Alcohol Use to Facilitate a Suicide Attempt: An Event-Based Examination

Abstract

ABSTRACT. Objective: The current study is based on the hypothesis that alcohol-involved suicide attempts are characterized by lower premeditation and intent, but only when the use of alcohol is not motivated by the desire to facilitate the attempt. Test of this idea was conducted by comparing proximal suicide premeditation and intent of suicide attempts among three groups: individuals who (a) drank to facilitate the attempt (e.g., to "numb fears" about attempting), (b) drank for nonfacilitative motives, and (c) did not use alcohol before the attempt. Method: Participants included 324 (62% female) recent suicide attempters presenting to a Level 1 trauma hospital. The Timeline Followback Interview for Suicide Attempts and a novel Suicide Facilitative Drinking Motives Scale were used to assess facilitative motives for drinking and characteristics of the attempt. Results: One third of participants drank before the attempt, and most (73%) who used alcohol did not do so to facilitate the attempt. As hypothesized, attempts carried out by this group had shorter proximal suicide premeditation and lower suicide intent compared with the other study groups; in contrast, individuals who drank to facilitate the attempt were similar to non-alcohol users on these indices. Conclusions: Alcohol-involved suicide attempts are heterogeneous. Motives for drinking are a key source of heterogeneity insofar as fundamental characteristics of attempts (proximal premeditation, intent) differ as a function of drinking motivation. Clinical implications include that individuals making suicide attempts with facilitative motives for drinking cannot be assumed to be at lowered risk upon a drop in blood alcohol level. (J. Stud. Alcohol Drugs, 76, 474-481, 2015)

Substance use and self-harm: a cross-sectional study of the prevalence, correlates and patterns of medical service utilisation among patients admitted to a South African hospital

“…These associations calculated using the Chi-Square statistical test were not statistically significant ( p  > 0.05), though the overall direction of the findings were in keeping with studies from high-income countries [12, 15, 32]. It is possible that given a larger sample and more accurate measures of AUS, we would have found the differences we observed to be statistically significant.…”

“…High levels of substance use during social events are associated with self-harm, independent of the level of suicidal intent, as a result of disinhibition, increased impulsivity, impaired judgement, increased feelings of depression or hopelessness, and the urge to escape a situation or to change the behaviour of someone else [13, 14]. In cases with higher levels of intent to die and premeditation, AUS may facilitate self-harm by easing the distress of engaging in self-harm [15]. …”

“…Ries and colleagues reported that self-harm patients who had used substances at the time of injury were discharged sooner than patients whose behaviour was not perceived to be related to substance use [16]. Clinicians believe that AUS related self-harm is linked to lower levels of premeditation (i.e., is more impulsive) and lower levels of suicidal intent [15]. This belief together with aggressive or uncontrolled behaviour upon arrival at the emergency department, seems to lead to self-harm patients who had been using substances receiving less intensive medical care and being discharged sooner than patients who did not have a substance-related risk for suicidal behaviour [17].…”

A meta-analysis of acute use of alcohol and the risk of suicide attempt

“…This study demonstrated that across the 24 hours prior to a suicide attempt, the AUA within a specific hour led to increased intensity of suicidal ideation in the subsequent hour, controlling for the prior hour level of suicidal ideation. Further, some individuals use alcohol prior to an attempt to facilitate the attempt (e.g., numb fears about attempting)(see (Bagge et al, 2015). This research demonstrates that a “one size fits all” model cannot be used to understand the role of AUA on suicide attempts.…”

Acute Alcohol Co‐Ingestion and Hospital‐Treated Deliberate Self‐Poisoning: Is There an Effect on Subsequent Self‐Harm?

“…Alcohol co‐ingestion may have a disinhibiting effect, with increased levels of impulsivity and/or self‐aggressive tendencies (Bagge & Sher, ). There is empirical evidence to suggest that a proportion of those who consume alcohol prior to their DSP episode have lower suicidal intent than those who do not, particularly those in which alcohol was consumed for nonfacilitative (i.e., for recreation) purposes as opposed to facilitative reasons (i.e., to numb fears or enhance toxicity of poisons; Bagge, Conner, Reed, Dawkins, & Murray, ).…”