Alcohol and Suicidal Thoughts: Understanding the Link

Note: If you or someone you know is experiencing suicidal thoughts or is in crisis, call your local emergency number or mental health crisis hotline (911 or 988 in the United States). Click here for a list by country.

Life is full of ups and downs. There are moments of joy and laughter, shared experiences with our loved ones, and times when we experience sadness, disappointment, and frustration. Having this mix of feelings is perfectly normal — and part of life. But for some, feelings of despair and extreme sadness overshadow the good things. Without professional help, these feelings can become difficult to cope with.

When feelings of depression become overwhelming, some of us turn to self-medication, and alcohol is a common choice. While alcohol’s short-term effects offer relief from emotional pain, it only makes things worse in the long run. Alcohol misuse has serious physical, mental, and social consequences, one of which is suicide.

Let’s delve into the intricate link between alcohol and suicidal behaviors or thoughts and shed some light on this sensitive topic.

Defining the Issues

Having a drink may seem like a good way to relax, but alcohol can become a double-edged sword when misused. Alcohol may provide a fleeting escape from painful feelings, but it also opens the door to a host of mental health struggles and leads to a growing cycle of drinking followed by despair. 

Let’s begin by defining alcohol misuse and suicidal thoughts as separate conditions before exploring their relationship with each other.

• Alcohol misuse is an umbrella term 
referring to problematic drinking that 
results in difficulties with health, work, 
finances, social bonds, and relationships. Alcohol misuse includes behaviors like
binge drinking (drinking too much at 
once), chronic heavy drinking, or drinking to cope (using alcohol to deal with stress, anxiety, or physical conditions). 
• Suicidal thoughts or ideations refer to persistent thoughts about suicide. These thoughts can range from a momentary consideration to detailed planning, and they signal our distressed mental state.

Unfortunately, these conditions go hand-in-hand, amplifying each other and creating a vicious negative feedback loop.

Making the Connection 

Unfortunately, suicidal thoughts are incredibly common, and recent research has painted a concerning picture.

• A 2015 survey reported that 9.8 million American adults thought seriously about suicide during the past 12 months, and of them, 2.7 million made plans and 1.4 million made nonfatal attempts.

• Young adults aged 18 to 25 were more likely than adults in other age groups to have serious thoughts of suicide, to have made suicide plans, or to have attempted suicide (Piscopo and Lipari, 2016).

• Several recent studies point to alcohol being a predominant factor when suicidal ideations happen after drinking episodes Schaffer et al., 2008; Klimkiewicz et al., 2012).

• A more recent study by Ledden et al. (2022) provided further insight into the connection between alcohol and suicide by identifying that alcohol dependence symptoms and binge drinking were both associated with increased occurrence of suicidal ideations, suicide attempts, and completed suicides.

There’s no doubt that alcohol plays a role in a sizable proportion of suicidal ideations and subsequent attempts, some of which are fatal. But what other factors are at play here? 


Underlying Factors Associated With Alcohol Use and Suicide

Alcohol misuse and suicide are both extremely complex topics — many factors determine our mental health and our tendency to cope with substances. Let’s explore a few.


Mental Health Conditions


Although there is no single cause of suicidal thoughts, there is considerable research recognizing the link between alcohol and mental health conditions in general. For many people with mental health conditions, using alcohol as a form of self-medication is a common coping mechanism. For some, it’s a replacement for medical treatment, while for others, it temporarily alleviates their symptoms even while being treated.

The following are mental health disorders most commonly linked with alcohol misuse and dependence:

• Depressive disorders. Al-Sadi et al. (2015) found that 21.1% of people diagnosed with depression reported excessive alcohol use.

• Anxiety disorders. That same study by Al-Sadi et al. reported that 21% of those diagnosed with anxiety reported excessive alcohol use, with males reporting it more frequently than females.

• Bipolar disorder. Potash et al. (2000) found those with both alcohol use disorder and bipolar disorder reported a higher rate of attempted suicide among family members. When explaining this association, the researchers suggested that people’s propensity toward suicidal behaviors (including suicidal thoughts) is likely grounded in a genetic origin and influenced by the presence of alcohol and emotional instability during youth.

Let’s now explore how different medications interact. Given the prominent role alcohol plays in suicidal thoughts and behaviors, the potential for harm increases when it is mixed with other drugs. 

Medications

When taking certain medications (including OTC meds), we need to be cautious of their interactions with other drugs — including alcohol. Adverse effects and warnings are listed on medications’ labels, and alcohol is often included.

When mixed with certain medications, alcohol can have serious adverse effects. This is especially true when it comes to drugs used to treat mental health conditions. The following drug types are noted to have possible negative effects when consuming alcohol:

• Antidepressants. Mixing alcohol with antidepressants such as selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants can increase sedation and worsen drowsiness.
• Benzodiazepines. Medications like diazepam or alprazolam, often used to treat anxiety disorders, should not be combined with alcohol as both substances depress the central nervous system. Mixing the two can lead to excessive sedation and respiratory depression.
• Antipsychotics. Drugs prescribed for conditions like schizophrenia or bipolar disorder (such as olanzapine or clozapine) can interact adversely with alcohol, intensifying drowsiness and impairing cognitive function.
• Mood stabilizers. Alcohol reduces the effectiveness of medications like lithium or valproic acid, which are used to manage mood disorders. Mixing alcohol with mood stabilizers increases the risk of the drugs’ side effects and toxicity.

The bottom line is that if we are taking medication for a psychiatric condition, alcohol can negatively affect our symptoms, reduce the effectiveness of our medication, and exacerbate suicidal thoughts.


Genetics


There is reason to believe that genetics play a role in suicidal thoughts and behaviors, especially when alcohol and mental disorders are involved. 

Suicide risk is estimated to be 17%−55% attributable to genetic factors. This tracks with findings that other psychiatric conditions are also theorized to have genetic components, including depression, psychosis, autism, and alcohol use disorder.

Why, exactly, is alcohol a trigger for these things, and who is most at risk for this response? Read on to learn how alcohol may increase the risk of suicidal thoughts and behavior. 


Alcohol as a Trigger


Although alcohol alone doesn’t cause suicidal thoughts — it can trigger them. How, exactly?

• Impaired judgment. Alcohol impairs our judgment and may cause us to think or act against our best interest. For those of us who are struggling with difficult situations or who are being treated for mental health conditions, impaired judgment caused by drinking too much increases the likelihood of acting on suicidal thoughts.
• Depressant effects. Alcohol is classified as a depressant. Even though it initially makes us feel happy or energized, it slows down communication between the nerve cells in our brains. Poor nerve cell communication leads to slow reflexes, poor coordination, and a slowdown in our mental and physical processes.


  
  As a depressant, alcohol also affects our mood in different ways. For those of us struggling with depression or other mental disorders, alcohol can intensify feelings of hopelessness and despair, contributing to suicidal thoughts and ideations.

This response to alcohol isn’t just a rare phenomenon; it happens all the time, even to celebrities.

The Case of Robin Williams

Robin Williams passed away on August 11, 2014, at age 63. He was a beloved comedian and four-time Oscar nominee, and he suffered from chronic depression and alcohol abuse.

From the late 1970s until the early 1980s, Robin Williams was also addicted to cocaine, which he eventually gave up after a friend’s death from a cocaine overdose. Shortly after his recovery, he was diagnosed with major depression — a condition that followed him until his death. Although he stopped using cocaine, Robin Williams continued to struggle with alcohol misuse, despite several stints in treatment centers.

The results of Robin Williams’ autopsy showed no drugs or other substances present at the time of his death. However, Tohid (2016) concluded that alcohol, along with his depression, were two major contributors to his suicide.

The case of Robin Williams sadly illustrates how alcohol abuse can play a role in suicidal thoughts and behaviors. Research shows that quitting and cutting back on alcohol improves our mental health when coupled with professional care.

Risk Factors

Alcohol’s role in suicidal thoughts and behaviors is complex. It includes a web of risk factors ranging from underlying mental health conditions to the cyclical nature of alcohol misuse and the many social elements intertwined within. The following are some of the risk factors associated with higher risk of suicidal behaviors:

• Mental health conditions. Those with pre-existing depression or anxiety disorders are more vulnerable to the depressive effects of alcohol. The cyclical nature of bipolar disorder (from mania to depression) is often amplified by alcohol, leading to more extreme mood swings and increased suicidal ideation.
• History of childhood trauma. Persons with a history of childhood trauma sometimes experience symptoms of PTSD, such as anxiety or flashbacks. Many turn to alcohol as a way to cope with these symptoms.
• Social isolation. The effects of alcohol misuse often exacerbate existing feelings of loneliness and isolation, creating a negative feedback loop.
• Family history. A family history of AUD or mental health issues can contribute to an individual's predisposition to both alcohol misuse and suicidal thoughts.
• Chronic illness or pain. Some of us cope with chronic illnesses and physical pain by using alcohol as a form of self-medication.

These risk factors create a breeding ground for suicidal thoughts. If too many come together, some of us may be in a dangerous place. However, stopping or reducing drinking can also keep a suicide-prone person safer by preventing them from carrying out actions they might not consider while not under the influence.

Warning Signs

Let’s examine some warning signs that may signal a heightened suicide risk. Remember that if you or someone you know is experiencing suicidal thoughts or is in crisis, call your local emergency number or mental health crisis hotline (911 or 988 in the United States).

• Behavioral changes. People struggling with suicidal thoughts typically show changes in their behavior. One of those changes could be increased alcohol consumption. A suicidal person may also withdraw from friends and family and isolate themselves.
• Emotional indicators. Expressing feelings of hopelessness and despair, displaying extreme mood swings, or believing that things will never improve can indicate that a person is having suicidal thoughts.
• Neglect of responsibilities. Neglecting responsibilities and declining performance at work or school may indicate underlying distress, which can lead to suicidal thoughts and ideations.
• Changes in sleep patterns. Disturbed sleep patterns (either insomnia or an excessive need to sleep) can be both a cause and a consequence of alcohol misuse and suicidal thoughts.
• Giving away possessions. People struggling with suicidal thoughts sometimes react by disposing of their personal belongings. A gesture like this may indicate a sense of finality and detachment and is considered a serious warning sign of suicide.

Awareness of these risk factors and warning signs is crucial for early intervention. If you notice these signs in yourself or someone else, seek professional help promptly by dialing 988 in the United States or your local emergency hotline.

Prevention and Support

The fallout from losing a family member, friend, or acquaintance to suicide is dramatic and widespread. The best way to support someone struggling is to stay educated about warning signs. Prevention begins by understanding the multifaceted factors behind suicide and the influence of alcohol. 


• Eliminate mental health stigma. Mental health stigma is old news, and it should stay in the past. Developing an open and honest cultural conversation about mental health is the first step to creating an environment where people feel comfortable seeking help. Be clear with friends and family that it’s safe for them to share with you (as long as you can listen). 
• Increase awareness and education. Education raises awareness about the link between alcohol and suicidal thoughts by emphasizing the importance of moderation, responsible drinking, and seeking help when needed. 
• Access to mental health resources. People struggling with alcohol misuse and suicidal thoughts require early intervention, and everyone should have easy access to mental healthcare and support networks. At the individual level, we can create a supportive environment by expressing our support to friends and loved ones. 
• Screening and intervention programs. Early intervention programs in healthcare settings help identify at-risk individuals before they are at serious risk of self-harm.
• Follow-up for suicide-prone individuals with AUD. Since alcohol misuse is largely associated with suicidal ideations and behaviors, having access to AUD programs can address both problems. 

Effective preventive and support initiatives should be based on a holistic approach that combines mental health awareness, accessible resources, and compassionate support. These programs are crucial to preventing the emergence and escalation of suicidal thoughts linked to alcohol misuse.


How We Can Help 


Starting a conversation with a loved one about alcohol and suicidal thoughts is never easy. It requires empathy, patience, and a nonjudgmental approach. Here are several tips on approaching the topic, expressing concern, and empowering them to seek help:

• Express empathy and understanding. Let your loved one know you care about their well-being and avoid judgment or dismissive remarks. Be kind and tell them you’re there to listen without trying to solve the problem.
• Ask direct questions. It’s probably awkward and uncomfortable, but ask direct, open-ended questions about their feelings. Encourage them to share their thoughts and emotions and listen actively without interrupting. Asking direct questions creates a space for them to express themselves honestly.
• Avoid minimizing their feelings. Refrain from minimizing or trivializing their struggles. Acknowledge the validity of their emotions and let them know it's okay to feel the way they do. Avoid phrases like "it's not that bad" or "you'll get over it," as this invalidates their experiences.
• Encourage professional help. Empower them to seek professional help without being accusatory or dismissive. Emphasize that mental health professionals are trained to provide support and guidance, but expect some resistance to your suggestion. Help your loved one over this hump by offering to assist in finding a therapist, counselor, or helpline (if you have the capacity). Reinforce that seeking help is a sign of strength, not weakness.

• Prioritize your well-being. You are not responsible for other people’s emotions. Don’t take on so much emotional burden that your well-being suffers.
• Stay connected and follow up. Suicidal thoughts can be overwhelming, and ongoing support is crucial. Stay connected with your friend or loved one through regular check-ins to remind them that you care — and that they are not alone.

A Final Thought

Alcohol misuse and suicide are two complex, heavy, and emotionally taxing topics. Fortunately, there is hope for overcoming both of these circumstances. If you or someone you know is experiencing suicidal thoughts or is in crisis, call your local emergency number or mental health crisis hotline (911 or 988 in the United States). Click here for a list by country.