Suicide Risk and Addiction: The Impact of Alcohol and Opioid Use Disorders PMC

Impulsive suicide attempts are common in patients with an alcohol use disorder [67,68]. However, whether a history of suicide attempts is related to the risk for relapse in alcohol-dependent patients is still a matter of debate. A suicidal ideation is « thinking about, considering, or planning for suicide » [16].

How Alcohol Use Affects the Risk of Death by Suicide

Whether you’re seeking treatment for yourself or you’re concerned about a loved one, know that there are many ways to help prevent suicide and stop alcohol misuse. Many people in similar situations have benefited from a combination of mental health and substance use disorder treatment. The studies included in the review predominantly investigated the effect of restrictions on alcohol availability and increased cost of alcohol, and majority found associations with reduced suicides across Western and Eastern Europe, as well as the US. Despite the above limitations, the current meta-analysis could efficiently estimate the association between AUD and suicide. Furthermore, a wide search strategy was developed in order to increase the sensitivity of the search to include as many studies as possible.

Potential confounders

In women, a quarter of oral cavity, esophageal and pharyngeal cancers were attributable to alcohol consumption. “The increased risk is because of the alcohol in alcoholic beverages, not the type of beverage,” he said. A standard alcoholic beverage in the United States has about 14 grams of pure ethanol. That looks like one 12-ounce serving of 5% ABV beer, a 5-ounce serving of 12% ABV wine, 8-10 ounces of 7% ABV hard seltzer, or 1.5 ounces of 40% ABV liquor. Research suggests the higher a person’s consumption, the higher the risk of cancer. “It was surprising to see the significant impact estrogen had on alcohol-induced heart dysfunction, despite its known cardioprotective effects.

Alcohol – Beer, Wine, & Liquor in Glasses

1. Of 40,000 Norwegian conscripts followed prospectively over 40 years, the probability of suicide was 4.76% (relative risk +6.9) among those classified as alcohol abusers compared with 0.63 for non-drinkers [84].
2. Some of these studies have found significant correlations between suicidal ideation and excessive alcohol use (Arria et al., 2009; Lamis et al., 2014, 2016), but others have not (Garlow et al., 2008; Gauthier et al., 2017).
3. The well-established heritability of alcohol consumption and the interaction of genes with social and environmental factors [274] should also be taken into account when dealing with alcohol use as related to suicidal behavior.
4. Biological interpretations of the association include impaired physical and mental functioning [191] and interactions with other psychotropic drugs [192].
5. Alcohol affects neurotransmitters, which are the chemical messengers such as GABA and serotonin that help regulate mood.
6. If it means saving a loved one, warning labels on beer cans seem like a pretty low price to pay.

In a national survey of adults in the U.S. in 2020, less than a third of respondents knew alcohol increased cancer risk. About 10% said they thought drinking wine reduced their risk of developing cancer. We retrieved 8548 references until February 2015, including 6658 references through searching electronic databases, 1890 references through checking other sources, including reference lists, relevant web sites, or personal contact with authors of the included studies. We excluded 8380 duplicates and clearly irrelevant references through reading titles and abstracts. Of the 168 references considered potentially eligible after screening, 137 studies were excluded because they were not original article (i.e., letter, commentary, review) or did not meet the inclusion criteria (Fig 1).

Evidence of impaired serotonin (5-hydroxytryptamine; 5-HT) transmission has been found postmortem in the brains of suicide decedents [62], as well as in the cerebrospinal fluid (CSF) of nonfatal attempters [63, 64]. Reductions in binding of 5-HT1A receptors and serotonin transporter have likewise been found in prefrontal brain regions of alcoholic individuals [65]. Importantly, serotonergic dysfunction may be central to the pathogenesis of depression [66], specifically with regard to 5-HT 1A and 5-HT 1B receptors [67] thought to play a role in mood and reward sensitivity, and regulation of impulsivity and aggression [67].

However, there is insufficient evidence in regard to the dose-response relationship between alcohol drinking and risk of suicide. Further investigation based on observational studies are needed to expect the dose-response pattern of alcohol-related suicide. The supporting PRISMA checklist of this review is available as supporting information; see S1 PRISMA Checklist. The observational studies addressing suicide rate among alcohol abusers without comparison group or self-harm without suicide intention were excluded. Suicide is one of the top 20 leading causes of death in the world for all ages [1], the third leading cause of death among people aged 15–44 years, and the second leading cause of death among people aged 10–24 years [2]. These numbers underestimate the problem and do not include suicide attempts which are up to 20 times more frequent than completed suicide [2].

However, extant data are not conclusive [115•], and further research is necessary to evaluate the combined effectiveness of psychotherapy and pharmacology in co-occurring suicidality and AUD [138]. Using the psychological autopsy method, Heilä et al. [254] investigated schizophrenic subjects in whom active illness and depressive symptoms were highly prevalent immediately before suicide and a history of suicide attempts was common. Women were more likely to have committed suicide during an acute exacerbation of the illness. Alcoholism was most common among middle-aged men (45%), whereas middle-aged women had a high rate of depressive symptoms (88%). Taken together, these results remain highly suggestive, but not conclusive, for a neurobiological link between alcohol misuse and suicidal behavior.

Two authors (ND and JP) independently screened the title and abstract of the retrieved studies and decided on which studies met the inclusion criteria of this meta-analysis. The between authors disagreements were resolved through discussion among the authors until consensus was https://rehabliving.net/ reached, otherwise a senior author arbitrated. The number of people die from homicide and suicide is much more than the number of people die from the attack in a war. In fact, for every death due to war, there are three deaths due to homicide and five deaths due to suicide [5].

However, mRNA for CRF1, but not CRF2 receptors, were found to be reduced in the frontal cortex of suicides, along with mRNA for the alpha1, alpha3, alpha4, and delta receptor subunits of the GABAA-benzodiazepine receptor cortex [167]. It has to be mentioned, however, that CRF receptor numbers and affinity have been reported to be either reduced [168] or unchanged by different groups of investigators [169]. Alcohol-induced disorders comprise delusions and delirium, memory disorder and sleep disorders appearing during intoxication or withdrawal and, in addition, anxiety, mood and psychotic disorders, dementia, and sexual dysfunction related to both acute and chronic alcohol use. These disorders also include the typical microzooptic hallucinations, delirium tremens and Korsakoff’s syndrome, which may occur in the alcohol withdrawal syndrome. The more we talk about it, the more we can create space for support, healing, and recovery. Finally, our review is limited by inclusion of English language literature and the studies included have been mainly conducted in Western settings, which limits the generalizability.

Of 40,000 Norwegian conscripts followed prospectively over 40 years, the probability of suicide was 4.76% (relative risk +6.9) among those classified as alcohol abusers compared with 0.63 for non-drinkers [84]. Murphy et al. studied 50 suicides and found that an alcohol use disorder was the primary diagnosis in 23% and a co-occurring diagnosis in 37% [86]. Conwell et al. performed a study in New York City and reported that alcohol misuse was present in the history of 56% of individuals who completed suicide [43]. Several reviews have discussed the relationship between alcohol use disorder (AUD) and suicidal thoughts and behavior, but none has given a pooled effect estimate [9–11]. An old meta-analysis was conducted by Smith et al [12] based on studies published before 1999.

They based their definitions on the presence or absence of suicidal intent and the presence or absence of injury. They purposely avoided adding a third domain of lethality (or degree of injury) because currently there is a lack of consensus for defining lethality. According to this classification, suicide is a fourth order event in a set where the first order (i.e., the name of the set) is represented by Self-Injurious Thoughts and Behaviors. Subsets of the set are risk-taking thoughts and behaviors and suicide-related thoughts and behaviors. The former is subdivided into immediate or remote risk for life and further subclassified, as all other subsets of the classification, according to the outcome, that is, non injury, injury (no matter how severe) and death.

Males were 2.7 times more likely to have an alcohol use disorder than were females. Those who shot themselves were 2.4 times more likely to have an alcohol use disorder than those who hanged themselves or used other methods. However, although alcohol or illicit drug use is frequently cited as a risk factor for suicide, the authors reported a low prevalence of intoxication, again suggesting that suicide is not simply (or not often) the result of an impulse. Therefore, the use of suicide as a way of solving a chronic problem rather than an impulsive response to stress means that prevention programs based on impulse control, such as crisis intervention, will be less effective in this population. However, impulse reduction may reduce self-damaging acts and, de facto, contribute to a reduction in self-inflicted mortality, be it suicidal in nature or not. Simon et al. [113] found that individuals who made impulsive suicide attempts reported higher rates of aggressive behavior than those who made non-impulsive suicide attempts.

The high rate of suicide among adolescents and young adults is a challenge for prevention. The CDC’s National Center for Injury Prevention and Control [259] published guidelines for the development of intervention strategies for communities interested in adolescent and youth suicide prevention programs. The strategies focus on identifying youths at risk so as to direct them to healthcare centres, defining the risk factors, and providing support to manage stressful life events.

In most cases, mid-to-long-term alcohol abuse makes suicidal ideation both more frequent and more powerful, subsequently increasing the likelihood of suicide attempts. Additionally, alcohol abuse generally makes other contributing factors to suicide worse. For example, alcohol exacerbates the symptoms of many mental health conditions such as bipolar disorder, borderline personality disorder, and depression, all of which can contribute to suicide. 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.

The authors are supported as described here but have not provided grant codes as these other funds did not directly contribute to this research. Are supported by the NIHR Biomedical Research Centre at University College London Hospitals. Is supported by the NIHR Biomedical Research Centre at University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol. The views expressed in this https://rehabliving.net/ketamine-abuse-hazards-overdose/ publication are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Contributed to the formulation of research questions, study conceptualisation and design, data acquisition, data analysis and interpretation, and writing and editing the article. Contributed to the study conceptualisation, data interpretation, and reviewing and editing the article.

Interestingly, buprenorphine has shown efficacy in treating depressive symptoms during the course of treatment of OUD [251], as well as in treatment-resistant depression [252–254]. Additionally, buprenorphine has shown promise in reducing suicidal ideation [255, 256]. Some case reports reported significant reduction in suicidal ideation with the start of buprenorphine treatment for OUD [257, 258]. Even in individuals without OUD, Yovell et al. [259] found that a very low dose of buprenorphine (0.1–0.8 mg/day) significantly reduced suicidal ideation in 2 weeks, compared with placebo.