Author: Alex Thompson

The Role of Alcohol and Substances in Suicide

This is particularly significant in older populations who are less physiologically resilient due to increased chronic medical comorbidities and neurodegenerative diseases (10). In older populations, suicide is closely linked first with psychiatric illness and subsequently with substance use disorders, particularly alcohol use disorder. Therefore, persons in this patient population have a higher risk of suicidal behavior compared with younger individuals (9).

Currently, no single rating scale or clinical algorithm can accurately predict the risk of suicide, because suicidal behavior emanates from a convergence of multiple predisposing and concurrent risk factors. Even if all the scales were combined into a single risk assessment form, other clinical risk factors would be omitted (19). Furthermore, suicide is difficult to predict, as shown in one report suggesting that 83% of deaths by suicide were unexpected or unavoidable (20).

This strategy provides for participation in activities that exclude alcohol, tobacco, and other drug use. Constructive and healthy activities offset the attraction to, or otherwise meet the needs usually filled by, alcohol, tobacco, and other drug use, which ultimately reduces suicidal tendencies. Most important to motivational interviewing is to engage patients in a discussion that is noncoercive and nonthreatening, and to create an atmosphere that is empathic, nonjudgmental, and supportive of the patients’ concerns. Open-ended questions, affirmations, reflective listening, and summarizing are the cornerstones of this approach.

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. Drinking alcohol at an early age, binge or heavy drinking, and drinking behaviors that meet criteria for mild, moderate, or severe alcohol use disorder can all lead to increased suicidal ideation. Persons with heavy alcohol use are five times more likely to die by suicide than social drinkers (11). 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.

Patients are often unaware of the resources available to them and are more likely to use them if they know where to look. 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. It can be pretty complicated to figure out exactly where that line is.

Therefore, reasonable clinical assessment and judgment is key. Safety planning is a brief intervention to help individuals survive suicidal crises by having them develop a set of steps to reduce the likelihood of engaging in suicidal behavior. 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.

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Early intervention after a suicide attempt is vital because the 3-month period after an initial attempt is when an individual is at the highest risk of additional suicidal behavior. Yet those who attempt suicide have been found to be very difficult to engage in treatment. These interventions can include outpatient or inpatient treatment depending upon the severity.

1. In 2015 alone, the Centers for Disease Control and Prevention reported a total of 52,000 drug overdose-related deaths, with 63.1% involving a prescription or illicit opioid (15).
2. • Extend the action beyond the immediate situation to promote ongoing treatment and safety.
3. This is why many individuals often turn to risky behaviours, including using drugs and alcohol.
4. Methadone treatment in particular has been shown to make patients 20% less likely to commit suicide (21).
5. In older populations, suicide is closely linked first with psychiatric illness and subsequently with substance use disorders, particularly alcohol use disorder.

There is a useful answer to be found by putting your drinking in perspective, however. Drinking starts out by causing the release of dopamine and other chemicals that make your brain feel nice. But that stops after a bit, and the experience starts to become grueling around the 0.08 blood-alcohol mark—at which point you’re likely too drunk to drive. “I can’t give you a case history but there are individuals who put away that amount of alcohol per day,” Koob told me. But assuming Bonham was hovering right around that .34 percent sweet spot all day, he was in constant danger.

The Link Between Alcohol and Suicide

You can see a frame of a web app for it below—I used it to determine how many drinks it would take for me to get as shitfaced as the drunkest sorority girl of all time, Vodka S​amm. ​Hopefully, ​​the guy in the ​video above puked right after he pushed stop on his recording. “A whole bottle of Scotch contains about 17 drinks,” Koob told me. But 101-proof Wild Turkey has much more alcohol than Scotch.

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. 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. It’s OK to experience depression, anxiety, and hopelessness.

Opioid Use Disorder and Suicide

Everyone knows that some binges that heavy drinkers routinely engage in will leave others in a coma. But if you’re planning on doing something stupid but seemingly possible, like downing an entire bottle of liquor, you should know that it’s actually a suicide attempt for most people. Nearly half of us know someone who ended their life by suicide. In Canada, 12 people die by suicide each day — and another 200 attempt suicide. While the prevalence and destructiveness of suicide is clear, much less is known about why people die by suicide.

The literature suggests numerous schemas to assist in evaluating individuals for potential suicide risks. One schema categorizes risk factors as either dynamic (acute) or static (long-term) (see box). Regarding patients who are suicidal and have a concurrent substance use disorder, clinicians should pay attention to dynamic risk factors that affect the individual’s life. These factors can change rapidly but are easy to target for treatment intervention.

There are several neurobiological and psychological theories proposed to explain the relationship between alcohol use and suicide. Alcohol affects neurotransmitters, which are the chemical messengers such as GABA and serotonin that help regulate mood. There is so much concern about Canadians’ drinking that some policymakers are advocating for warning labels on alcohol bottles like those on cigarette packages.

That means even if this guy’s tolerance is high, “that’s basically Russian roulette,” Koob said. There are times in life when you know you’re about to go hard. All the advice in the world about ​moderation tends to go out the window if, say, your hard-partying uncle is getting married. At that point “know your limits,” can become less important than “know the absolute limit,” because you’re on your way there. Simon Sherry, Ph.D., is a psychology professor at Dalhousie University. He is also a clinical psychologist at CRUX Psychology, a Canadian-based psychology practice offering online and in person services.