How alcohol use increases risks, and what can be done about it

Nearly half of us know someone who ended their life by suicide. Worldwide, 700,000 people die by suicide each year. In Canada, 12 people die by suicide each day — and another 200 attempt suicide. While the prevalence and destructiveness of suicide is clear, much less is known about why people die by suicide.

Alcohol is believed to be a major contributor to death by suicide. Among people who die by suicide, alcoholism is the second-most common mental disorder, and is involved in roughly one in four deaths by suicide. However, there is still much to learn. As a psychologist and scientist, my research aims to understand whether alcohol actually increases the risk of dying by suicide.

Alcohol recently became a hot topic when the Canadian Centre on Substance Use and Addiction updated Canada’s low-risk alcohol drinking guidelines. The difference in what they considered low-risk consumption in 2018 and 2022 was drastic: from the previous two to three drinks per day, they now suggest two to three drinks per week. Moreover, the entire emphasis of the guidelines changed from how to drink safely, to the message that drinking is never completely safe.

There is so much concern about Canadians’ drinking that some policymakers are advocating for warning labels on alcohol bottles like those on cigarette packages. Clinicians and scientists are concerned. The public is concerned. In fact, we are so concerned about excessive drinking that we implement initiatives like Dry January where we challenge ourselves not to drink alcohol for a month.

I’m an addiction researcher and therapist. Here’s why promoting sober ‘dry months’ bothers me.

Alcohol and suicide

There are well-established links between alcohol and cancer, heart disease and violence. Alcohol also undermines mental health, with links to depression and anxiety. However, more investigation is required before making any statements on the link between alcohol and suicide. This is where my and my colleague’s research comes in.

We conducted the most comprehensive meta-analysis on the link between alcohol (ab)use and death by suicide to date. By analyzing the data from 33 longitudinal studies — and 10,253,101 participants — we determined that alcohol use is a substantial risk factor for death by suicide. In fact, we found that alcohol use increased the risk of death by suicide by a frightening 94 per cent.

So, how can we understand this link and use the results of our study to help prevent suicide?

There are several neurobiological and psychological theories proposed to explain the relationship between alcohol use and suicide. Alcohol affects neurotransmitters, which are the chemical messengers such as GABA and serotonin that help regulate mood. Upsetting these systems could increase suicidal thoughts.

Chronic and heavy alcohol use is related to depressed mood. It can increase aggressive behaviour and suicide motivation, and inhibit decision-making and pain responses. Social psychologist Roy Baumeister’s theory of suicide asserts problematic alcohol use and suicide share an underlying root cause: a desire to escape painful self-awareness and the associated negative mood and emotions.

Another theory of suicide suggests the severity of depressive symptoms, such as a hopeless sense of not belonging, is directly proportional to the likelihood of a lethal suicide attempt. The effects of problematic alcohol use can have similar effects.

Recognizing risk

Beyond current theories regarding the link between suicide and alcohol use, effective prevention requires knowing who is most at risk. Our study found those who drink heavily and more frequently have increased risk of death by suicide, particularly over longer periods of time. Especially vulnerable populations include women, military personnel and youth.

Women could be at greater risk because heavy drinking generally has more negative physical and cognitive consequences for women than men. For youth, perhaps the higher risk is due to the elevated rates of heavy and problematic drinking in young adults or that suicide is the second leading cause of death among 15 to 29-year-olds.

Military personnel have higher rates of both suicide and alcohol use. Our study indicates these combine to produce a 282 per cent increased risk of death by suicide.

These are the people we should be working to help.

Public policies should be looking to increase awareness of the link between alcohol and suicide and to assess and treat problematic alcohol use as a way to prevent suicide. The results of our research highlight just how needed these measures are in our society, but prevention requires change at both the individual and systemic level.

Over three-quarters of Canadians drink alcohol, so either you drink or know someone who does. As Canadians weigh the pros and cons of adopting the new drinking guidelines, they should be thinking not just about the risks to their physical health, but also to their mental health.

Suicide, heart disease and cancer are consistently among the top 10 causes of death of Canadians, and alcohol increases the risk of all of these killers.

People with problematic alcohol use are also a vulnerable population and we owe them a special duty of care; that should also inform public policies. If it means saving a loved one, warning labels on beer cans seem like a pretty low price to pay.

If you or someone you know is thinking about suicide, please contact Canada Suicide Prevention Service at 1-866-277-3553 (from Québec) or 1-833-456-4566 (other provinces), or send a text to 45645. Visit Crisis Services Canada for more resources.