In addition, a sensitivity analysis examined AUD and risk of suicide death after ascertaining AUD using only clinical diagnoses and not alcohol-related convictions. To address a potential multiple comparisons problem, the Benjamini-Hochberg procedure was applied post hoc to control the false discovery rate to 0.05 (Benjamini and Hochberg, 1995). 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. 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. 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.

Suicidal Behavior: Links Between Alcohol Use Disorder and Acute Use of Alcohol

1. There is so much concern about Canadians’ drinking that some policymakers are advocating for warning labels on alcohol bottles like those on cigarette packages.
2. 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.
3. These attempts are a leading cause of hospitalizations from injury and a potent risk factor for eventual suicide.
4. There are well-established links between alcohol and cancer, heart disease and violence.

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.

Statistical analyses

Part of preventing suicide is raising awareness around the topic and bringing it into conversations. The topic of suicide is surrounded by secrecy, which is one of the barriers to getting treatment for people who need it. Mental health clinicians can play a part in dispelling the secrecy and stigma around suicide, and increase social empathy by discussing it as often and openly as other mental health issues are commonly verbalized. Another strong correlation is that alcohol and mind-altering substances are used as means of self-medication to cope with untreated mental health disorders, the symptoms of which are reciprocally exacerbated by substances. This causes a spiral effect of emotional decline and mental impairment that occurs with chronic alcohol and drug use and intoxication.

Suicide is a major public health problem and must be given high priority with regard to prevention and research. The cultural and biological underpinnings of alcohol use may have a preeminent place in this effort. Alcohol prevention programs may positively impact public mental health and help reduce suicide risk indirectly. Despite using highly complete national registries, SUDs were still likely under-reported, which may potentially influence results conservatively (i.e., toward the null hypothesis) by including undiagnosed SUDs in the comparison group. Despite the large size of this cohort, statistical power was still limited for certain SUDs (hallucinogen, cannabis, and cocaine) because of low numbers.

Ascertainment of SUDs

As there was no way of specifying past year non-suicidal self-harm in 2007, only the 2014 data were used for this outcome. PsychiatryOnline subscription options offer access to the DSM-5-TR® library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. 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. Emotional reactions in survivors differ, with spouses and parents significantly more affected than adult children 224.

Neither gender nor age modified any of these associations (see Supplementary Tables 5 and 6, Supplementary Figs 1–3). 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. Suicide hotlines are designed to assist people contemplating suicide or otherwise in distress by providing emotional support and connecting them with crisis resources. The following resources offer confidential services, so you don’t have to provide any identifying information if you don’t want to. Furthermore, Storvick et al. 163 reported a decrease of the serotonin transporter density in the perigenual anterior cingulate cortex in the Cloninger type 1 alcoholics (prone to anxiety) using postmortem whole-hemisphere autoradiography. They also found that the 5-HT(1A) density was significantly decreased in the upper level of the perigenual anterior cingulate cortex.

They based their definitions on the presence or absence of suicidal intent and the presence or absence of injury. They purposely avoided adding a third domain of lethality (or degree of injury) because currently there is a lack of consensus difference between na and aa for defining lethality. According to this classification, suicide is a fourth order event in a set where the first order (i.e., the name of the set) is represented by Self-Injurious Thoughts and Behaviors.

AUD and Suicidal Behavior

Future research must focus on the development of suicide-prevention based on specific assessment and treatment protocols. Wojnar et al. 112 investigated the correlates of impulsive and non-impulsive suicide attempts in 154 hospitalized patients with alcohol dependence. Lifetime suicide attempts were reported by 43% of the patients, 62% of whom scored high on impulsiveness. The only significant factor that distinguished patients making impulsive suicide attempts from patients making non-impulsive suicide attempts and with no suicide attempt was a higher level of behavioral impulsivity. The lifetime prevalence suicide of attempts in patients with alcohol dependence is high. About 40% of all patients seeking treatment for alcohol dependence report at least one suicide attempt at some point in their lives 64–66.

Brief motivational enhancement techniques to increase patients’ willingness to pursue treatment and overcome obstacles may also be an effective engagement approach. Motivational interviewing is focused on helping people work through their ambivalence about changing their behavior and explores patients’ concerns and beliefs about change. A total of 15,616 persons (0.2% of the cohort) died by suicide, compared with 3.0% of those with any DUD and 2.4% of those with AUD (Table 2). The median age for the entire cohort at the end of follow-up was 61.1 years (mean, 62.3 ± 18.7), and the median age at death by suicide was 54.1 years (mean, 54.8 ± 16.9).

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. 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.

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. Based on psychological autopsy investigations, results indicate that AUD is prevalent among individuals who die by suicide. 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.