The present article provides a conceptual framework of the relation between alcohol involvement (A) and suicide attempts (S). This framework can be broadly construed to reflect two dimensions: directionality (direction of causality; A→S, S→A, or a spurious relation) and temporality (distinguishing between proximal and distal effects of both behaviors). We review and evaluate the evidence on the association between A and S among adolescents using this conceptual framework as a guide. The extant data suggest that this relation is complex and not fully understood. Further, it seems unlikely that a single approach will be found to determine direction of causality, and the specification and validation of hypothesized mechanisms will involve a variety of different types of evidence. Suggestions for additional research using informative designs are discussed.Suicide is the third leading cause of death among adolescents and accounts for more deaths per year than the next seven leading causes combined (Anderson & Smith, 2003). In 2004, the incidence of suicide was 1.3/100,000 per year among youth aged 10-14 and 8.2/100,000 per year among adolescents aged 15-19 (Center of Disease Control [CDC], 2005). It is estimated that for every death by suicide there are between 8 to 25 nonfatal suicide attempts (Moscicki, 2001). Beyond the tragedy of self-inflicted mortality, the repercussions of adolescent suicide on close friends, extended peer networks, and the family are often severe and account for additional emotional and economic costs to individuals and society (Miller, Covington, & Jenson, 1999). Recognizing the importance of adolescent suicide and suicide attempts to the Nation's health, Healthy People 2010 (Department of Health and Human Services [DHHS], 2000) has listed as high priority goals to reduce, by more than half, completed suicide overall and suicide attempts in youth.Given the seriousness of suicide, there is historical interest in identifying the factors that predispose adolescents to attempt suicide. Alcohol involvement (AI) is consistently implicated in adolescent suicide attempts (Mehlenbeck, Spirito, Barnett, & Overholser, 2003). This association has been hypothesized since the birth of modern psychiatry. Menninger conceptualized addiction as both a protracted from of chronic suicide and as playing a part in focal deliberate "accidents" (Menninger, 1938). Similar to Menninger, we believe that alcohol can relate to suicide attempts both situationally and chronically, and the aim of this paper is to put forth a conceptual framework of the relation between AI and suicide attempts.Correspondence concerning this article should be addressed to Courtney L. Bagge, University of Missouri-Columbia, Department of Psychological Sciences, 200 South Seventh Street, Columbia, MO 65211-0001. I may also be reached by telephone at (573) 882-9770, by fax at (573) 884-5588 or by email at CLBF34@mizzou.edu. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a...