Collectively, this may support the beneficial effect of buprenorphine as a rapid-acting treatment for high-risk suicidal individuals, particularly in those with OUD. Accumulating evidence suggests that kappa antagonism properties of buprenorphine may underlie its antisuicidal properties via reducing negative affect responses in the amygdala and enhancing activity of regulatory frontal regions. In preclinical models of depression, buprenorphine produced antidepressant and anxiolytic responses 265,266,267,268 driven by its kappa antagonist properties 267, 268.
The Alcohol-Suicide Link: A Bond Difficult to Disentangle
In combination, MET/CBT interventions have shown effectiveness in adolescent populations with co-occurring MDD and AUD 135. Other interventions, such as relapse prevention therapy (RPT) and contingency management (CM), directly target the psychological reinforcement mechanisms that maintain addictive behavior. While they have been effective in populations with AUD/SUDs, there is limited evidence of what is smack in the dirt their utility in co-occurring suicidality/depression and alcohol misuse 136.
In clinical contexts, patients often avoid mentioning their suicidal ideation, but they are more willing to discuss it if the doctor asks specific questions about their suicidal intentions. Therefore, giving information and training to general practitioners and nurses may have an enormous impact on how the patients at risk are evaluated and managed. This may be useful also for teachers, parents, relatives and all those who come into contact on a regular basis with at-risk individuals.
Alcohol use and death by suicide: A meta-analysis of 33 studies
However, in a later study conducted in Canterbury, New Zealand, Conner et al. 63 failed to detect an effect of gender in mediating the association between alcohol dependence and serious suicide attempts. Co-use of alcohol and opioids can significantly increase the risk of death from overdoses due to respiratory depression 153, and in fact, many OUD-related deaths involve alcohol use 154. There are a number of predisposing risk factors that contribute to both AUD and OUD, and some pharmacological treatments are indicated for both AUD and OUD (e.g., naltrexone).
As yet, however, there are no FDA-approved medications specifically indicated for suicidal ideation, urges, or behavior 113. A few pharmacotherapies have been approved for the treatment of alcohol misuse 114, 115. They include disulfiram, which produces aversive symptoms following alcohol intake; acamprosate, thought to mitigate withdrawal-related symptoms; and naltrexone, a nonselective opiate receptor antagonist that reduces alcohol cravings. These drugs primarily operate by targeting reinforcement mechanisms involved in alcohol misuse; however, extended-release naltrexone has also shown some benefits in reducing attendant anxiety and depressive symptoms 116.
This week, we at Psychiatric Times want to highlight how best to support patients, friends, family, and anyone who might be having suicidal thoughts. We sat down with Manish Mishra, MBBS, the Chief Medical Officer of the Texas Healthcare and Diagnostic Center, to discuss. They may think they’re a burden to others and begin to develop a higher pain tolerance and fear of suicide.
Alcohol use and the gender-specific risk of suicidal behavior: a systematic review and meta-analysis protocol
- Regarding other receptors involved in the action of ethanol, genetic polymorphisms have been found in suicidal persons for both the CRF1 165 and CRF2 receptors 166, but the latter is not apparently involved in the action of ethanol 127.
- Reduced serotonergic functioning, implicated in the pathophysiology of depression and suicidality 62, 63, may also play a role in OUD 231.
- Further research is needed to understand the effects of alcohol and opioid use on suicide risk, as well as address notable gaps in the literature on psychosocial and pharmacological interventions to lower risk for suicide among individuals with AUD/OUD.
- Recent research suggests that a suicidal element may play a significant role in opioid overdose deaths 140, 141.
Koob and LeMoal 144 suggested that the changes in hedonic tone that accompany substance use are central aspects of the addictive process, and the maintenance of substance use in the dependent person is driven by attempts to regulate the affective disturbance that results from substance use. Ethanol has been shown to potentiate acutely 5-HT3 receptor function and to modulate chronically 5-HT3-augmented mesolimbic dopaminergic function, but also to regulate alcohol drinking and its reinforcing properties at the ventral tegmental area level 145,146. However, 5-HT3 receptors were not found to be altered postmortem in suicides 147. Furthermore, our analyses identified simple domains of alcohol misuse, such as others’ concerns about drinking, which can be readily understood by the public and targeted, perhaps through motivational interviewing,40 to reduce risk of future suicidal behaviour. McGirr et al. 252 reported that, compared to other suicides, schizophrenic and schizoaffective suicides showed comparably elevated levels of impulsive aggressive traits.
Globally, alcohol consumption has increased in recent decades, with all or most of that increase occurring in developing countries. Alcohol consumption has health and social consequences via intoxication (drunkenness), dependence (habitual, compulsive and long-term drinking), and biochemical effects. In addition to chronic diseases that may affect drinkers after many years of heavy use, alcohol contributes to traumatic outcomes that kill or disable at a relatively young age, resulting in the loss of many years of life to death or disability. There is increasing evidence that, aside from the volume of alcohol consumed, the pattern of the drinking is relevant for health outcomes.
AUA and Suicidal Behavior
We found evidence of a linear association between total AUDIT score and suicide attempt, suicidal thoughts and non-suicidal self-harm in a representative English general population sample. Our analyses suggest that where alcohol use significantly disrupts day-to-day functioning, this may underpin the relationship between alcohol use and suicide-related outcomes to a greater extent than higher alcohol consumption. Wojnar et al. 112 investigated the correlates of impulsive and non-impulsive suicide attempts in 154 hospitalized patients with alcohol dependence.
Simply select your manager software from the list below and click Download.For more information or tips please see ‘Downloading to a citation manager’ in the Help menu. We would like to thank the Islamic Azad University, Hamadan Branch, for financial support of this study. We also thank our colleagues Ensieh Jenabi and Mina Madadian for finding full text articles. Two authors (ND and JP) independently screened the title and abstract of the retrieved studies and decided on which studies met the inclusion criteria of this meta-analysis. The between authors disagreements were resolved through discussion among the authors until consensus was reached, otherwise a senior author arbitrated. The number of people die from homicide and suicide is much more than the number of people die from the attack in a war.
According to this classification, suicide is a fourth order event in a set where the first order (i.e., the name of the set) is represented by Self-Injurious Thoughts and Behaviors. Subsets of the set are risk-taking thoughts and behaviors and suicide-related thoughts and behaviors. The former is subdivided into immediate or remote risk for life and further subclassified, as all other subsets of the classification, according to the outcome, that is, non injury, injury (no matter how severe) and death. The latter subset is further subclassified into suicide-related ideation, suicide-related communications, and suicide-related behaviors. Ideation is further subclassified according to intent, that is, absent, undetermined or present (independent of its degree), and may be casual, transient, passive, active, or persistent. Brief motivational enhancement techniques to increase patients’ willingness to pursue treatment and overcome obstacles may also be an effective engagement approach.
