Complicated or traumatic grief, anxiety, unremitting hopelessness after recovery from a depressive episode, and a history of previous suicide attempts are risk factors for attempted and completed suicide. Overt suicidal behavior and indirect self-destructive behaviors, which often lead to premature death, are common, especially in residents of nursing homes, where sober living homes comparison more immediate means to commit suicide are restricted. 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.
- Bereavement counsellors should be alert for complex grief and mourning responses among this group of suicide survivors.
- Strategies for patients with psychoses must take into account the fact that alcohol dependence and psychosis, which alone are risk factors for medical problems, multiply the risk when comorbid [245].
- Animal studies suggest that an activated kappa receptor system is a key mediator of dysphoria-related symptoms and depressive-like behavior [215–220], both relevant to mood disorders and chronic drug use/dependence [221–228].
Links between alcohol use and suicidal behavior
In opioid-using adolescents and young adults, motivational enhancement therapy (MET) and CBT, as well as combined MET/CBT, have demonstrated efficaciousness in compared to a community reinforcement approach, although findings appeared to be mediated by sex and age [277]. 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. This likely will concern two phases, development of research for acute intervention (e.g., crisis-line calls, hospital presentation) and then linkage to integrated interventions that address the specific role of AUA in suicidal risk for a particular patient, and target both behaviors. Among females, the average annual number of deaths from excessive alcohol use increased by 15,136 (34.7%), from 43,565 during 2016–2017, to 58,701 during 2020–2021.
How alcohol misuse relates to death by suicide.
Various classical studies found an excess of suicide among alcoholics [73–80]. Beck and Steer [81] and Beck et al. [82] found that alcoholism was the strongest single predictor of subsequent completed suicide in a sample of attempted suicides. Raising awareness in these age groups about the severe consequences of substance abuse and chemical dependence requires a clinical approach to young, impressionable minds that are still developing. Adolescents are exposed to a lot of misinformation and skewed perceptions of drug culture through social media and society in general. It is critical to provide them with accurate information through a lens of empathy and compassion. Research on the link between alcohol and substances in suicide has been driven by the prevalent involvement of alcohol and substance abuse in suicide cases.
Recognizing risk
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. 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. Despite all the troubling trends and clear data from established public health experts, including the government’s own public health and safety authorities, our elected leaders are still pushing to sell more alcohol. The new state budget includes several changes to the state’s Alcohol Beverage Control Law including extending the state’s “drinks-to-go” provision through 2030 and even allowing the sale of alcohol in movie theaters.
1. Suicide and Alcohol Abuse in Adolescents
This means that alcohol-related suicide is mainly a male phenomenon, as was shown in previous studies [96,97]. Follow-up studies suggest that alcoholics may be between 60 and 120 times more alcohol withdrawal symptoms timeline and detox treatment 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].
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 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]. Additional meta-analytic research similarly suggests lower performance of SSRIs relative to tricyclics in comorbid MDD and AUD/SUD [119, 125], but results should be interpreted cautiously given the potentially mediating roles of study design and sample selection. Additionally, findings regarding depressive symptom reduction are equivocal when controlling for study quality and bias [126], and antidepressants may not be justified for treatment of alcohol misuse in the absence of MDD [118, 127].
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]. Mood [10,16,17], anxiety [18] and schizophrenia-spectrum disorders [16,19,20] have been found to constitute independent risk factors for suicidal behavior. Additionally, co-morbid psychiatric disorders are found to be common in patients with alcohol use disorders [21–24]. Alcohol use is highly prevalent worldwide, and suicide is highly prevalent in populations of patients with alcohol use disorders. However, co-morbid psychopathology is neither sufficient nor necessary for this association [14].
This causes a spiral effect of emotional decline and mental impairment that occurs with chronic alcohol and drug use and intoxication. Chronic liver disease and cirrhosis is another, long-term adverse consequence of alcohol abuse, and those deaths have increased during the pandemic as well, from over 44,000 deaths in 2019 to over 56,000 deaths in 2021 – an increase of more than 26 percent. Chronic liver disease and cirrhosis became the 9th leading cause of death of all Americans in 2021, up from 11th prior to the pandemic. 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.
A few pharmacotherapies have been approved for the treatment of alcohol misuse [114, 115]. They include disulfiram, which produces aversive symptoms following alcohol intake; acamprosate, thought to mitigate withdrawal-related symptoms; and naltrexone, a nonselective opiate receptor antagonist that reduces alcohol cravings. These drugs primarily operate by targeting reinforcement mechanisms involved in alcohol misuse; however, extended-release naltrexone has also shown some benefits in reducing attendant anxiety and depressive symptoms [116]. Progress may be accelerated by developing and testing treatments that, based on their characteristics (e.g., simplicity), may be presumed to have the greatest potential for successful implementation.
Further research in needed to address the impact of the quality of the relationship, emotional attachment, age (of the survivor and the suicide) and other factors on bereavement. Providing patients with resources is an opportunity that clinicians should use to empower patients to take initiative how to stop drinking 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.
Translated, this mean that one out of four youths regularly engages in binges and that about the same proportion has started taking alcohol early in their life when their brain is still maturating. Among people with depression, those who consumed substances or alcohol have a higher probability of attempting suicide as compared with depressed individuals who did not [201]. A state of intoxication may trigger self-inflicted injuries, not only by increasing impulsivity, but also by promoting depressive thoughts and feelings of hopelessness, while simultaneously removing inhibiting barriers to hurting oneself [177]. Indirect mechanisms, including alcohol consumption as a form of self-medication for depression, or alcohol use as a marker for other high-risk behaviors, may also be relevant.
