University of Michigan Addiction Research Center, USA
Title: Suicide in patients with alcohol use disorders: Risk assessment and prevention strategies
Kirk J. Brower is Professor of Psychiatry at the University of Michigan, where he joined the faculty in 1986. He graduated medical school with honors from the University of California, Irvine and completed a psychiatry residency at UCLA. He directs the University of Michigan Addiction Treatment Services as well as their accredited Addiction Psychiatry Fellowship Program. He is a Fellow of the American Society of Addiction Medicine. His research focuses on improving treatment for alcohol dependence and co-occurring insomnia. He has authored over 100 peer-reviewed journal articles, and serves on the Board of Field Editors for Alcoholism: Clinical and Experimental Research.
Over 38,000 people in the U.S. committed suicide in 2011, a rate of 12.3 per 100,000. More than half of suicides in the U.S. involve fi rearms. Alcohol use disorders (AUDs) increase the risk for suicide by greater than 3-fold aft er adjusting for other psychiatric disorders, and 20-33% of increased deaths in alcoholics are explained by suicide. A history of suicide attempts is one of the strongest risk factors for eventual suicide, and there are 25 suicide attempts for every suicide in the U.S., with approximately 1 million adults attempting suicide in the past year. Risk factors for suicide attempts in patients with AUDs are well-studied and deserve careful assessment in clinical settings. Th ey include predisposing or distal factors such as genetics,family history, childhood trauma, personality traits (impulsivity, negative aff ect), illness severity, and comorbidity; and precipitating or proximal factors such as stressful life events, new-onset depressive episodes, andrelapse to drinking. Intoxication with alcohol increases the odds of a suicide attempt by at least 6-fold. Modifi able, protective factors are less well-studied in patients with AUDs, but include coping skills for stressful life events, social network supports, and treatment aimed at relapse prevention and comorbid mental disorders. Assessment of risk and strategies for prevention will be reviewed.