Some of these studies have found significant correlations between suicidal ideation and excessive alcohol use (Arria et al., 2009; Lamis et al., 2014, 2016), but others have not (Garlow et al., 2008; Gauthier et al., 2017). Indeed, one study found a significant negative relationship between frequency of alcohol use and the likelihood of seriously considering suicide (Kisch et al., 2005). The same study reported rates of suicide attempts in the previous year but did not assess risk factors for having had attempts.
Research indicates that AUA increases risk for suicidal behavior by lowering inhibition and promoting suicidal thoughts. Buprenorphine, a mu opioid receptor partial agonist and kappa receptor antagonist, has become one of the most prescribed treatments for OUD relapse prevention in the US [248, 249]. Induction of buprenorphine in the emergency room for individuals with OUD who present with opioid overdoses has been shown to decrease the risk for future overdose [250]. Interestingly, buprenorphine has shown efficacy in treating depressive symptoms during the course of treatment of OUD [251], as well as in treatment-resistant depression [252–254]. Some case reports reported significant reduction in suicidal ideation with the start of buprenorphine treatment for OUD [257, 258]. Even in individuals without OUD, Yovell et al. [259] found that a very low dose of buprenorphine (0.1–0.8 mg/day) significantly reduced suicidal ideation in 2 weeks, compared with placebo.
Drinking and suicide: How alcohol use increases risks, and what can be done about it
Importantly, serotonergic dysfunction may be central to the pathogenesis of depression [66], specifically with regard to 5-HT 1A and 5-HT 1B receptors [67] thought to play a role in mood and reward sensitivity, and regulation of impulsivity and aggression [67]. Thus, serotonergic dysfunction may reflect a common pathway to suicidal outcomes and AUD, perhaps mediated by underlying depression or impulsive aggression. Lower concentrations of 5HIAA have also been found in alcoholic individuals compared to controls [69] and in impulsive violent offenders compared to premeditated offenders [70].
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The association between OUD and increased suicide risk may be attributed to several factors. Social and environmental disadvantages, such as lack of family support, unemployment, and homelessness [144, 156–158] are highly prevalent among persons with maverick sober living OUD, as well as suicidal individuals. Childhood trauma (e.g., physical or sexual abuse) is a particularly significant early risk factor for suicide [159] and is highly prevalent in OUD [160–162].
There is so much concern about Canadians’ drinking that some policymakers are advocating for warning labels on alcohol bottles like those on cigarette packages. In fact, we are so concerned about excessive drinking that we implement initiatives like Dry January where we challenge ourselves not to drink alcohol for a month. 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. They may think they’re a burden to others and begin to develop a higher pain tolerance and fear of suicide. The more we talk about it, the more we can create space for support, healing, and recovery.
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In fact, we found that alcohol use increased the risk of death by suicide by a frightening 94 per cent. 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. Comparisons of continuous variables (AUDIT and PHQ Scores) used two-tailed independent t-tests and categorical comparisons used Chi-square tests. Binary logistic regression used the presence or absence of any suicide attempt at the 2-month or 6-month follow-up as the dependent variable. Subsequent analyses tested all possible interactions between the independent variables, with non-significant interactions dropped from the eventual final model. There was no clear pattern based on levels of consumption, as there were not consistent differences in suicide attempt and self-harm risk between people with light, moderate, and hazardous drinking consumption.
While they have been effective in populations with AUD/SUDs, there is limited evidence of their utility in celebrities who drink every night co-occurring suicidality/depression and alcohol misuse [136]. Brief interventions for suicidal crises (e.g., Safety Planning Intervention; SPI) often implemented in healthcare settings typically involve a written compilation of STB triggers, coping strategies, and sources of support [129]. Similar variations may include a risk assessment component (e.g., ED-SAFE) or intermittent outreach (e.g., SPI+) [130]. These interventions have shown success in reducing imminent suicide risk [52] and may be potentially adapted to address simultaneous risk of alcohol misuse.
- A few pharmacotherapies have been approved for the treatment of alcohol misuse [114, 115].
- In combination, MET/CBT interventions have shown effectiveness in adolescent populations with co-occurring MDD and AUD [135].
- Strengths of this study include the size of the high-risk cohort and the fact that they were sampled across four separate settings.
- There is some evidence to support the incremental utility of psychosocial interventions in combination with pharmacotherapy for OUD [274, 275].
- Open-ended questions, affirmations, reflective listening, and summarizing are the cornerstones of this approach.
- 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].
Models of Suicide—Alcohol Relationships and Shared Risk Factors
In the latter study, the lowest levels of CSF-5HIAA were found in impulsive offenders with a past suicide attempt, perhaps suggesting that impulsivity and suicidality are independently and additively related to serotonergic dysfunction. Even if someone does not fit all the criteria of an alcohol use disorder, they can still be at risk of developing alcohol dependence, putting their physical and mental health at risk due to alcohol abuse. Addressing alcoholism in a clinical setting and providing recommendations about setting limits or considering abstinence can help people make informed and conscientious decisions about their alcohol consumption.
Lastly, studies combining pharmacotherapies for depression and alcohol dependence (e.g., sertraline and naltrexone) suggest better results for mood symptoms and abstinence than either mood or AUD treatment alone [123, 128]. To date, however, there are insufficient trials comparing one medication to another [126], and few that examine the effects of pharmacotherapy on suicidality in alcohol users. Alcohol misuse is robustly linked to heightened risk for suicidal ideation, attempts, and deaths in youths and adults [10, 15–17], a phenomenon not accounted for by comorbid psychiatric disorders [18].
This lends support to the clinical utility of targeting suicidality and alcohol misuse simultaneously in the acute stages of treatment. 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].
Public policies should be looking to increase awareness of the link between recovery group activities alcohol and suicide and to assess and treat problematic alcohol use as a way to prevent suicide. The results of our research highlight just how needed these measures are in our society, but prevention requires change at both the individual and systemic level. Individuals with OUD frequently present to the emergency room with complications from opioid use, including withdrawal-related symptoms or overdose [236], and therefore emergency room-based intervention reflects a key point of linkage to care for this population. 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.
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However, those in the highest category of consumption (‘probable dependence’, counted as drinking more than 30 units of alcohol per week) did face higher odds of suicide attempt and self-harm. Whether you’re seeking treatment for yourself or you’re concerned about a loved one, know that there are many ways to help prevent suicide and stop alcohol misuse. Many people in similar situations have benefited from a combination of mental health and substance use disorder treatment.