Alcohol Misuse and Suicide Risk

Suicide, suicidal ideation, and suicidal attempts are major concerns for individuals who misuse alcohol, as alcohol use can lead to impaired judgment, decreased inhibitions, and impulsiveness.

When discussing suicide, it’s important to be aware of different terms: suicide is death caused by behaviors you engage in with the intent to die, suicidal ideation involves planning for or otherwise contemplating suicide, and suicidal attempts are potentially injurious behaviors that are intended to cause death but ultimately do not.¹

If you (or someone you care about) have thoughts of self-harm or are thinking of taking action to hurt yourself, you should know that help is available and that you’re not alone. There is always a place to turn, no matter how dire or hopeless your situation may seem in the moment.

Reaching out for assistance and seeking appropriate treatment for alcohol misuse is one of the best ways to obtain support, overcome the addiction to alcohol, and prevent suicide.

Scope of the Problem

Suicide is a serious global health issue and one of the biggest preventable causes of death in the United States. According to the World Health Organization (WHO), over 700,000 people commit suicide each year around the world.² Globally, there’s approximately one death every 40 seconds from suicide.³

In the United States, there were more than 45,000 deaths due to suicide in 2020.¹ Suicide is the second leading cause of death for people between the ages of 10–14 and 25–34 and the fourth leading cause of death for those between ages 35–54.¹

In 2020, almost twice as many suicides were committed in the U.S. than homicides.¹ Further, between 1999 and 2018, the suicide rate increased by 35%, from 10.5 per 100,000 people to 14.2.⁴ In those same years, the suicide rate for males was between 3.5 and 4.5 times the rate for females.⁴

According to the National Survey on Drug Use and Health, around 4% of adults aged 18 or older had serious thoughts of suicide in the past 12 months.⁵ Past survey results have indicated that firearms were the most common method of suicide among both men and women.¹

Certain populations have a higher risk of suicide. These include American Indians, Alaska Natives, people who have lost someone to suicide, people involved in the criminal justice and child welfare systems, people who engage in self-harming behaviors, people who have medical conditions, people with mental health and/or substance use disorders, members of the LGBT community, veterans and members of the armed forces, men in midlife, and older men.⁵

How Prevalent Is Substance Misuse and Suicide in the United States?

Suicide is one of the major causes of death in the U.S. among people who struggle with a substance use disorder (SUD).⁵ Although there’s a well-established connection between suicide and alcohol use, less is known about the relationship between suicide and other types of substance abuse.⁴ There is some indication, however, that the number of substances being used may more closely predict suicide than the specific types of substances a person uses.⁵ 

Previous estimates from the Centers for Disease Control and Prevention (CDC) have indicated that approximately 22% of suicides involve blood alcohol content (BAC) levels at or above the legal limit.⁵ The CDC has also indicated that 20% of suicides involve opioids (such as heroin and prescription opioid painkillers), 10.2% marijuana use, 4.6% cocaine use, and 3.4% amphetamine use.⁵

Between 2000 and 2018, there were 1,677,435 suicide attempts among people aged 10–25 that involved self-poisoning. The most serious outcomes were due to the use of over-the-counter analgesics (e.g., acetaminophen), antidepressants, antihistamines, and antipsychotics.⁶ 

How Does Alcohol Misuse Affect Suicide and Suicidal Attempts?

Acute alcohol intoxication is involved in 30–40% of all suicide attempts.⁵ Past studies have suggested that heavy drinkers may have a suicide risk 5 times that of social drinkers, while people with issues of alcohol abuse or dependence may have a suicide risk 10 times greater than the general population.^3,5

Suicide and alcohol misuse are both complex issues that develop as a result of a wide range of factors that can vary by individual circumstances. In addition to contributing factors such as decreased inhibitions and poor judgment, an increased risk of suicidal behavior could stem from alcohol’s potential to increase psychological distress and aggressive behavior.⁷ Alcohol can also impair cognition, leading to individuals forgoing healthy coping strategies.⁷

People who have co-occurring mood disorders (particularly depressive disorders) and struggle with alcohol misuse may have a relatively higher risk of suicide than those with no mental health issues, and this risk may become more pronounced with age.⁸ This is particularly true in middle-aged and older men.⁸

A systematic review of 31 studies investigated the relationship between alcohol use disorder (AUD), the diagnostic term used for alcoholism, and suicide. The results showed a significant relationship between AUD and suicidal ideation, suicide attempts, and completed suicide. The researchers concluded that a diagnosis of AUD is a significant “predictor of suicide and great source of premature death.”⁹ 

Treatment for Suicidal Behaviors and Alcohol Use Disorder

Whether you’re seeking treatment for yourself or you’re concerned about a loved one, know that there are many ways to help prevent suicide and stop alcohol misuse. Many people in similar situations have benefited from a combination of mental health and substance use disorder treatment.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), specific programs that provide support and life skills training have been shown to help protect people from both suicide and substance misuse.⁵ Identifying and treating alcohol misuse is a crucial component of suicide prevention.³ A failure to identify specific alcohol-related disorders can result in both increased morbidity and mortality of those at risk of suicide.³

Behavioral approaches to treating alcohol use disorder should also incorporate specific therapeutic elements, including social skills training, goal setting, and education on relapse prevention. Evidence-based approaches used to treat alcoholism include:¹⁰

• Brief Interventions: These are short and time-limited approaches where a counselor provides personalized feedback about your habits and risks and helps you identify goals for treatment so you can form a plan to stop drinking.
• Cognitive Behavioral Therapy: This form of therapy can be applied in either one-on-one or small group settings. It aims to help people identify maladaptive thoughts, feelings, and behaviors that can contribute to problematic patterns of drinking. The goal is to help people develop healthier thoughts and coping skills so they can decrease their drinking behavior or avoid a future relapse.
• Motivational Enhancement Therapy: This is a short-term treatment to increase a person’s motivation to stop drinking. People work with a therapist to discuss the pros and cons of seeking treatment, work to build confidence, form a treatment plan to stop drinking, and develop the skills needed to stick with it.
• Marital and Family Counseling: As family members and spouses are also affected by a person’s drinking, it’s important to include them as a part of a comprehensive treatment program. Marital and family counseling aims to strengthen and repair relationships. It’s also been proven to help people maintain abstinence.

Suicide Hotlines

Suicide hotlines are designed to assist people contemplating suicide or otherwise in distress by providing emotional support and connecting them with crisis resources. The following resources offer confidential services, so you don’t have to provide any identifying information if you don’t want to.

• National Suicide Prevention Lifeline at 988. This hotline is available 24/7, 365 days a year. It has a separate hotline for Spanish-speaking callers available at 1-888-628-9454. If you are deaf or hard-of-hearing, you can chat with a Lifeline counselor 24/7 via the following options:
  • Online chat by clicking the chat button on this website.
  • Video relay service by calling 1-800-273-8255.
  • TTY by calling 1-800-799-4889.
  • Voice/Caption Phone by calling 800-273-8255.
• Veterans Crisis Line at 988. You may also text 838255 or chat online through their website. If you are deaf or hard-of-hearing, call 1-800-799-4889. Their services are available to all veterans, service members, members of the National Guard and Reserve, and their family members and friends.
• Vets4Warriors at 1-855-838-8255. You can click on the chat button on their website or email them at vets4warriors@ubhc.rutgers.edu. This is a support service designed for veterans but it is not a crisis hotline; it is intended to help you “address challenges before they escalate into a crisis.” You will be connected with a peer who is also a veteran or member of the armed forces.
• IMALIVE chatline, which can be reached through clicking the button on their website. It is a nonprofit chatline that offers suicide intervention, prevention, awareness, and education services 24/7, 365 days a year.
• Crisis Text Line by texting 741741. Services are offered 24/7 and you will usually be connected with a trained crisis volunteer within 5 minutes.
• The Trevor Project at 1-866-488-7386. You can also connect via instant messaging using the button on their website or by texting START to 678-678. Services are available 24/7, 365 days a year. This program is specifically geared toward providing crisis intervention and preventing suicide in LGBTQ youth.
• The Trans Lifeline at 1-877-565-8860 (US) or 877-330-6366 (Canada). Available 24/7, this trans-led organization “connects trans people to the community, support, and resources they need to survive and thrive.” You can call if you are in crisis or if you just need someone to talk to.
• The SAMHSA helpline at 1-800-662-HELP (4357) or TTY 1-800-487-4889. This confidential, free, 24/7, 365-day-a-year information service is available in English and Spanish for people and family members facing mental and/or substance use disorders. It is not a crisis hotline, but it provides information and referrals to local treatment facilities, support groups, and community-based organizations.

It’s important to call 911 or a hotline right away if you or a friend or family member are in danger or are actively considering suicide. Don’t delay in reaching out for help.