Problem drinking linked to increased risk of suicide attempt and self-harm University College London

We hypothesize that use of alcohol among individuals intending to make a suicide attempt, for the purpose of facilitating the suicidal act, may represent a distinct group typified by greater suicide planning, intent, lethality, and potentially co-occurring depression. Such an idea could be tested using a large sample of suicide attempts preceded by AUA whose motivations for alcohol use (among other variables) were retrospectively assessed shortly after the attempt. We investigated the association between specific domains of alcohol use and suicide attempt, suicidal thoughts and non-suicidal self-harm in a general population sample. Military personnel have higher rates of both suicide and alcohol use. Our study indicates these combine to produce a 282 per cent increased risk of death by suicide. 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.

Drinking and suicide: How alcohol use increases risks, and what can be done about it

1. We hypothesize that use of alcohol among individuals intending to make a suicide attempt, for the purpose of facilitating the suicidal act, may represent a distinct group typified by greater suicide planning, intent, lethality, and potentially co-occurring depression.
2. Suicide, suicidal ideation, and suicidal attempts are major concerns for individuals who misuse alcohol, as alcohol use can lead to impaired judgment, decreased inhibitions, and impulsiveness.
3. Extending such research to non-traditional settings, for example, 12-step or peer-led programs, is another important direction that carries the potential for increased social support generally as well as more targeted support designed to prevent suicidal behavior.
4. Studies of implementation of screening in key settings (e.g., AUD treatment programs) and meaningful intervention based on screening results are also needed.

Many people in similar situations have benefited from a combination of mental health and substance use disorder treatment. 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. 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. For practical reasons, these studies should be based in settings that frequently treat those with AUDs who may be experiencing suicidal thoughts, such as AUD treatment programs, emergency departments, inpatient psychiatry units, and detoxification units. With the exception of inpatient psychiatry treatment, these are settings that typically do not involve much, if any, suicide-related assessment or treatment; thus, even minimal increases in the quantity/quality of suicide prevention may represent an improvement in the standard of care. Prior studies of AUA and suicidal behavior have failed to consider that the circumstances and motivations for drinking prior to suicidal behavior may differ in key ways.

For our main analysis, we used total AUDIT score (continuous) to investigate whether there is a linear association between AUDIT score and outcomes. To investigate associations of our three outcomes with other domains of alcohol use, we ran models with categorical measures of drinking risk category (low-/moderate-/high-risk alcohol use) and of five specific domains of alcohol 2c-b-fly use. Interaction tests were used to explore whether age and gender modified any associations between alcohol use and outcomes.

’, ‘Have you ever thought of taking your life, even though you would not actually do it? ’ and ‘Have you ever deliberately harmed yourself in any way but not with the intention of killing yourself? Those who answered positively to either of these questions were asked a follow-up question on when this had last occurred. Figure 1 outlines how these responses were collected across the APMS surveys.

How alcohol misuse relates to death by suicide.

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. The new research examined the increase in suicide mortality among women in the context of data showing an increase in heavy alcohol use over time. The study included data from the National Violent Death Reporting System, in which 115,202 suicides—including 87,771 men and 27,431 women ages 18 and up—were reported between 2003 and 2018. Suicides among people who had a blood alcohol concentration (BAC) of 0.08 g/dL or greater were considered alcohol involved. Public policies should be looking to increase awareness of the link between 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.

As there was no way of specifying past year non-suicidal self-harm in 2007, only the 2014 data were used for this outcome. Concern from others about drinking was measured by a single AUDIT item asking if anyone, professional or signs you’ve been roofied personal, had expressed concerns about drinking. Participants were coded positive for ‘concern from others about drinking’ if they reported ever having received expressions of concern from others.

If you need suicide- or mental health-related crisis support, or are worried about someone else, please call or text the 988 Suicide and Crisis Lifeline or chat with Lifeline to connect with a trained crisis counselor. There is so much concern about Canadians’ drinking activities for substance abuse groups 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. The more we talk about it, the more we can create space for support, healing, and recovery. Alcohol is the most often detected substance in the body of a person who has committed suicide.

Main findings

We found evidence of a linear association between total AUDIT score and suicide attempt, suicidal thoughts and non-suicidal self-harm in a representative English general population sample. Our analyses suggest that where alcohol use significantly disrupts day-to-day functioning, this may underpin the relationship between alcohol use and suicide-related outcomes to a greater extent than higher alcohol consumption. Longitudinal research is needed to further understand these relationships. The study team found that whether other people have expressed concern about someone’s drinking was the strongest predictor of suicide attempt, suicidal thoughts, and self-harm risk. Because there are very likely mutually influential interrelationships between drinking and AUD symptoms and suicidal thoughts and behavior,11,12,34 future development of integrated treatment interventions is essential. It is also essential to continue studying how prevention strategies focused on the reduction of risk factors (e.g., co-occurring depression) and the promotion of protective factors (e.g., positive social support) may reduce the likelihood of AUD and suicidal thoughts and behaviors.

Potential confounders

Contributed to the study conceptualisation, data interpretation, and reviewing and editing the article. Contributed to the formulation of research questions, study conceptualisation and design, data interpretation, and reviewing and editing the article. Neither gender nor age modified any of these associations (see Supplementary Tables 5 and 6, Supplementary Figs 1–3). The data that support the findings of this study are held by NatCen Social Research and NHS Digital, and access is available on request through the UK Data Request Service. Suicide, heart disease and cancer are consistently among the top 10 causes of death of Canadians, and alcohol increases the risk of all of these killers. In Canada, 12 people die by suicide each day — and another 200 attempt suicide.

Recognizing risk

Treatment development efforts would be enhanced by the examination of data regarding mechanisms of action, for example, the role of drinking and AUD in depression and interpersonal stressful life events, both of which are potent risk factors for suicidal behavior. After a finer-grained understanding of the role of AUA and suicidal thoughts and behavior is obtained, treatment development research may proceed to prevent attempts in acutely intoxicated individuals expressing suicidal ideation and to prevent reattempts among individuals with a history of attempt(s) while drinking. 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.

This association was attenuated when sociodemographic and clinical covariates were added to the model, but strong evidence of an association remained (adjusted odds ratio 1.06, 95% CI 1.03–1.09). Similarly, there was evidence of a relationship between AUDIT score and suicidal thoughts in both the unadjusted (odds ratio 1.07, 95% CI 1.06–1.10) and fully adjusted model (adjusted odds ratio 1.05, 95% CI 1.03–1.07). 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.

While the prevalence and destructiveness of suicide is clear, much less is known about why people die by suicide. 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. To find alcohol treatment for yourself or an adult loved one, visit the NIAAA Alcohol Treatment Navigator. People with problematic alcohol use are also a vulnerable population and we owe them a special duty of care; that should also inform public policies. If it means saving a loved one, warning labels on beer cans seem like a pretty low price to pay.

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. Especially vulnerable populations include women, military personnel and youth.