Proximal risk pathways of momentary alcohol urges and use: differences based on suicidal ideation history

Abstract

Despite alcohol use being a proximal risk factor for suicidality, there have been limited examinations of alcohol use risk pathways at the momentary level among those at elevated suicide risk. Thus, we aimed to investigate risk factors relevant to predicting alcohol use experiences among those with and without a history of suicidal ideation. Data from 51 participants with a probable alcohol or substance use disorder across 21 days of ecological momentary assessment was utilized. Participants reported relevant risk factors (i.e., affect, thwarted belongingness, perceived burdensomeness) and alcohol use experiences (i.e., urges, use) four times per day. Group-level analyses examining differences in momentary associations between risk factors and alcohol use experiences based on suicidal ideation history did not detect group differences in predicting alcohol use, but group differences emerged for concurrent and prospective prediction of alcohol urges. Individual-level analyses demonstrated heterogeneity in momentary associations between risk factors, alcohol urge, alcohol use, and suicidal thinking. Together, results demonstrate the role of negative emotion, thwarted belongingness, and perceived burdensomeness in understanding momentary alcohol use experiences. Findings also highlight the complexity of, and significant heterogeneity in, the alcohol use experience among those who have experienced suicidal ideation.