Feature article
Alcohol and Suicide: An Inextricable Link
For centuries society has recognized an inextricable link among alcohol, self-destructive behaviors and suicide. This link is apparent in some of the most talented creative geniuses among us, including acclaimed writer Ernest Hemingway, legendary for excessive drinking and severe depression. Hemingway used a shotgun to end his life on July 2, 1961, following in the footsteps of his father, brother and sister who also killed themselves. His eldest granddaughter Margaux, a model and film actress, too ended her life by overdosing on barbiturates in July 1996.
What have we learned about the relationship between alcohol and suicide, among not only creative minds but society-at-large?
Decades of research strongly suggest that alcohol is a contributing factor in scores of suicides for both men and women.(1) One study showed that between 18 and 66 percent of suicide victims have alcohol in their blood at time of death.(2)
Yet the role that alcohol plays in suicide remains unclear.
- Do those on the verge of taking their life drink alcohol to lower inhibition and calm themselves as they face death?
- Does alcohol impair psychological and cognitive processes that would normally block non-drinkers from contemplating or completing suicide?
- Is excessive alcohol consumption merely one indicator of a broader social disintegration that often accompanies suicide?
- Are those who kill themselves abusing alcohol in the months or years prior to their death? Are they alcoholics?
- Are alcoholics more prone to consider suicide by the very nature of their disease?
- Does chronic alcoholism change brain chemistry to make the addict more prone to bouts of depression or other mental illness that can bring about thoughts of suicide?
- Are those with depression or other mental illness more likely to abuse alcohol and form addictions to “self-medicate” a brain disorder, to alleviate their “psychache?” Will that brain disorder itself eventually lead to suicide?
For decades the study and treatment of alcoholism has evolved without giving adequate consideration to potential for suicide among alcoholics. That began to change in 2002 when the National Institute on Alcohol Abuse and Alcoholism (or NIAAA, one of the National Institutes of Health) co-sponsored a workshop to advance a national research agenda for alcoholism and its link to suicide.
“We met in Bethesda in March of 2002,” recalls Conner, who co-chaired the workshop. “The group focused on a discussion of available research on alcoholism and suicide, gaps in the knowledge, and how to fill those gaps and improve prevention and treatment for both alcoholism and suicide.”
This workshop reflected a general groundswell of interest in research and prevention of suicide, notes Conner. That interest also led to two federal program announcements in August 2003 calling for research on suicidal behavior, and reducing and preventing suicidality tied to alcoholism. NIAAA was one of the agencies releasing these program announcements, joined by NIMH (National Institute of Mental Health) and NIDA (National Institute on Drug Abuse). Their goal?
“To stimulate research on suicidal behavior and alcoholism,” notes Conner. “For the first time NIAAA was specifically soliciting suicide-related research.” Conner adds that while research on suicide and alcohol has occurred over the years, this area is not as well developed as other alcoholism research.
An outcome of the March 2002 research workshop is a focus on suicide and alcoholism in a special issue of “Alcoholism: Clinical and Experimental Research” (ACER). Slated for publication later this year, this special issue is a first for the alcoholism research community. It will include among other content a summary of proceedings from the 2002 Bethesda workshop.
“This is a huge step forward,” says Conner of the pending publication of the suicide-focused issue of ACER. “This is a very prominent alcoholism journal – and it’s dedicating a specific issue to suicide.” Page Chiapella, Ph.D., with the Division of Treatment and Recovery Research at NIAAA serves as co-editor of this pending special issue along with Conner.
“NIAAA is emphasizing suicide and suicide-related issues more than ever before,” notes Conner. “This includes recognizing research accumulated over years time showing that suicide is a grave problem in alcoholics – and that the two are inextricably linked. There’s generally an increased interest in suicide prevention given the surgeon general’s report, the Senate and House resolutions, activities of SPAN (Suicide Prevention Action Network),” Conner continues. “It’s kind of a groundswell of interest. And alcoholism institutions recognize this.”
Some of the latest research findings about alcoholism and suicide are aiding treatment and prevention efforts.
“It’s a bit speculative, but there’s some promising research on the treatment of depression in alcoholics using fluoxetine, an antidepressant,” notes Conner. “Such treatment might reduce suicide risk in alcoholics.”
Marital- or couples-based treatment is another promising area, according to Conner.
“Alcoholics seem to commit suicide in the throes of severe marital or relationship difficulties,” he points out. “Given the connection between partner-relationship difficulties and suicide among alcoholics, couples’ treatments demonstrated to be effective in the treatment of this population may also be a promising strategy to reduce risk for suicidal behavior.”
For now these research findings should be applied only conditionally to current treatment regimens to reduce suicide risk among alcoholics, according to Conner.
He recommends that promising findings be evaluated in a sub-population of alcoholics – those at high risk for suicide. High-risk alcoholics could be defined as those who have a co-occurring depression diagnosis, are in treatment because of a suicide attempt or have attempted suicide in the past. Once evaluated, this research could be widely disseminated and applied to current treatment procedures.
In the meantime, Conner stresses the importance of alcoholism clinicians and counselors having training and knowledge of depression and other mental disorders that can lead to suicide.
“I don’t think alcoholism clinicians in general have a lot of training in this area,” he notes. “We’re (the research community) not ready to hand them a package and say, ‘Do this.’ But a better dissemination of basic research information about the inextricable link between alcoholism and suicide would certainly be useful. If they can better recognize depression, that will improve their ability to effectively treat the alcoholic.”
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