Problematic alcohol use is associated with increased odds of suicide or self-harm, according to a new study led by UCL researchers.

The study, published in BJPsych Open, did not identify a clear association with levels of alcohol consumption and risk of suicide or self-harm, other than among those with “probable dependence” (the highest consumption level); rather, they identified signs of alcohol negatively impacting people’s lives as risk factors.

Lead author, Ph.D. candidate Sarah Ledden (UCL Psychiatry), said, “We found that it’s not just how much people drink that is associated with their risk of suicide or self-harm, but whether they show signs of more problematic alcohol use. Drinking alcohol might not be the problem per se, but how it’s affecting your life and potentially causing you problems.”

The study involved 14,949 people, broadly representative of the general public in England, who completed surveys (Adult Psychiatric Morbidity Surveys) about alcohol consumption and patterns of harmful use (measured by the Alcohol Use Disorder Identification Test—AUDIT). The researchers compared this to self-reported incidence of suicide attempts, suicidal thoughts and non-suicidal self-harm in the past year.

The study team found that whether other people have expressed concern about someone’s drinking was the strongest predictor of suicide and self-harm risk. People whose friends, family or colleagues have expressed concerns about their drinking were found to be three times as likely than those who hadn’t received any concern from others to have attempted suicide in the last year, two and a half times as likely to have had suicidal thoughts, and one and a half times as likely to have self-harmed (after accounting for confounding factors such as self-reported mental health problems, past year drug use, deprivation, age and others).

People with dependence symptoms—such as an inability to stop drinking, failure to meet normal expectations due to drinking, and feeling a need to drink after a heavy session—and those who reported harmful effects of drinking—such as drink-related guilt, memory loss, or injury—also faced higher odds of suicide or self-harm.

There was no clear pattern based on levels of consumption, as there were not consistent differences in suicide and self-harm risk between people with light, moderate, and hazardous drinking consumption. However, those in the highest category of consumption (“probable dependence,” counted as drinking more than 30 units of alcohol per week) did face higher odds of suicide and self-harm.

The researchers say that as the research was cross-sectional (one snapshot in time, rather than longitudinal), they cannot say whether harmful drinking is what makes mental health worse, or rather if it is a sign of already declining mental health—but they say the causation may go in both directions.

Sarah Ledden added, “In our study, we found that alcohol misuse, particularly if it impairs someone’s day-to-day functioning, may be a modifiable risk factor for suicide and self-harm, so helping people with alcohol dependence may help to prevent suicides. People should be aware that if they are concerned about someone’s drinking patterns, it could well be a sign that person’s mental health is very poor and they might be at risk of harming themselves.”

Senior author Dr. Alexandra Pitman (UCL Psychiatry and Camden & Islington NHS Foundation Trust) said, “Our findings suggest that clinicians should inquire particularly carefully about suicidal behavior in anyone with signs of harmful drinking, using non-judgmental and sensitive questioning, as this provides an important opportunity for therapeutic assessment and risk management. Gaining an understanding of the circumstances that lead to binge drinking and dependence whilst using a motivational interviewing approach may help identify how harmful drinking patterns might be shifted to the benefit of the patient, thereby reducing risk.”

Dr. Emily Finch, Chair of the Addictions Faculty at the Royal College of Psychiatrists, said, “This research shows a clear link between alcohol use, self-harm and suicidality, indicating a person’s pattern of drinking has the most impact rather than frequency or quantity alone. This suggests we could reduce the risk of suicidality in people who use alcohol by examining their relationship with binging, concern from friends and family, and dependence symptoms.

“People who use alcohol often receive very different crisis care than those who don’t, and it is vital that they are not excluded from therapeutic interventions to tackle self-harm. We must urgently incorporate harm minimization and alcohol treatment into crisis care and safety planning, to ensure those struggling with alcohol use are not forgotten about.”