How Does Drinking Alcohol Increase Suicide Risk – and How Can it Be Managed?

Alcohol and Suicide: What Do We Know?

Each year, about 800,000 people die from suicide. Death from suicide often does not just impact people engaging in the act. In fact, each suicide has been shown to intimately impact at least six other people. Other impacts of suicide have also been sizeable. For example, economic costs of suicide amount to over $5.5 billion dollars annually in countries with the highest life expectancy, education, and income.

Alcohol use has been one factor that has been shown time and time again to increase the risk of suicidal behaviours. But… most of the research on alcohol and suicide up until recently has been quite broad with the way it has been defining ‘suicidal behaviours’. For example, some research has included people who have had ‘suicidal ideation’ (i.e., suicidal thoughts) or ‘suicide attempt’ in their study designs. However, real-world outcomes of suicidal behaviours can often look different if the result of suicidal behaviour is end of life.

At the same time, many prior studies on alcohol and suicide have been quite particular about who they include in their designs. For example, many studies have only studied people with an alcohol use disorder, or a certain level of alcohol use, or some other specific drinking profile. In practice, people demonstrate different degrees of drinking, and the implications of drinking any alcohol can still be very important to consider when thinking about alcohol’s potential connections to suicide.

A New Investigation of Alcohol and Suicide

Our research team identified a big research gap surrounding the link between different degrees of alcohol use and death by suicide. We set out to explore this connection with a meta-analysis. We then decided to take this analysis further by focusing on the importance of time in the alcohol-suicide relationship. Sizeable research up until now has highlighted a connection between alcohol and suicide at a specific point in time. For example, autopsy data has been used many times to demonstrate blood-alcohol levels in people’s bodies prior to suicide. However, this data is usually not used to determine someone’s prior history of drinking leading up to an eventual suicide.

So, we set out to explore the link between alcohol and suicide over time. To do this, our meta-analysis included 33 studies that looked at both drinking and completed suicide – and we focused on studies where there was a gap in time between the two variables. Our analysis was large, and it allowed us to analyse the alcohol-suicide link in 10,253,101 people.

What Do We Now Know about the Connection between Drinking and Suicide?

What did the study show? Notably, alcohol use was associated with a 94% increase in the risk of completed suicide. This finding is worrying, and on the surface, it might lead to concerns about drinking alcohol at all. However, we took the study one step further to uncover factors that would place someone at a higher risk for suicide if they had drunk alcohol in the past. For example, a key risk factor for suicide was being a younger drinker. Also, the link between alcohol and suicide was stronger for people in the military (when compared to people in other settings such as psychiatric facilities or general community settings). Further, the link between alcohol and suicide was stronger for people who were found to drink larger amounts of alcohol or those who drank more frequently. In fact, a heavier pattern of drinking was found to be the most consistent risk factor for suicide in our study.

Why is the Alcohol-Suicide Link Important?

Why are these findings relevant? Several biological and neurological connections between alcohol and suicide have been proposed in the past. For example, the link has been purported to be explained by alcohol having an effect on neurotransmitters that impact mood (such as serotonin or GABA), which could increase suicidal thoughts. Several theories have also attempted to explain the alcohol-suicide link. For example, social psychologist Roy Baumeister’s theory asserted that a desire to escape pain and negative emotions is a root cause for both alcohol use and suicidality. In practice, our current study underscores this link between alcohol and suicide over time.

It also highlights that certain types of drinkers may be at a higher risk of suicide. This doesn’t mean that everyone in a higher-risk group is at a high risk for suicide. For example, being younger or having served time in the military does not mean that suicidal behaviour is inevitable. Nor would drinking in heavier amounts fully predict that someone will engage in suicidal behaviours. But what it does mean is that the high-risk factors established in our study could be important considerations for those who may generally be more vulnerable to completing a suicide attempt.

What Does this Updated Alcohol-Suicide Knowledge Mean for Us?

Taken together, how can we practically navigate this alcohol suicide link? It serves as a reminder that it is important to recognise if you are feeling suicidal and possibly intending to act on your thoughts. When suicidal intention is higher, seeking help is important, whether it is from individuals you trust, from your local crisis phone numbers or services, or from a direct visit to your nearest emergency clinic.

For front-line healthcare providers, finding ways to increase access to mental health services for suicidal patients is crucial, especially among individuals who have been demonstrating patterns of heavier drinking. Conversations about suicide with patients can ultimately be very valuable when suicidality and a history of heavier drinking exists, in order to guide potential follow up or access to further support.

Suicide consistently ranks among the top 10 causes of death in several countries, and public policy can benefit from continuing to think about ways to assist in managing suicidality associated with alcohol use. Some countries have already started paving the way for change – such as Canada, who has recently sparked debate with their update of low-risk drinking guidelines from 12-15 drinks to just two drinks. The new drinking guidelines in Canada were developed by an expert panel and are structured as a continuum of risk, where a greater number of drinks is reported to increase risks of injury, violence, and health problems. Seven or more drinks per week has been labeled as “increasingly high risk” in the new guidelines. These types of risk-related recommendations can often be met with shock or pushback. However, attending to expert-informed and evidence-based guidance on alcohol use may ultimately be a worthwhile approach to increase safety and reduce suicidality among those in a higher risk category.

Written by Jason Isaacs, PhD Candidate in Clinical Psychology, Dalhousie University.