Suicidality and Substance Abuse in Affective Disorders
J Clin Psychiatry 2001;62(suppl 25):35-43
© Copyright 2014 Physicians Postgraduate Press, Inc.
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The relationship between suicidality and substance abuse has long been recognized, although
studies have only fairly recently begun to identify factors that may help clarify how alcohol or other
drug abuse increases the susceptibility to suicidal behavior in vulnerable populations. In particular,
alcohol and other psychoactive substance misuse has been linked with mood destabilization and the
induction of manic or depressive episodes in affectively ill individuals, while also demarcating
groups with heightened tendencies toward impulsivity, aggression, and sensitivity to interpersonal
loss. Serotonergic mechanisms have been implicated in each of these clinical settings, along with
possible dysregulation of other neurotransmitter systems. Psychosocial aspects of alcohol or drug
abuse relevant to suicide may involve a heightened sensitivity to interpersonal loss, poor coping
skills in response to adverse life events, and affective dysregulation induced by circadian and
psychosocial stresses. Consequently, self-destructive behaviors with relatively little premeditation
may arise during periods of increased stress, intoxication, depression, or other psychopathology.
Early detection of substance abuse followed by appropriate pharmacologic and/or psychotherapeutic
interventions may greatly help to minimize the formation of complex comorbid psychiatric conditions
and reduce the potential for suicidal acts among high-risk populations.