Suicidality and Substance Abuse in Affective Disorders

The relationship between suicidality and substance abuse has long been recognized, althoughstudies have only fairly recently begun to identify factors that may help clarify how alcohol or otherdrug 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 theinduction of manic or depressive episodes in affectively ill individuals, while also demarcatinggroups with heightened tendencies toward impulsivity, aggression, and sensitivity to interpersonalloss. Serotonergic mechanisms have been implicated in each of these clinical settings, along withpossible dysregulation of other neurotransmitter systems. Psychosocial aspects of alcohol or drugabuse relevant to suicide may involve a heightened sensitivity to interpersonal loss, poor copingskills in response to adverse life events, and affective dysregulation induced by circadian andpsychosocial stresses. Consequently, self-destructive behaviors with relatively little premeditationmay arise during periods of increased stress, intoxication, depression, or other psychopathology.Early detection of substance abuse followed by appropriate pharmacologic and/or psychotherapeuticinterventions may greatly help to minimize the formation of complex comorbid psychiatric conditionsand reduce the potential for suicidal acts among high-risk populations.