Patients are often unaware of the resources available to them and are more likely to use them if they know where to look. The authors would like to thank the Islamic Azad University, Hamadan Branch, for financial support of this study. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Contributed to the formulation of research questions, study conceptualisation and design, data acquisition, data analysis and interpretation, and writing and how to smoke moonrocks editing the article. Contributed to the study conceptualisation, data interpretation, and reviewing and editing the article. Contributed to the formulation of research questions, study conceptualisation and design, data interpretation, and reviewing and editing the article.

Data availability

1. Universal preventive interventions are directed to the entire population, selective interventions target people at greater risk for suicidal behavior, and indicated preventions are targeted at individuals who have already exhibited self-destructive behavior.
2. Several countries have established national suicide prevention strategies which include specific targets for the reduction of suicide.
3. In opioid-using adolescents and young adults, motivational enhancement therapy (MET) and CBT, as well as combined MET/CBT, have demonstrated efficaciousness in compared to a community reinforcement approach, although findings appeared to be mediated by sex and age 277.
4. Multivariate meta-regression indicates the impact of moderator variables on study effect size.

These findings are interesting in pointing to alcohol-suicide commonalities in neurochemical alterations but, unfortunately, these post-mortem findings in the brains of suicides are only partially matched by alterations found in brains of non-suicidal people with chronic alcoholism. Notably, GABAA receptors were reduced 172–174, but the subunit compositions only partly overlap with those found in suicides. However, despite higher rates of impulsive attempts and a higher level of lethality in patients with alcohol use disorders, the use of alcohol at the time of attempt did not differ significantly between impulsive and non-impulsive attempters 113–115.

Cited by other articles

A good prevention program should adopt a broad spectrum approach since suicide cannot be explained with linear cause-and-effect logic, but rather as a complex and multidimensional phenomenon. The guidelines also recommend incorporating promising, but underused, strategies into current programs where possible, expanding suicide prevention efforts for adolescents and young adults, introducing screening programs, and evaluating the prevention programs. Excluding substance-induced psychotic disorders, the lifetime rate of substance use disorders in people with psychotic disorders is 62.5%. Alcoholism may cause acute paranoid-hallucinatory psychosis and, although prognosis is good, 10–20% of patients with alcohol psychosis will develop a chronic schizophrenia-like syndrome 243,244. Strategies for patients with psychoses must take into account the fact that alcohol dependence and psychosis, which alone are risk factors for medical problems, multiply the risk when comorbid 245.

A study 52 assessed the association between AUD and suicide in two different countries (the USA and France) concurrently. Eight studies reported the association between AUD and suicidal ideation, 15 studies reported the association between AUD and suicide attempt, and 14 studies reported the association between AUD and completed suicide. Since four studies 29,30,46,52 have reported the association between AUD and suicidal ideation, suicide attempts, and completed suicide concurrently, therefore, the number effect sizes given in the forest plots is more than the total number of included studies. Some cohort studies reported RR and some others as well as the case-control and cross-sectional studies reported OR. Longitudinal research is needed to further support these findings empirically and ascertain potential causal associations, in addition to gaining insights into which groups of alcohol users in the general population would be most at risk for suicidal behaviours. Shifting the research focus from binge drinking to other dimensions of alcohol use may be warranted, subject to the availability of sufficiently nuanced data.

Reducing alcohol consumption, thereby rendering the person less abusing and less dependent, may focus on socially reinforcing the sober condition rather than blaming alcohol intake. Increasing the person’s social acceptance is one of the means to reduce suicide thinking. In fact, people with alcohol abuse often are afflicted with self-blame and may feel rewarded or vindicated when the self-fulfilling prophecy of being rejected is realized. Fostering and strengthening positive values may indirectly reduce suicide risk by rendering life more pleasurable. Although groups at risk can be identified, the prediction of suicide in individuals is difficult because individual risk factors account for only a small proportion of the variance in risk and lack sufficient specificity, resulting in high rates of false positives 227. The management of people at risk of suicide is challenging because of the many causes and limited evidence base.

AUA and Suicidal Behavior

Suicide claims more than 800,000 lives each year worldwide and is the second-leading cause of death among people ages 15 to 29.1 For every suicide, at least 20 nonlethal suicide attempts have occurred, primarily by attempted overdose. These attempts are a leading cause of hospitalizations from injury and a potent risk factor for eventual suicide. Therefore, examination of suicide and suicide attempt is a critical focus for injury research and prevention efforts.

In 1996, O’Carroll et al. 29 proposed a classification based on three characteristics, that is, intent to die, evidence of self-inflicted injury and outcome (injury, no injury and death). Another strong correlation is that alcohol and mind-altering substances are used as means of self-medication to cope with untreated mental health disorders, the symptoms of which are reciprocally exacerbated by substances. This causes a spiral effect of emotional decline and mental impairment that occurs with chronic alcohol and drug use and intoxication. If you struggle with other mental health disorders, alcoholism can worsen depression and suicide ideation.

Thus, alcohol abuse may affect the risk for suicide in schizophrenia, but several factors may be critically involved in this association. So, the poor antidepressant treatment response in subjects with co-morbid alcohol dependence and depression, or only with alcoholism, may have important negative effects also, such as increasing suicidality. The spouses of suicides who misused alcohol were significantly more likely to react with anger than the spouses of those who did not. The children of parents with alcohol use disorder who completed suicide were less likely to feel guilty or abandoned than the children of non-alcohol-related suicides. Alcohol use disorder before suicide changes the affective responses in the spouses and the children who are left behind.