Suicide and Alcoholism

Alcohol use and alcoholism are high risk factors for suicide. A fuller appreciation of causal relationships however will await understanding the interaction of intervening variables such as personality disorders, depression, other substance abuse, unemployment, recent loss, gender, age, and physical illness due to alcohol use. Methodologic problems in measuring these relationships include ambiguity of definition or means of measuring alcohol use, abuse, or dependency; reliably delineating natural history and depth of depressive mood; and accurately classifying overt and hidden selfdestructive behavior. Alcohol use has been found to be associated with 50% of suicides and to increase the risk of suicidal behavior both for alcoholic and nonalcoholic populations. Between 5% and 27% of all deaths of alcoholics are caused by suicide.'S2 The incidence of alcoholism among persons who commit suicide ranges from 6% to 30% in different studies with approximately 20% most frequently ~ited.2.~ Lifetime risk for suicide is 1% in the general population, 15% for major affective illness, and 15% for alcoholism.'~5 It is hard to evaluate how many of the 200,000 alcohol-related deaths per year are related to possible self-destructive behavior associated with motor vehicle accidents, serious medical illness such as cirrhosis of the liver, and being the victim of homicide. Menninger has said that alcoholism itself is a chronic form of suicide.6 We will review the research literature on alcohol use, alcoholism, and suicide in relation to (1) depression, (2) toxic effects on mood, (3) interaction with other psychopathology, (4) social and interpersonal effects, and (5) common biologic markers. We will also discuss some of the diagnostic and management problems faced by clinicians in relation to alcohol use, alcoholism, and suicide.