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Suicide and alcohol: an unholy alliance

Robin Wulffson MD's picture
suicide, alcohol abuse, violent death, intoxication

Suicide is the 10th leading cause of death in the US; thus, it is a significant public health problem. A new study has reported that 24% of male suicide victims and 17% of female suicide victims are legally intoxicated when they die. In addition, compared to their sober counterparts, these individuals are prone to die by violent means such as hanging, using a firearm, or falling.

The results of the study were published online in BMJ’s journal Injury Prevention.

The study authors noted that it is well known that individuals with alcohol dependence are at a significantly increased risk for suicide, much less is known about the role of acute alcohol use in suicidal behaviors. Therefore, the researchers conducted an epidemiological study that assessed the prevalence and factors associated with acute alcohol intoxication.

The study group was comprised of 57,813 suicide victims in 16 states. The researchers accessed data from the restricted National Violent Death Reporting System 2003–2009 for male and female suicide victims aged 18 years and older. They compared individuals with and without alcohol intoxication (defined as blood alcohol concentration (BAC) of 0.08 g/dl or more).

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The researchers found that men who were younger, American Indian/Alaska Native, Hispanic, military veterans, of lower educational attainment, and rural residents died from a self-inflicted firearm injury or hanging/suffocation were more likely to have been intoxicated at the time of death. Factors associated with a BAC at or above the 0.08 legal limit among female suicide victims were younger age, and being American Indian/Alaska Native. These women were more likely to die from using a firearm, hanging/suffocation, or falling.

The authors concluded that in both men and women, alcohol intoxication was associated with violent methods of suicide and decreased markedly with age. They noted that their findings suggested that addressing risks associated with acute alcohol use may provide the most significant benefit for the prevention of violent suicides among young and middle age adults. They explained that the study illustrates the need for government and state programs aimed at lowering suicide rates and developing targeted prevention strategies designed for groups identified at high risk of alcohol-associated suicide.

A treatment plan for alcohol abusers should include behavior-modification techniques, counseling, goal-setting, and use of self-help manuals or Internet resources. Counseling on an individual or a group basis is an essential treatment component. Group therapy is particularly valuable because it allows interaction with other alcohol abusers. It increases the awareness that one’s problems are not unique. Therapy may include the presence of a spouse or other family members. Family support is a significant component of the recovery process. Alcohol abuse may be a component of other mental health disorders. For these individuals, psychological counseling or psychotherapy may be recommended. Treatment for depression or anxiety may also be a part of follow-up. Beyond counseling and medication, other modalities may be helpful. For example, in September 2010, UCLA researchers released the results of a clinical trial on a unique new therapy that applies electrical stimulation to a major nerve emanating from the brain. The technique, trigeminal nerve stimulation (TNS) achieved an average of a 70% reduction in symptom severity over an eight-week study period.

Long-term pharmaceutical treatment may be used. Oral medications are available for treatment including disulferam, acamprostate, and naltrexone. Disulferam (antabuse®), which is taken by mouth, produces unpleasant physical reactions such as flushing, headaches, nausea, vomiting and headaches. Disulferam does not reduce the craving for alcohol; however, acamprosate (Campral®) may reduce alcohol craving. Naltrexone (ReVia®) also may reduce the urge to drink; furthermore, it blocks the pleasant sensations associated with the consumption of alcohol. A problem with oral medications is that if one desires to return to drinking, he or she can simply stop taking the medication.

Aftercare programs and support groups are essential for the recovering alcoholic to avoid (or manage) relapses and deal with the necessary lifestyle changes to maintain sobriety. Regular attendance at a support group such as Alcoholics Anonymous (AA) is often a component of follow-up care.

Reference: BMJ's Injury Prevention