Concurrent Cocaine, Alcohol Use Linked to Suicidality

Megan Brooks

April 14, 2016

The concurrent use of cocaine and alcohol may flag individuals at high risk of attempting suicide, according to a large study of suicidal emergency department patients.

When examined independently, alcohol use had no significant association with suicidality, and cocaine use had a borderline significant association. But alcohol misuse and cocaine use combined was significantly associated with a future suicide attempt, investigators found.

"The findings highlight that the impact of substance use on future suicide behavior is not clear-cut," lead investigator Sarah Arias, PhD, assistant professor (research) of psychiatry and human behavior in the Alpert Medical School of Brown University, Providence, Rhode Island, told Medscape Medical News.

"There are differential levels of risk when we consider other factors, such as sex or race. The findings show that not all substances or substance users are impacted equally when we look at risk for future suicide behaviors. These findings may be useful for providers when assessing at-risk patients," Dr Arias added.

Dr Sarah Arias

The findings were published online April 4 in Crisis.

Useful for Risk Assessment

The study included 874 men and women who presented at one of eight emergency departments around the country between 2010 and 2012 and who screened positive for active suicidal ideation or behavior. The patients were part of the Emergency Department Safety Assessment and Follow-up Evaluation (ED-SAFE) study.

The study team gathered demographic and substance use information from all participants and then followed them for 12 months. During follow-up, 195 (22%) of the 874 participants attempted suicide again at least once. Of those who again attempted suicide, 59% were younger than 40 years, 59% were women, (59%) and 76% were non-Hispanic whites.

Participants in the study reported misusing many different substances, including marijuana, prescription painkillers, tranquilizers, and stimulants, but only the combined use of cocaine and alcohol was found have a significant association with suicide attempt.

Among all participants, 298 (34%) misused alcohol, 72 (8%) used cocaine, and 41 (5%) used both. Those reporting both alcohol misuse and cocaine use had a significantly higher proportion of suicide attempts (39%) compared with those without comorbid alcohol misuse and cocaine use (21%, P = .008).

The researchers also found that substance misuse was less likely an indicator of suicide risk among whites and women, whereas in older adults, the association between substance misuse and suicide was more likely. Women were more likely than men to have a history of suicide attempt, but the data showed that women were less likely to engage in substance abuse.

"These disparate findings emphasize the complex interaction of sex, substance use, and suicide attempts," the investigators write. They also suggest that women may be differentially at risk, depending on whether they report substance use or past suicide attempts.

Dr Arias said she hopes the data help shed light on how misuse of particular substances, among particular patients, may affect their risk for suicide.

"It's not a clear-cut, straightforward association," she said in a news release. "Even though substance use is often touted as a very strong predictor of suicidal intentions and behaviors, when we look at individual substances, we're seeing that there's not that consistency in the future association with behavior."

Identifying factors that predict and protect against attempted suicide are important for the development of effective suicide prevention and intervention programs.

"We're on our way to trying to identify factors that can be used to better assess and identify people who are at risk for suicide, and ultimately, I think this is a step in the right direction to get a better picture," Dr Arias said. "Patients who have potentially comorbid alcohol and cocaine use may be at a higher risk. Findings like these can be useful for informing suicide risk assessment."

She also said it is unclear why combined alcohol and cocaine use might raise the risk for suicide. "This may be related to previous research indicating that concurrent use of alcohol and cocaine elicit an amplified high that can last three to five times longer than a high from cocaine use alone. Unfortunately, we weren't able to investigate this further with the data we had available," she said.

The study was funded by the National Institute of Mental Health. The authors report no relevant financial relationships.

Crisis. Published online April 4, 2016. Abstract

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