DRINKING, DRUG USE INCREASE SUICIDE RISK

NEW YORK, Apr 20 (Reuters Health) -- Alcohol and drug use can lead to
suicidal thoughts and even unplanned spur-of-the-moment suicide attempts
while under the influence, according to a new report.

"You don't have to be an alcoholic, just the fact that you're disinhibited
at the moment is enough --which is bad news," according to study co-author
Ronald C. Kessler, professor of healthcare policy at Harvard Medical School
in Boston, Massachusetts.

Kessler and his associates analyzed data collected between 1990 and 1992 by
the US National Comorbidity Survey -- a nationwide sampling of information
related to suicide plans, attempts, mental disorders, and substance use and
abuse among over 8,000 men and women aged 15 to 54. Combined with two
in-person interview sessions, the researchers assessed the nature of any
psychiatric disorders the survey respondents may have had. Their report is
published in the American Journal of Epidemiology.

The investigators found that among the sample, those exhibiting alcohol and
substance dependence did exhibit a higher likelihood of attempting suicide.
However, the authors note that for those who had underlying mental
disorders in addition to such dependence, it was often the use of the
alcohol or drugs itself that led directly to such attempts rather than the
history of mental problems.

Kessler and his colleagues also note that current use alone, with or
without a history of dependence, was associated with impulsive suicide
attempts and thoughts of suicide, and that no one type of drug was more
associated with suicide than another -- with depressants and stimulants
equally likely to illicit suicidal thoughts and attempts. In addition, the
researchers found that substance disorders are not associated with the
planning of a suicide -- as has been the traditional assumption -- but
rather is more closely associated with suicidal thoughts and unplanned
attempts.

In an interview with Reuters Health, Kessler said the ramifications of the
study results could be profound. "Basically, the point is that you don't
really have to be a big-time problem drinker," he said. "That has important
implications for therapists dealing with patients at risk for suicide.
Their antennas are already out for substance abusers, but the fact that
even occasional users can be at risk is something that therapists and
clinicians need to be concerned about."

Kessler added that individuals at risk for suicide learn early on that
drugs dull emotional pain, failing to realize that those same drugs may
heighten suicidal thoughts. "Among people who are seriously thinking about
killing themselves, people who are in that place in their life are
vulnerable in a variety of ways," he said. "And when you are on the edge
little things can tip you over. A single bout of heavy drinking sometimes
can be enough if people are close enough to that edge. And unfortunately
alcohol and drugs are so widely available and there's a stigma to getting
professional help for emotional problems."

Kessler further suggested that educators get the word out that drinking and
drugs are not the way out of depression and anxiety issues. "One important
thing to tell people who have emotional problems is that they have to be
cautious or realize what they're doing when they use drugs as a crutch,
because in the long-run, they're digging themselves into a hole."

SOURCE: American Journal of Epidemiology 2000;151:781-790.