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The Link Between Alcohol and Suicide
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. Among people with an underlying vulnerability to risk-taking and impulsive behaviors, chronic alcohol intoxication can increase maladaptive coping behaviors and hinder self-regulation, thereby increasing the risk of suicide. Additionally, chronic opioid use can result in neurobiological changes that lead to increases in negative affective states, jointly contributing to suicide risk and continued opioid use. Despite significantly elevated suicide risk in individuals with AUD/OUD, there is a dearth of research on pharmacological and psychosocial interventions for co-occurring AUD/OUD and suicidal ideation and behavior.
The management of people at risk of suicide is challenging because of the many causes and limited evidence base. 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.
Sociological interpretations include the hypothesis that acute alcohol use leads to increased social deterioration and anomie [177], unemployment, debts, and social isolation [188–190]. Biological interpretations of the association include impaired physical and mental functioning [191] and interactions with other psychotropic drugs [192]. Disinhibition, in which alcohol acts to remove psychological and even physiological barriers to self-harm, has also been proposed as a relevant factor [193]. The association between alcohol use and suicide has also been documented using aggregate studies of alcohol consumption in various countries [50,51]. Results from time-series analyses on aggregate level data from several European countries indicates a stronger effect of alcohol consumption on suicide in low consumption countries than in high consumption countries [54–58].
- In almost all industrialized countries, the highest suicide rate is found among men aged 75 years and older [207].
- Additionally, co-morbid psychiatric disorders are found to be common in patients with alcohol use disorders [21–24].
- Similar variations may include a risk assessment component (e.g., ED-SAFE) or intermittent outreach (e.g., SPI+) [130].
- Simon et al. [113] found that individuals who made impulsive suicide attempts reported higher rates of aggressive behavior than those who made non-impulsive suicide attempts.
- Velleman and Templeton [221] described the impact of parental substance use disorder on adolescents and young adults.
Methadone is a long-acting full opioid receptor agonist that has been long used for treatment of individuals with OUD [237]. Although methadone treatment in persons with OUD and comorbid depression may lead to modest improvement in depressive symptoms, they often require antidepressant medications to produce meaningful reductions in depressed mood [237]. Extended-release naltrexone hydrochloride (XR-NTX) is a nonselective opioid receptor antagonist that has been also widely used dangers of dmt for treatment of OUD and AUD, among other indications. Although initial dysphoria and anxiety have been reported when starting treatment with naltrexone, presumably a result of unmasking symptoms of psychiatric distress concealed by daily intake of opioids, these symptoms gradually subside in participants adherent to treatment [240–247]. Some studies report an improvement in depressive symptoms in patients with OUD after 4 weeks of adherence to naltrexone treatment [242, 246].
Implications for Public Health Practice
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. Reducing alcohol consumption, thereby rendering the person less abusing and less dependent, may focus on socially reinforcing the sober condition rather than blaming alcohol intake. Increasing the person’s social acceptance is one of the means to reduce suicide thinking. In fact, people with alcohol abuse often are afflicted with self-blame and may feel rewarded or vindicated when the self-fulfilling prophecy of being rejected is realized. Fostering and strengthening positive values may indirectly reduce suicide risk by rendering life more pleasurable. Although groups at risk can be identified, the prediction of suicide in individuals is difficult because individual risk factors account for only a small proportion of the variance in risk and lack sufficient specificity, resulting in high rates of false positives [227].
Suicide Risk and Addiction: The Impact of Alcohol and Opioid Use Disorders
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. 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.
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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. Among people who die by suicide, alcoholism is the second-most common mental disorder, and is involved in roughly one in four deaths by suicide. As a psychologist and scientist, my research aims https://sober-house.net/ to understand whether alcohol actually increases the risk of dying by suicide. 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 example, although seldom considered, alcohol may be used deliberately prior to suicidal behavior in order to remove psychological barriers by increasing courage and numbing fears; anesthetizing the pain of dying18,19; or to make death more likely (e.g., “I mixed alcohol with pills”).
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Kolves et al. in a psychological autopsy study reported that 68% of males and 29% of females who committed suicide met the criteria for alcohol abuse or dependence [89]. Strong support for a direct link between alcohol and suicide comes from aggregate-level data. Both longitudinal and cross-sectional aggregate-level studies usually report a significant and positive association between alcohol consumption and suicide [91–93].
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. Ethanol-induced NMDA inhibition in the cerebral cortex results in the reduction of noradrenaline and acetylcholine [136], and this might be related to the development of depression. This has been proposed as an explanation of the association between alcohol and depression, but may be also relevant to suicide. Glutamate in the cerebellum increases the levels of BDNF via NMDA, and this in turn reduces apoptosis.
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