Suicidal behavior in alcohol and drug abuse

Abstract

Suicidal behavior is common among individuals with substance use disorders. The large population of individuals with alcohol and drug abuse and dependence, the relative frequency of suicides and suicide-related behaviors in this population, and the devastating effects of attempted and completed suicides on individuals, families, and society make this an important area for clinical and research work. Multiple lines of evidence suggest that lower serotonin activity is tied to increased aggression/impulsivity which in turn is presumed to enhance the probability of suicidal behavior. Dopaminergic dysfunction may play a role in the pathophysiology of suicidal behavior in alcoholism. Alcohol and drugs can damage the brain in many ways. The brain is vulnerable to the toxic effects of alcohol and drugs and can be affected by substance-related damage to other organs, including the liver, pancreas, and heart. Brain damage and neurobehavioral deficits are associated with suicidal behavior. It is possible that cognitive abnormalities contribute to increased suicidality in individuals with alcohol use disorders. Low selenium status is associated with depressed mood, anxiety, and cognitive decline. These symptoms are commonly observed in persons with alcohol use disorders. Selenium deficiency may play a role in the pathophysiology of depression and suicidal behavior in individuals with alcohol abuse. Cocaine use is associated with suicidal behavior. The management of the suicidal patient with substance abuse/dependence involves three components: first, the diagnosis and treatment of existing -substance abuse and other psychiatric disorders; second, the assessment of suicide risk and limiting access to the most lethal methods for suicide; and third, specific treatment to reduce the diathesis or propensity to attempt suicide. Treatments designed to enhance social -supports and foster abstinence from alcohol and drugs, together with those directed at the resolution of major depression, often reduce the risk of suicide.