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. Because suicide is a complex problem, no single approach is likely to contribute to a significant, substantial decline in suicide rates. Clinical studies of suicide prevention are hindered by methodological and ethical problems, especially since many people at risk do not have contact with clinical services. Knowledge about who is at risk of suicide is crucial, and a number of interventions show promising effects. Future research must focus on the development of suicide-prevention based on specific assessment and treatment protocols.

Suicide prevention

Psychotherapy in combination with psychopharmacological treatment may also benefit from the advantages of each of these modalities [137]. 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]. However, extant data are not conclusive [115•], and further research is necessary to evaluate the combined effectiveness of psychotherapy and pharmacology in co-occurring suicidality and AUD [138]. Further research is needed to understand the effects of alcohol and opioid use on suicide risk, as well as address notable gaps in the literature on psychosocial and pharmacological interventions to lower risk for suicide among individuals with AUD/OUD. Attitudes toward and drinking and help-seeking behavior are culturally determined, but genetic factors play an important role in the predisposition to both suicidal behavior [271] and alcohol abuse [272,273].

Alcohol and Drug Abuse Common in Suicides

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. Harmful effects of drinking were measured with three AUDIT items that captured drink-related guilt, drink-related memory loss and alcohol-related how to help an alcoholic parent injury. The alcohol-related injury item score was coded as a binary measure, with lifetime or past year involvement in an alcohol-related 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.

Treatment Interventions for Co-occurring Suicidality and OUD

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. Although we are far from understanding the relationships between alcohol use and suicidal behavior, a number of possible direct mechanisms for the association have been proposed. The existence of a link between alcohol use and suicide was known to Kraepelin [6]. This link has been advanced more convincingly since the mid-1960s [7–9] and confirmed in recent years [10–13].

Alcohol and suicidal thoughts

These factors can change rapidly but are easy to target for treatment intervention. They include current misuse of alcohol and other drugs, concomitant depression, criminality, and difficulties in controlling aggression and impulsivity. The characteristics of the included studies are summarized and listed in Table 1. A study [52] assessed the association between AUD and suicide in two different countries (the USA and France) concurrently.

How Prevalent Is Substance Misuse and Suicide in the United States?

Psychiatric disorders, especially depression, are common in suicides in Western [208], as well as in Eastern countries [209]. Depression on the other hand, is frequently comorbid with alcohol abuse/dependence in the aged [210–212]. Although alcohol may provide temporary relief from suicidal ideation (thoughts of suicide), in reality, it makes the issue exponentially worse. In most cases, mid-to-long-term alcohol abuse makes suicidal ideation both more frequent and more powerful, subsequently increasing the likelihood of suicide attempts.

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. 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 support for policies that serve to reduce alcohol availability in populations with high rates of AUD and suicide, that promote AUD treatment, and that defer suicide risk assessments in intoxicated patients to allow the blood alcohol concentration to decrease.

When treating patients with alcohol use disorder, a multilevel model of protection is recommended. This includes protecting against biological, behavioral, environmental, and cultural factors. Effective clinical care for patients with alcohol use disorder as well as other psychiatric and medical disorders will mitigate suicide risk, given the preponderance of evidence linking alcohol use disorder and suicidal behavior. In addition, easy access to a variety of clinical and nonpharmacological interventions can be helpful.

1. 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.
2. They also found that the 5-HT(1A) density was significantly decreased in the upper level of the perigenual anterior cingulate cortex.
3. So, if you drink before the age of 14, there’s about a 50% chance you’re going to develop an alcohol use disorder in your adulthood,” explains Dr. Anand.
4. Collaboration between substance use treatment providers, other health care practitioners, family members, and community resources is imperative to the successful rehabilitation of patients with substance use disorders.
5. Alcohol is estimated to cause about 20–30% of cases of oesophageal cancer, liver cancer, cirrhosis of the liver, homicide, epilepsy and motor vehicle accidents.

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. Suicide, suicidal ideation, and suicidal attempts are major concerns for individuals who misuse alcohol, as alcohol use can lead to impaired judgment, decreased inhibitions, alcohol and anxiety and impulsiveness. Individuals could seek integrated treatment and support, which typically has better results than treatment for either a mental health disorder or AUD alone. Genetic and environmental factors both contribute to the co-occurrence of the disorders. Data were analyzed and the results were reported using a random effects model [22].

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. There is a multitude of factors to be considered when examining the correlation between substance abuse and suicide as independent differences between crack and cocaine and myths variables with an anecdotally strong interdependent relationship. Common causes include mental health problems, relationship issues, worries about money or work, bullying or discrimination, as well as alcohol and substance misuse or feeling desperate, helpless or without hope.

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].

Additionally, acutely intoxicated individuals with suicidal urges appear to stabilize quickly in inpatient care [107]. However, relapse and suicidal behavior following discharge remain significant concerns [108]. Transfer to another inpatient setting following acute stabilization may decrease the risk of postdischarge suicide attempts [109], and longer treatment courses, whether inpatient or outpatient, may lower the posttreatment risk of suicidal behavior [110]. Notably, impulsive suicide attempts may be a strong indicator of relapse risk after discharge. 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].

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. Suicide is the result of complex interactions between biological, psychological, social and environmental factors (Figure 1), and all of these conditions impact on one another. Environmental stressors act on a genetically-determined and environmentally-modulated physical structure that in turn impacts psychological well-being and may cause a psychiatric illness that affects the person’s inner world and paves the way for suicide. Alcohol abuse is a means of easing one’s psychological stress but, at the same time, impacts on all other factors, rendering suicide more likely. Discover how many people with alcohol use disorder in the United States receive treatment across age groups and demographics.

Deaths grew across both rural and urban areas in the past decade; however growth was fastest in rural areas–nearly doubling in the past decade and increasing by 35% during pandemic years. Existing shortages of mental health and substance use treatment professionals may make it particularly difficult to access care in rural areas, where the supply of behavioral health workforce is even more scarce. During the pandemic, telehealth services for behavioral health and other care may have been more accessible to those living in urban areas, where an internet connection is more likely to be available or reliable (Figure 5). This may be due to various factors, such as people attempting to self-medicate with alcohol. Some symptoms of mental health conditions, such as stress or negative emotions, may increase the risk of excessive alcohol use if a person uses alcohol to cope with their symptoms. People with alcohol use disorder (AUD) have high rates of co-occurring mental health conditions.

Co-use of alcohol and opioids can significantly increase the risk of death from overdoses due to respiratory depression [153], and in fact, many OUD-related deaths involve alcohol use [154]. There are a number of predisposing risk factors that contribute to both AUD and OUD, and some pharmacological treatments are indicated for both AUD and OUD (e.g., naltrexone). However, despite the high cooccurrence of AUD and OUD [155], research on the contribution of this comorbidity to suicide risk is lacking. The below review therefore primarily concerns research on the cooccurrence of OUD and suicidality, without specifically accounting for comorbidity with other substances. Globally, alcohol consumption has increased in recent decades, with all or most of that increase occurring in developing countries. Alcohol consumption has health and social consequences via intoxication (drunkenness), dependence (habitual, compulsive and long-term drinking), and biochemical effects.