A magazine for friends of the Warren Alpert Medical School of Brown University.

A Deadly Mix


Simultaneous cocaine and alcohol use is linked to suicide.

In a general sense, medical studies support the popular intuition—a staple of movies and literature—that suicidal behavior and substance misuse are linked. But the relationship between the two is not so simple. A new examination of hundreds of suicidal emergency department patients from around the US found that the significance of the link varied with age, gender, and race. Across the board, however, the use of cocaine and alcohol together was a red flag.

“One unexpected finding was that, when examined independently, alcohol use had no significant association and cocaine use had a borderline significant association,” authors of the study wrote in the journal Crisis. “However, reporting both alcohol misuse and cocaine use was significantly associated with a future suicide attempt.”

Led by Sarah Arias, PhD, assistant professor (research) of psychiatry and human behavior, the team examined 874 men and women who presented at emergency departments around the country between 2010 and 2012. All of that group had attempted suicide or had suicidal thoughts; of them, 195 people attempted suicide at least once in the year following the ED visit.

What Arias, who is also a research psychologist at Butler Hospital, and her colleagues found was that although people in the study reported misusing many different substances, including marijuana, prescription painkillers, tranquilizers, and stimulants, only cocaine and alcohol appeared to have a significant association with suicide risk. Of those using both, the chance of attempting suicide again was 2.4 times greater than among people in the study who were not.

The study does not say anything about whether substance abuse causes suicidal behavior because it only reports observations of associations. But Arias says she hopes the data will advance the understanding of how misuse of particular substances, among particular patients, may affect their risk of suicide.

“We’re on our way to trying to identify factors that can be used to better assess and identify people who are at risk for suicide, and ultimately I think this is a step in the right direction to get a better picture,” she says. “Patients who have potentially comorbid alcohol and cocaine use may be at a higher risk. Findings like these can be useful for informing suicide risk assessment.”


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