongly linked with the mental health resources in the community. A good prevention program should adopt a broad spectrum approach since suicide cannot be explained with linear cause-and-effect logic, but rather as a complex and multidimensional phenomenon. 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.
Links between alcohol use and suicidal behavior
Alcohol becomes a way of facilitating communication with others and adapting to the environment. Suicide is also both a social and a personal act and is related to conditions that How to Help an Alcoholic in Denial render life difficult. It is possible that when one decides to commit suicide, he/she may select one of the options available to make the act more socially and personally acceptable, and one of these may be alcohol. The results of research do not support the hypothesis that, when a youth gets drunk, this in itself leads to that youth deciding to commit suicide.
Follow-up studies suggest that alcoholics may be between 60 and 120 times more likely to complete suicide than those free from psychiatric illness 12. Studies of samples of completed suicides indicate that alcoholics account for 20–40% of all suicides 99. What is less clear is the role that alcohol plays in the events leading up to an act of suicide. It has been suggested that alcohol may influence an individual’s decision to complete suicide, but few studies have investigated this possibility 100. 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, 117,118,119.
Individuals with alcohol dependence who are hospitalized for an impulsive suicide attempt have higher rates of postdischarge relapse, and relapse faster, than those without an impulsive attempt 111. This lends support to the clinical utility of targeting suicidality and alcohol misuse simultaneously in the acute stages of treatment. In 1997, Harris and Barraclough, in their unusually comprehensive meta-analysis analyzed 32 papers related to alcohol dependence and abuse, comprising a population of over 45,000 individuals 34. They found that combining the studies gave a suicide risk almost six times that expected but with variation of 1–60 times.
Addiction and Suicide: An Unmet Public Health Crisis
Higher suicidality in depressed patients with alcohol dependence compared to depressed persons without comorbid alcohol dependence may also be related to the differences in dopaminergic regulation between the two groups. It has been observed that depressed subjects with a history of alcohol dependence had lower CSF HVA levels, compared with depressed subjects without a history of alcoholism 159. Alcohol misuse is robustly linked to heightened risk for suicidal ideation, attempts, and deaths in youths and adults 10, 15,16,17, a phenomenon not accounted for by comorbid psychiatric disorders 18. Cross-national studies indicate a linear relationship between suicide rates and per-capita alcohol consumption 19, 20, suggesting that alcohol may be a key factor in suicide.
Tapert et al. 164 found that alcohol-dependent women showed less differential response to working memory than controls in frontal and parietal regions, especially in the right hemisphere. Furthermore, Storvick et al. 163 reported a decrease of the serotonin transporter density in the perigenual anterior cingulate cortex in the Cloninger type 1 alcoholics (prone to anxiety) using postmortem whole-hemisphere autoradiography. They also found that the 5-HT(1A) density was significantly decreased in the upper level of the perigenual anterior cingulate cortex. People with problematic alcohol use are also a vulnerable population and we owe them a special duty of care; that should also inform public policies.
Providing patients with resources is an opportunity that clinicians should use to empower patients to take initiative in maintaining and protecting their mental health. Patients are often unaware of the resources available to them and are more likely to use them if they know where to look. This strategy provides for participation in activities that exclude alcohol, tobacco, and other drug use. Constructive and healthy activities offset the attraction to, or otherwise meet the needs usually filled by, alcohol, tobacco, and other drug use, which ultimately reduces suicidal tendencies. The UK low risk drinking guidelines recommend not to drink more than 14 units a week, with several alcohol-free days each week and no binge drinking.
- Most areas have an NHS mental health crisis number you, or someone on your behalf, can call.
- This strategy provides for participation in activities that exclude alcohol, tobacco, and other drug use.
- Stimulating effects may include impulsivity and aggression, while sedating effects may include feelings of sadness and despair.
- The authors are supported as described here but have not provided grant codes as these other funds did not directly contribute to this research.
Other meta-analytic work conclude that structured psychosocial interventions contribute little to opiate substitution programs beyond the routine counseling provided with pharmacological treatment 278. However, such studies do not account for the utility of psychosocial treatment in reducing suicidal ideation and behavior in individuals with OUD, and research on psychosocial interventions for opioid use and co-occurring suicidality remains an outstanding area of study. The lifetime prevalence suicide of attempts in patients with alcohol dependence is high.