Thoughts on Alcohol Depression and Suicide

Alcoholics generally have alcohol problems in conjunction with other medical illnesses and   mental health disorders.  Lapham (2001) reported that about one-half of women and one-third of men who have a history of alcohol abuse or dependence will be diagnosed with at least one other mental health disorder.

 One of the more difficult aspects of alcohol abuse is that alcohol can function as both a stimulant and as a depressant, depending on when the drinking occurs and the quantity of alcohol used.  According to Regier  (1990) one-third to one-half of alcoholics also are afflicted with a Major Depressive Disorder during their abuse. It is important to understand that more than three-quarters of men and women who are identified as alcoholics will also meet the criteria for a Major Depressive Disorder (Regier 1990).  The reason we need to be aware of depression as a comorbid condition with alcoholism, is simple.  If depression is untreated, sometime during the treatment the alcoholic will leave treatment and relapse.

One of the reasons alcoholics are often diagnosed as depressed is due to the similarity of symptoms between alcohol abuse and depression. There is a mimicry which can be hard to sort out during the diagnostic phase.

The fact that ‘binge drinking” and severe alcohol intoxication can also cause mood swings, and the “manic-like” behaviors we associate with Bipolar disorder, does not make the diagnosis any easier.  During the course of the disease, we will also notice insomnia, decreased appetite, temporary depressive symptoms and a general decrease in overall energy, even if the abuser has no history of a depressive illness.

Other things to look for include cirrhosis (swelling) of the liver, anti-social and other personality disorders, nicotine dependence, hepatitis, eating disorders, anxiety disorders,  major depressive disorder and, of course bipolar disorder.

Currently, we do not know by what mechanism  depression and alcohol dependence are intertwined, however, both conditions share very similar risk factors.  It is absolutely important to treat the Co-Morbid disorders your client arrives with, in order to prevention serious adverse consequences much as suicide. 

Because alcohol often makes depression worse, it can be a significant factor in suicide.  Therefore, identifying the risk factors associated with alcohol abuse and dependence are  absolutely essential.

According to the American Association of Suicidality (AAS), Suicide is the 11th leading cause of death overall and the 3rd leading cause among persons 15 to 34 years of age.  According to the AAS, In 2007, 34,598 people in the United States committed suicide and an estimated 864,950 attempted suicide.

Cornelius  (1996) found that as many as 85% of individuals who commit suicide suffer from depression or alcohol dependence, and 70% of alcoholics with comorbid depression report that they have made a suicide attempt at some point in their lives.  Alcohol abuse and dependence can exaggerate depression and increase the chance of an impulsive act including aggression, suicide and violent ideations.

In the alcohol dependent population, fifteen to twenty people out  a hundred will attempt suicide.  Of those who have attempted suicide in the past,  fifteen to twenty people out  a hundred will attempt a second time within five years of the first attempt.

Alcoholism and Suicide:

Effective prevention of suicide and suicidal behaviors can only be achieved if the providers are competent and skilled at obtaining both a substance abuse history and a psychiatric history.  Experience has shown that abstinence from alcohol for fourteen to twenty-one days and good nutrition, the depressive effects of alcohol begin to recede.  Alcohol and drug dependence are second only to age in determining the most important risk factors in a Suicide Risk Assessment.  If you look at the population who have attempted suicide, nine out of ten will have a diagnosable mental health disorder according to Mann (2002).

Among the population that will attempt suicide, alcohol dependence is common.  Alcohol is the number one drug of abuse associated with suicide. The most commonly diagnosed mental health disorders in mental health patients are Major Depressive Disorder and Alcohol Dependence.  This information allows us to target our resources quickly when determining patient triage.  

Often, alcohol is involved in suicide attempts by “driving a vehicle” and suicide by “overdose.”  Some of the reason we believe this connection exists comes from alcohols ability to impair judgment, block physical pain and lowering the survival threshold.  Preuss (2002) have estimated the overall suicide risk for an alcoholic dependent individual was about one in ten, which is five to ten times higher than seen in the general population. Murphy  (1990) has placed the likelihood of suicide for those diagnosed with Alcohol Dependence as sixty to one-hundred twenty times higher than individuals without alcohol involvement.

Murphy GE, Wetzel RD. The lifetime risk of suicide in alcoholism. Arch Gen Psychiatry. 1990;47(4):383-392.

Mann JJ. A current perspective of suicide and attempted suicide. Ann Intern Med. 2002;136(4):302-311.

Preuss UW, Schuckit MA, Smith TL. Comparison of 3190 alcohol-dependent individuals with and without suicide attempts. Alcohol Clin Exp Res. 2002;26(4):471-477.

Cornelius JR, Salloum IM, Day NL, Thase ME, Mann JJ. Patterns of suicidality and alcohol use in alcoholics with major depression. Alcohol Clin Exp Res. 1996;20(8):1451-1455.

American Association of Suicidology. U.S.A. Suicide: 2007 Official Final Data. Available at http://www.suicidology.org/c/document_library/get_file?folderId=232&name=DLFE-232.pdf. Last accessed December 16, 2013.

Lapham SC, Smith E, C'de Baca J, et al. Prevalence of psychiatric disorders among persons convicted of driving while impaired. Arch Gen Psychiatry. 2001;58(10):943-949.

Regier DA, Farmer ME, Rae DS, et al. Comorbidity of mental disorders with alcohol and other drug abuse. JAMA. 1990;264: 2511-2518.