Beyond current theories regarding the link between suicide and alcohol use, effective prevention requires knowing who is most at risk. Our study found those who drink heavily and more frequently have increased risk of death by suicide, particularly over longer periods of time. Aharonovich et al. 258 found that all subtypes of depression increased the risk for making a suicide attempt in patients with substance dependence abuse. Major depression occurring before the patient became substance dependent predicted the severity of suicidal intent, while major depression during abstinence predicted the number of attempts. Using the psychological autopsy method, Heilä et al. 254 investigated schizophrenic subjects in whom active illness and depressive symptoms were highly prevalent immediately before suicide and a history of suicide attempts was common. Women were more likely to have committed suicide during an acute exacerbation of the illness.
Understanding and Lowering Risk Associated with AUD
Open-ended questions, affirmations, reflective listening, and summarizing are the cornerstones of this approach. The more we talk about it, the more we can create space for support, healing, and recovery. The town was once synonymous with alcohol and drug-fuelled jungle parties for backpackers but has since re-branded as an eco-tourism destination. Police in Laos have detained the manager and seven staff members of a backpacker hostel in Vang Vieng following the deaths of six tourists from suspected methanol poisoning, state media reported Tuesday. “AUDs and SUDs are undertreated pharmacologically, despite the availability of effective treatments. However, novel treatments are also needed because existing treatments may not be suitable for all patients.
While the prevalence and destructiveness of suicide is clear, much less is known about why people die by suicide. Emotional reactions in survivors differ, with spouses and parents significantly more affected than adult children 224. Parents showed more sorrow, depression, feeling of powerlessness and guilt, while spouses felt more abandoned and angry 224. Their anger is directed to the lost person significantly more than that of spouses whose suicidal partner had no alcohol problems 225.
Treatment for Suicidal Behaviors and Alcohol Use Disorder
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.
Summarizing, one of the most effective strategies for suicide prevention is to teach people how to recognize the cues for imminent suicidal behavior and to encourage youths at risk to seek help. Antisocial traits and substance abuse (including alcohol abuse) are strongly connected to suicide. It is important that psychiatric disorders in youths are immediately diagnosed and treated. 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 eco sober house 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. Some evidence points to the specific role of kappa opioid receptors in mediating negative affective states in OUD.
1. Suicide and Alcohol Abuse in Adolescents
However, co-morbid psychopathology is neither sufficient nor necessary for this association 14. Alcohol use and suicide are intimately linked, but they are both complex phenomena, springing from a multitude of factors. Menninger conceptualized addiction itself both as a form of chronic suicide and as a factor involved in focal suicide (deliberate self-harming accidents) 25. Clinical policy interventions targeting AUD also have the potential to affect suicide rates in health systems that have high rates of AUD and suicide. In almost all industrialized countries, the highest suicide rate is found among men aged 75 years and older 207.
In many cases, the physical illness itself, and medications adopted to treat it, may cause depressive symptoms. 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 more immediate means to commit suicide are restricted.
- Over time, opioid abuse may lead to adaptive changes in the brain that impair serotonergic modulation of pain and reward, resulting in increased pain sensitivity and opioid dependence 231, 233.
- For example, in a study of adolescents with AUD receiving fluoxetine for depression, those who also received a manualized CBT/MET protocol had superior outcomes for depression and alcohol-related symptoms compared to those who did not 135.
- In our research, it was found that a higher frequency and quantity of alcohol consumed plays a major role in death by suicide.
- Alcohol use is highly prevalent worldwide, and suicide is highly prevalent in populations of patients with alcohol use disorders.
- Suicide is a major public health problem and must be given high priority with regard to prevention and research.
Neuroinflammation and Mental Health
Thus, the relationship between alcohol abuse and depression in determining suicidality is complex and multifaced, and there are many factors which may impact on suicidality in depressed patients. In light of the above evidence, it is difficult to attribute a role for alcohol in adolescent suicide. Patterns of alcohol consumption by youngsters in Western countries are changing, and singling-out the role of alcohol in suicide becomes an increasingly harder task, since alcohol use is increasing, as far as absolute numbers are concerned, while suicide changes very little in numerical terms. However, drinking alcohol has been used in human societies in ritualistic contexts and has a symbolic value, and it has maintained this role even when the formal framework has changed. Its anxiolytic properties help people in personal and social contexts in which they are confronted with difficulties. Alcohol becomes a way of facilitating communication with others and adapting to the environment.
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 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. Neither gender nor age modified any of these associations (see Supplementary Tables 5 and 6, Supplementary Figs 1–3).