Association With Suicidal Thoughts or Behavior

Most studies on suicidality and alcohol address alcohol consumption rather than alcohol use disorder. However, a psychological autopsy study in Australia found that aggression, psychiatric comorbidity, and recent interpersonal conflicts are suicide risk factors in individuals with alcohol use disorder. A review of studies from 1999 through 2014 conducted in several countries, including the United States, reported that both intoxication and chronic heavy alcohol use are associated with suicide, extensive population-level data link alcohol with suicide, and there is evidence suggesting that restrictive alcohol policies may help prevent suicide on a general population level. A meta-analysis of studies conducted in the United States and several other countries from 1996 through 2015 found that compared with nondrinking individuals, the acute use of alcohol was associated with a nearly sevenfold increase in risk of suicide attempt. Moreover, in this meta-analysis, as well as in U.S.-based case-control crossover studies, heavier alcohol use within 24 hours was a much more potent risk factor for suicide attempt than lower alcohol use. In a cohort of patients in Mississippi, acute co-use of alcohol and sedatives had an even stronger association with suicide attempt compared with alcohol use alone. A systematic review and meta-analysis of studies from 1975 through 2014 in several countries, including the United States, found that alcohol use is associated with possession of firearms, that alcohol drinkers are four to six times more likely to die by suicide with a gun than nondrinkers, and that heavy drinkers are more likely to choose firearms over other suicide methods compared with nondrinkers.

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