In his recent article,1 Caine provides a timely critique of suicide research and prevention efforts and thoughtfully proposes new directions within a public health framework. Several potential proximal and distal causes are noted and analyzed. The author persuasively notes the need for attention to both high-risk individuals and population level factors, drawing on the seminal work by Rose2 on the prevention paradox. Caine refers to alcohol use, chronic drinking, and alcohol dependence, and we wish to highlight an additional factor relevant to both perspectives—acute use of alcohol at the time of suicide.
A recent analysis indicates that alcohol is a leading contributor to disability-adjusted life years in high-income countries such as the United States.3 Therefore, it is not surprising that between 2001 and 2005 in the United States, the Centers for Disease Control and Prevention reported 7235 deaths and 242 456 years of potential life lost resulting from alcohol-attributable suicides.4 Alcohol may be related to suicidal behavior through risk conferred by chronic drinking and associated problems as well as through the acute effects of alcohol on impulsivity, emotionality, interpersonal conflict, and judgment during suicidal crises. The need to consider acute effects of alcohol is supported by research. Studies show that acute use of alcohol is common prior to suicidal behavior5 and is a potent risk factor for suicidal behavior after accounting for other variables related to drinking including alcohol use disorder, drinking pattern, and alcohol availability.6
Recent National Institute on Alcohol Abuse and Alcoholism–funded studies examined the presence of alcohol among suicide decedents and showed that acute alcohol use is a common concomitant of suicidal behavior.7–9 Several dimensions of the association among alcohol consumption, blood alcohol content levels, and suicide were examined. First, nearly one third of the suicide decedents were intoxicated at the time of death.7 Second, the American Indian and Alaska Native populations had the highest rate of intoxication, particularly among those younger than 30 years.8 Third, higher drinking levels were associated with the most violent suicide methods.9 Ongoing work will examine the relationship between access to alcohol and rate of alcohol-related suicide. Future epidemiological studies of suicide as well as programs to prevent suicide (which may include effective precautionary steps at the individual level10 facilitated by implementation of proven population-based alcohol policies11) need to consider acute alcohol use as a significant risk factor.
Acknowledgments
This research was funded by the National Institute on Alcohol Abuse and Alcoholism (grant R01 AA020063 to M. S. K., PI). Data for this study were made available through the Centers for Disease Control and Prevention.
Note. All interpretations and conclusions are solely the responsibility of the authors and do not represent the views of the National Institute on Alcohol Abuse and Alcoholism and the Centers for Disease Control and Prevention.
Human Participant Protection
The human subjects review committee at Portland State University reviewed and approved the study August 11, 2010.
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