Alcohol misuse is a compelling modifiable risk factor for both suicide and non-suicidal self-harm, and effective treatment for alcohol misuse and dependence exists.39,40,41 Our study provides further support that populations who are at increasing risk of alcohol misuse are also at a higher risk of suicidal behaviour. 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. The latest article from Alcohol Research Current Reviews explores links between alcohol use and suicidal behavior. Research on associations of suicidal behavior, including suicide and suicide attempt, with alcohol use disorder (AUD) and acute use of alcohol (AUA) are discussed, with an emphasis on data from meta-analyses.
How Prevalent Is Substance Misuse and Suicide in the United States?
We reported descriptive statistics, and presented associations between covariates and the primary exposures explored with chi-squared and t-tests, as appropriate. For main analyses, we conducted univariable analyses followed by multivariable analyses to adjust for the effects of ten specific potential confounders. There are several neurobiological and psychological theories proposed to explain the relationship between alcohol use and suicide. Alcohol affects neurotransmitters, which are the chemical messengers such as GABA and serotonin that help regulate mood. There are well-established links between alcohol and cancer, heart disease and violence. Alcohol also undermines mental health, with links to depression and anxiety.
Sensitivity analyses
Studies of interventions to prevent the recurrence of suicidal behavior that are appropriate for different age and cultural groups are especially needed. Longitudinal research is needed to further support these findings empirically and ascertain potential causal associations, in addition to gaining insights into which groups of alcohol users in the general population would be most at risk for suicidal behaviours. Shifting the research focus from binge drinking to other dimensions of alcohol use may be warranted, subject to the availability of sufficiently nuanced data.
- 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.
- The study included data from the National Violent Death Reporting System, in which 115,202 suicides—including 87,771 men and 27,431 women ages 18 and up—were reported between 2003 and 2018.
- However, alcoholism and alcohol misuse can significantly increase one’s risk of death by suicide.
- Women could be at greater risk because heavy drinking generally has more negative physical and cognitive consequences for women than men.
- There is also a need for studies of collaborative care across these settings.
For example, the current zeitgeist in emergency settings is to wait until intoxicated suicidal individuals “sober up” and reassess them for safety, with most being sent home with an outpatient appointment. Harmful effects of drinking were measured with three AUDIT items that captured drink-related guilt, drink-related memory loss and alcohol-related injury. The alcohol-related injury item score was coded as a binary measure, with lifetime or past year involvement in an alcohol-related why do alcoholics get red noses injury both coded as one, and reporting no history of alcohol-related injury coded as zero. Scores for these three variables were summed to give a score for harmful effects of drinking, ranging from 0 to 10. Dependence symptoms were measured by summing the scores of three AUDIT items that asked about inability to stop drinking, failure to meet normal expectations because of drinking and feeling a need for drink after a heavy session. The researchers say these findings suggest that alcohol use may have been a core driver in the accelerated increase in suicide among U.S. women.
Data availability
Qualitative research exploring drinking motives and contexts for alcohol consumption may further enhance our understanding of the role of alcohol use behaviours and links with suicidal and self-harming behaviour. The study involved 14,949 people, broadly representative of the general public in England, who completed surveys (Adult Psychiatric Morbidity Surveys) about alcohol consumption and patterns of harmful use (measured by the Alcohol Use Disorder Identification Test – AUDIT). The researchers compared this to self-reported incidence of suicide attempts, suicidal thoughts and non-suicidal self-harm in the past year (their study did not include mortality data to measure suicide deaths). To investigate the association between alcohol use and our three outcomes, we conducted multivariable logistic regressions.
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. Psychological autopsy investigations worldwide show that substance use disorders, most often AUD, are the second most common group of mental disorders among suicide decedents and that AUD is a risk factor for suicide.11 Epidemiologic studies12 also show that AUD is a risk factor for suicide attempts. Several reports13–15 have examined risk factors for suicide attempts and suicide among individuals with AUD.
We each have unique tolerances, relationships, and reactions to alcohol. If you struggle with other mental health disorders, alcoholism can worsen depression and suicide ideation. The researchers say that as the research was cross-sectional (one snapshot in time, rather than longitudinal), they cannot say whether harmful drinking is what makes mental health worse, or rather if it is a sign of already declining mental health – but they say the causation may go in both directions. The researchers found that during the study period, the proportion of suicides involving a BAC greater than or equal to 0.08 g/dL significantly increased each year for women of all age groups.
There is a paucity of data on drinking shortly prior liberty cap lookalikes to suicidal behavior beyond estimates of the number of drinks consumed in a general period of time (e.g., within 3 hours of death). Missing are data pertinent to understanding the progression or escalation of suicidal risk during drinking bouts. 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. Results for the univariable and multivariable analyses assessing the relationship between grouped AUDIT score and suicidal behaviour are shown in Table 3.
It may be used to reduce the last instinctive hestitations to taking one’s own life. People with cancer-related depression often use alcohol as a means of coping but they very rarely use it in order to kill themselves through acute intoxication. However, a case of a cancer patient who committed suicide consuming two bottles of spirit was recently investigated and the conclusions are presented. The post-mortem cardiac blood and vitreous humor alcohol level was found to be 9.0 and 6.2 mg/ml respectively. Contributed to the formulation of research questions, study conceptualisation and design, data acquisition, data analysis and interpretation, and writing and editing the article.
The odds of suicidal behaviour increased across alcohol use risk groups for all outcomes in the unadjusted models, with the highest risk group showing strong evidence of an association with suicidal behaviour outcomes. Adjusting for confounders attenuated the odd ratios for all outcomes. Following adjustment, evidence of an effect remained for suicidal thoughts and suicide attempts, but not for non-suicidal self-harm.
This study is funded by the National Institute for Health Research (NIHR) School for Public Health Research (grant reference number PD-SPH-2015), of which all the authors are members. The authors are supported as described here but have not provided grant codes as these other funds did not directly contribute to this research. Are supported by the NIHR Biomedical Research Centre at University College London Hospitals. Is also supported by the NIHR Applied Research Collaboration North Thames. Is supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.
We hypothesize that use of alcohol among individuals intending to make a suicide attempt, for the purpose of facilitating the suicidal act, may represent a distinct group typified by greater suicide planning, intent, lethality, and potentially co-occurring depression. Such an idea could be tested using a large sample of suicide attempts preceded by AUA whose motivations for alcohol use (among other variables) were retrospectively assessed shortly after the attempt. We investigated the association between specific domains of alcohol use and suicide attempt, suicidal thoughts and non-suicidal self-harm in a general population sample. Military personnel have higher rates of both suicide and alcohol use. Our study indicates these combine to produce a 282 per cent increased risk of death by suicide. Progress may be accelerated by developing and testing gift to celebrate sobriety treatments that, based on their characteristics (e.g., simplicity), may be presumed to have the greatest potential for successful implementation.
Main findings
Among people who die by suicide, alcoholism is the second-most common mental disorder, and is involved in roughly one in four deaths by suicide. As a psychologist and scientist, my research aims to understand whether alcohol actually increases the risk of dying by suicide. In our research, it was found that a higher frequency and quantity of alcohol consumed plays a major role in death by suicide. The more heavily and habitually one drinks, the more vulnerable they are to these risks. Although it is logical to pursue foundational studies at this early stage of research, there is also an urgency to explore what may work in preventing suicidal behavior based on current knowledge.
Effective interventions in these settings for individuals with AUD who are experiencing suicidal ideation would likely include some combination of education about suicide risk, motivational interviewing or relapse prevention to reduce substance use, and planning for how to respond to a suicide crisis. Extending such research to non-traditional settings, for example, 12-step or peer-led programs, is another important direction that carries the potential for increased social support generally as well as more targeted support designed to prevent suicidal behavior. For the purpose of case finding, it may be most practical to recruit participants for studies focused on reduction of the recurrence of suicidal behavior from acute psychiatric units and emergency departments. There are a number of breakthroughs that would need to occur to best inform prevention and intervention efforts concerning the association between AUA and suicidal behavior.
Another theory of suicide suggests the severity of depressive symptoms, such as a hopeless sense of not belonging, is directly proportional to the likelihood of a lethal suicide attempt. Reaching out for assistance and seeking appropriate treatment for alcohol misuse is one of the best ways to obtain support, overcome the addiction to alcohol, and prevent suicide. Once the efficacy (or combined efficacy–effectiveness) trials are completed and with positive results, the longer-term research agenda may proceed to focus on the difficult task of successful implementation in real-world clinical settings. Studies of implementation of screening in key settings (e.g., AUD treatment programs) and meaningful intervention based on screening results are also needed. There is a clear need to conduct randomized trials of interventions for those with AUDs who are experiencing suicidal ideation. Indeed, it would be a coup to prioritize the inclusion of AUD patients with suicidal ideation, insofar as suicidal thoughts and behavior has so often served as exclusion criteria in clinical trials research.
