Alcohol and suicidal behavior

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Abstract

Alcohol dependence and alcohol intoxication are important risk factors for suicidal behavior. However, the mechanism for the relationship remains unclear. This review presents a conceptual framework relating alcohol to suicidal behavior. Distal risk factors create a statistical potential for suicide. Alcohol dependence, as well as associated comorbid psychopathology and negative life events, act as distal risk factors for suicidal behavior. Proximal risk factors determine the timing of suicidal behavior by translating the statistical potential of distal risk factors into action. The acute effects of alcohol intoxication act as important proximal risk factors for suicidal behavior among the alcoholic and nonalcoholic alike. Mechanisms responsible for alcohol's ability to increase the proximal risk for suicidal behavior include alcohol's ability to: (1) increase psychological distress, (2) increase aggressiveness, (3) propel suicidal ideation into action through suicide-specific alcohol expectancies, and (4) constrict cognition which impairs the generation and implementation of alternative coping strategies. Moreover, the proximal risk factors associated with acute intoxication are consistent with Baumeister's (1990) escape theory of suicide. Suggestions for additional research are discussed, including the possibility that a nonlinear cusp catastrophe model characterizes the relationship between alcohol intoxication and suicidal behavior.

Section snippets

Conceptual models of risk for suicidal behavior

By virtue of the complex behavior they are trying to understand, conceptual models of risk for suicidal behavior are modest and speculative by definition (Clark & Fawcett, 1992). A number of conceptual models have attempted to explain how our understanding of suicidal behavior must take into account variables exerting their influence over very different time spans. The different terms used across the models can obscure their similarities. For example, the terms predisposing factors,

Conclusions

A meaningful understanding of the different roles alcohol can play in suicidal behavior will inevitably be a product of careful clinical observation and empirical study. This review has only examined empirical evidence from psychological studies. A more complete understanding of the relationship between alcohol and suicidal behavior will require insights from biological, social, and epidemiological studies as well.

A substantial body of evidence suggests that alcohol can increase the distal and

Acknowledgements

This manuscript was supported by grant no. 292145 from the MONTS project (National Science Foundation, EPSCoR). I thank John Klocek, Alan Shields, Katie Witkiewitz, and two reviewers for their helpful comments.

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