Deadly Duo: Suicide Linked With Alcohol Abuse

Janis Kelly

June 24, 2009

June 24, 2009 — Suicide is linked to alcohol intoxication across a broad range of ethnic groups, according to data from 17 states reported in the Centers for Disease Control and Prevention's (CDC's) June 17 issue of Morbidity and Mortality Weekly Report (MMWR).

About 24% of those who die from suicide show evidence of alcohol intoxication, including 37% of American Indian/Alaskan Native suicide deaths, 29% of Hispanic suicide deaths, and 28% of persons aged 20 to 49 years. The lowest percentage was 7% in non-Hispanic blacks.

"The most important finding is that among the decedents tested, alcohol was found in every population and age group," lead author Alex E. Crosby, MD, from the CDC's National Center for Injury Prevention and Control, in Atlanta, Georgia, told Medscape Psychiatry. "Health disparities need to be addressed, but alcohol misuse is an important issue for every group. The findings suggest that suicide-prevention efforts should include components that focus on alcohol problems. This isn't a new idea, but one that needs to be reinforced."

The researchers analyzed data from the National Violent Death Reporting System (NVDRS) for 2005–2006, which showed that nearly 24% of the 70% of suicide decedents tested for alcohol had blood alcohol concentrations at or above the legal limit of 0.08 g/dL, indicating that they were intoxicated at the time of death.

The MMWR editors note that mechanisms that might link alcohol use and suicide include "alcohol's effect on promoting depression and hopelessness, promoting disinhibition of negative behavior and impulsivity, impairing problem solving, and contributing to disruption in interpersonal relationships." They also noted that racial/ethnic differences in the prevalence of problem drinking do not explain the pattern of alcohol-associated suicides.

Comprehensive Suicide-Prevention Programs Needed

The researchers argue that these data highlight an ongoing need for comprehensive suicide-prevention programs.

"There are several types of programs that have been successful in reducing suicides that relate to alcohol," Dr. Crosby said. "First, there are comprehensive suicide-prevention programs. They are comprehensive in the sense that they include multiple components such as training community members to respond to persons in crisis, notifying mental-health professionals in the event of a crisis, and providing health education in the schools and community."

Other program components include outreach to families after a suicide or traumatic death, immediate response and follow-up for reported at-risk persons, alcohol and substance-abuse programs, community education about suicide prevention, and suicide-risk screening in mental-health and social-service programs, he added.

"Second, there are alcohol-specific interventions that have shown an effect on decreasing suicide," he said. "These programs include raising the minimum legal drinking age; increasing taxes on alcohol sales; limiting the sale of alcohol products by age or time of day on certain businesses; and mandating that workplaces be alcohol-free."

Sociologist and substance-abuse specialist Philip A. May, PhD, professor of sociology and family and community medicine at the University of New Mexico's Center on Alcoholism, Substance Abuse, and Addictions, in Albuquerque, commented, "Alcohol involvement with suicide is nothing new, especially with acute, impulsive suicides among younger people, especially males (eg, less than 35 years). I don't think that it can be effectively addressed via alcohol policy per se but should be approached within the mental-health arena, especially with clinicians and families being especially aware of the link between alcohol and self-destruction."

He and colleagues are developing a public-health approach to suicide prevention in an American Indian tribal nation.

The authors have disclosed no conflicts of interest.

MMWR Morb Mortal Wkly Rep. 2009;58:637-641.

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