Links between alcohol use and suicidal behavior National Institute on Alcohol Abuse and Alcoholism NIAAA

Simon Sherry, Ph.D., is a psychology professor at Dalhousie University. He is also a clinical psychologist at CRUX Psychology, a Canadian-based psychology practice offering online and in person services. As a depressant, alcohol can worsen these feelings of loneliness and depression. It can also enhance aggression, hurt decision-making, and lower inhibitions. When someone’s at risk for suicide, they may feel like they don’t belong. They may think they’re a burden to others and begin to develop a higher pain tolerance and fear of suicide.

Associated Data

Based on psychological autopsy investigations, results indicate that AUD is prevalent among individuals who die by suicide. Results also indicate that AUD is a potent risk factor for suicidal behavior. Risk estimates are higher for individuals with AUD in treatment settings, when compared to individuals in the community who have AUD. Also, although rates of suicide and prevalence of AUD remain higher in men, they have increased more among women in recent decades.

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 sober house boston 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.

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.

1. Although more research is needed to elucidate the link between alcohol use and suicide, the findings point to a need for more education and awareness of this relationship, as well as improved screening and intervention strategies.
2. As Canadians weigh the pros and cons of adopting the new drinking guidelines, they should be thinking not just about the risks to their physical health, but also to their mental health.
3. Alcohol use is an established risk factor for suicidal behaviour both at the individual and population level.1–5 Yet we know little about the relationship between alcohol use and suicidal and self-harming behaviour in the general population, beyond diagnostic levels of disordered or harmful alcohol use.
4. Suicide, heart disease and cancer are consistently among the top 10 causes of death of Canadians, and alcohol increases the risk of all of these killers.
5. 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).
6. 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.

Potentially informative naturalistic studies of intoxicated suicidal states, such as during presentations to emergency departments, for example, may not be possible because of prohibitions on obtaining informed consent for research from intoxicated persons. Similarly, for ethical reasons, controlled experiments to examine the role of drinking in suicidal thoughts or other relevant cognitive or affective states may only be able to be conducted in low-risk populations, with unclear generalizability to high-risk patients known to become suicidal while drinking. Alcohol use is a risk factor for suicidal behaviour, yet the nature of the relationship is unclear. Most research on the topic is conducted in clinical populations, with few studies exploring this association across the general population.

There’s Support and Healing for Alcoholism and Suicide

However, more investigation is required before making any statements on the link between alcohol and suicide. Suicide, suicidal ideation, and suicidal attempts are major concerns for individuals who misuse alcohol, as alcohol use can lead to impaired judgment, decreased inhibitions, and impulsiveness. When struggling with suicidal thoughts and tendencies, it’s common to want to escape the pain you’re feeling inside. This is why many individuals often turn to risky behaviours, including using drugs and alcohol. Suicide attempts, suicidal thoughts and non-suicidal self-harm were measured with famous fetal alcohol syndrome adults standardised items as part of the Clinical Interview Schedule, Revised, in 2007 and 2014, and were separately asked in a self-completed questionnaire that utilised a computer-assisted self-completed interview in 2014. Participants were asked ‘Have you ever made an attempt to take your life, by taking an overdose of tablets or in some other way?

Alcohol use and death by suicide: A meta-analysis of 33 studies

In contrast, only middle-aged men had a significant yearly increase in alcohol-involved suicides. Over three-quarters of Canadians drink alcohol, so either you drink or know someone who does. As Canadians weigh the pros and cons of adopting the new drinking guidelines, they should be thinking not just about the risks to their physical health, but also to their mental health. Women could be at greater risk because heavy drinking generally has more negative physical and cognitive consequences for women than men. For youth, perhaps the higher risk is due to the elevated rates of heavy and problematic drinking in young adults or that suicide is the second leading cause of death among 15 to 29-year-olds.

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.

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.

Based on postmortem blood alcohol concentrations, AUA was commonly present among those who died by suicide. AUA is a potent proximal risk factor for suicidal behavior, and the risk increases with the amount of alcohol consumed, consistent with a dose-response relationship. Research indicates that AUA increases risk for suicidal behavior by lowering inhibition and promoting suicidal thoughts. There is also a need for studies of collaborative care across these settings.

Statistical analyses

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. We conducted the most comprehensive meta-analysis on the link between alcohol (ab)use and death by suicide to date. By analyzing the data from 33 longitudinal studies — and 10,253,101 participants — we determined that alcohol use is a substantial risk factor for death by suicide. In fact, we found that alcohol use increased the risk of death by suicide by a frightening 94 per cent.

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.

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 maverick sober living 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.

There is a paucity of data on drinking shortly prior 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.

Along these lines, a brief, straightforward suicide prevention training curriculum designed for substance abuse treatment providers led to increases in provider self-efficacy, knowledge, and suicide prevention practice behaviors,29 suggesting the importance of future research on patient outcomes. The low incidence rate of suicidal behavior in most populations may make it impractical to study drinking immediately prior to suicidal behavior using intensive prospective study designs such as experience sampling where data may be gathered several times per day. Moreover, asking an individual to continue to document their drinking during an unfolding suicidal crisis raises ethical concerns and would presumably require the investigator to intervene whenever possible, altering the course of the phenomena under study. The strengths of our study include the use of a nationally representative sample, the use of a validated scale capturing alcohol use, our novel approach to exploring the associations of different domains of the AUDIT questionnaire with suicidal behaviour, and the use of multiple imputation to address missing data. Alcohol use is an established risk factor for suicidal behaviour both at the individual and population level.1–5 Yet we know little about the relationship between alcohol use and suicidal and self-harming behaviour in the general population, beyond diagnostic levels of disordered or harmful alcohol use. However, alcoholism and alcohol misuse can significantly increase one’s risk of death by suicide.