Alcohol Misuse and Suicide Risk
The latest article from Alcohol Research Current Reviews explores links between alcohol use and suicidal behavior. 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.
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Safety planning is frequently included as an element in cognitive behavioral interventions for suicide prevention and can also be used as a brief standalone intervention, typically paired with a referral for mental health treatment. 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.
Cross-national studies indicate a linear relationship between suicide rates and per-capita alcohol consumption [19, 20], suggesting that alcohol may be a key factor in suicide. Indeed, rates of alcohol misuse have escalated over the last two decades [21, 22] in parallel with rising drinking on shrooms suicide rates [23, 24]. Since 2001, past-year prevalence of high-risk drinking has increased by 29.9%, and alcohol use disorder (AUD) by an alarming 49.4% [21]. Importantly, rising rates of alcohol misuse are accompanied by a 35% increase in alcohol-related suicide deaths [23]. Alcohol and opioid use are the two most common substances implicated in suicidal behavior [14•]. This review briefly surveys the literature on the overlap of these disorders, highlighting the complex and multidirectional relationships between them.
You can find lasting healing and recovery with resources far more relieving than alcohol or drugs.
Alcoholism: Quantity and Frequency of Alcohol Use
More specifically, agonism to the amygdala kappa receptors mediated anxiogenic-like behavior [269] whereas antagonism to kappa receptors in the amygdala [269, 270] and prefrontal cortex [271] produced anxiolytic effects. Relative to controls, patients with OUD treated with buprenorphine demonstrated reduced amygdala activation in response to negative stimuli [272]. In addition, buprenorphine causes decreased amygdala responses to heroin-related cues in heroin-dependent patients [273]. Co-use of alcohol and opioids can significantly increase the risk of death from overdoses due to respiratory depression [153], and in fact, many OUD-related deaths involve alcohol use [154]. There are a number of predisposing risk factors that contribute to both AUD and OUD, and some pharmacological treatments are indicated for both AUD and OUD (e.g., naltrexone). However, despite the high cooccurrence of AUD and OUD [155], research on the contribution of this comorbidity to suicide risk is lacking.
When struggling with suicidal thoughts and tendencies, it’s common to want to escape the pain you’re feeling inside. This is why many individuals often turn to risky behaviours, including using drugs and alcohol. Providing patients with resources is an opportunity that clinicians should use to empower patients to take initiative in maintaining and protecting their mental health. Patients are often unaware of the resources available to them and are more likely to use them if they know where to look.
Chronic opioid use, tolerance, and stress may mobilize the kappa receptors system [214, 215]. 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]. In humans, increased expression of kappa receptors has been found postmortem in the brains of suicide victims [229]. Moreover, kappa receptors availability in the amygdala-anterior cingulate-striatal circuitry were shown to mediate the phenotypic expression of dysphoria [230].
This asked the participant to choose on a 4-point scale their response to the question ‘If you are experiencing any emotional or behavioral problem, how difficult has this made it to do eco sober house your work at school, take care of things at home, or get along with people? Online of 40,335 students at four universities took place at the beginning of four academic years, 2015–2018. Of these, 2296 met criteria for an increased risk of suicidal behavior and completed 1- and/or 6-month follow-up evaluation(s).
Alcohol Misuse and Suicide Risk
There are many FDA-approved medications for treatment of depression [112] and primary among them are selective serotonin reuptake inhibitors (SSRIs). As yet, however, there are no FDA-approved medications specifically indicated for suicidal ideation, urges, or behavior [113]. A few fetal alcohol syndrome face celebrities pharmacotherapies have been approved for the treatment of alcohol misuse [114, 115]. They include disulfiram, which produces aversive symptoms following alcohol intake; acamprosate, thought to mitigate withdrawal-related symptoms; and naltrexone, a nonselective opiate receptor antagonist that reduces alcohol cravings. These drugs primarily operate by targeting reinforcement mechanisms involved in alcohol misuse; however, extended-release naltrexone has also shown some benefits in reducing attendant anxiety and depressive symptoms [116]. 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.
- Indeed, one study found a significant negative relationship between frequency of alcohol use and the likelihood of seriously considering suicide (Kisch et al., 2005).
- Indeed, a history of childhood abuse significantly increase the risk for suicidal behavior in individuals OUD [144, 149, 157].
- The brevity of the principal measures of depressive symptoms and of alcohol use patterns precludes more detailed analysis, but this was necessary to maximize participation and sample retention.
- Social and environmental disadvantages, such as lack of family support, unemployment, and homelessness [144, 156–158] are highly prevalent among persons with OUD, as well as suicidal individuals.
- There is a multitude of factors to be considered when examining the correlation between substance abuse and suicide as independent variables with an anecdotally strong interdependent relationship.
The below review therefore primarily concerns research on the cooccurrence of OUD and suicidality, without specifically accounting for comorbidity with other substances. The initial screening for depressive symptoms consisted of the PHQ-2 (Kroenke et al., 2003), which assessed three depressive symptoms in the preceding 2 weeks, each scored 0–3. Students who had positive screens for high risk went on to rate the remaining PHQ-9 items (Kroenke et al., 2001). For the following analyses, a PHQ-8 scale was used to quantify depressive symptoms because the ninth item quantifies suicidal ideation. High-risk individuals also completed a 10th PHQ item (Kroenke et al., 2001) that rates functional impairment.
Results
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. If you (or someone you care about) have thoughts of self-harm or are thinking of taking action to hurt yourself, you should know that help is available and that you’re not alone. There is always a place to turn, no matter how dire or hopeless your situation may seem in the moment.
Suicidality and Alcohol Use as Predictors of Future Suicidal Behavior in College Students
Extended-release naltrexone hydrochloride (XR-NTX) is a nonselective opioid receptor antagonist that has been also widely used for treatment of OUD and AUD, among other indications. Some studies report an improvement in depressive symptoms in patients with OUD after 4 weeks of adherence to naltrexone treatment [242, 246]. Some evidence points to the specific role of kappa opioid receptors in mediating negative affective states in OUD. The euphoric effects of most abused opioids (e.g., heroin, oxycodone, and morphine) are due to their mu receptors agonism [213].
