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Veteran Suicide and Alcohol Use

Suicide is a national public health concern, between 2005 and 2015, an average of 16.5 veterans died by suicide every day!

In addition, 3.3 active-duty, guard, and reserve service members committed suicide every day which makes 19.8 total daily veteran and military suicides.[1]

For each veteran/service member who succumbs to suicide, about twenty–five others will attempt it, and even more will think about committing suicide.[2] In 2013, 44 percent of those returning from deployment had challenges with the transition, including the onset of problematic substance use behaviors.[3]

Alcohol usage is a major risk factor for both suicide and attempted suicide, and alcohol is directly associated with unplanned or impulsive suicide attempts.[4] Alcohol use has been identified as one of the top three signs preceding a suicide.[12] Alcohol facilitates suicidal behavior on a psychological level, regardless of the toxic effect. In the United States, 3 methods of violent suicide predominate; these are firearms, hanging or asphyxiation, and poisoning, which account for 90% of all suicides.[5] Alcohol intoxication, a blood alcohol concentration (BAC) of .08 or higher is typically reported in decedents from violent methods of suicide, of these results the BAC measurements were universally high across demographic groups, and the BAC range was between .08 - .17 depending on method of suicide.[11] A state of intoxication can trigger self-inflicted injuries by promoting depressive thoughts and feelings of hopelessness while simultaneously removing inhibiting barriers to hurting one-self.

Alcohol Use Disorders (AUD)

It is well established that long-term patterns of alcohol use and Alcohol Use Disorders (AUD) are both associated with a significant risk of death by suicide.[6] In addition, data on acute use of alcohol before suicide also indicates that it plays a significant role. Reports conclude that a median of 37% to as high as 69% of suicides among the general public were preceded by acute use of alcohol, and the risk of suicide increases based on both the availability and amount of alcohol consumed. There also is strong evidence for a link between acute drinking and violence.[7]

There exists a culture of alcohol use as a means of coping with stressful or traumatic events associated with military duties or exposures. Additionally, veteran isolation increases the risk of depression and suicide ideation. Alcohol consumption is commonly used as a form of self-medication to handle depression, stress, boredom, loneliness, and other negative feelings.

Alcohol Use Disorders have been associated with increased risk for death by suicide across several studies.[12] Risk of suicidal ideation, suicidal attempts, and completed suicide are each increased by 2–3 times among those with AUDs in comparison with the general population.[13] [14]

Posttraumatic Stress Disorder (PTSD)

Posttraumatic Stress Disorder (PTSD) has been associated with death by suicide and with higher levels of suicidal thoughts and behaviors among veterans.[8] Traumatic deployment experiences such as combat exposure and Military Sexual Trauma (MST) are independently significant predictors of both

PTSD symptom severity and directly associated with problematic alcohol use. [9] [10] A substantial proportion of combat veterans misuse alcohol, and veterans with a diagnosis of PTSD and/or depression are 3–4.5 times more likely to also meet criteria for Alcohol Use Disorders (AUD). Veterans with PTSD and AUD share high levels of co-morbidity, with rates ranging from 41–79%. PTSD symptoms predict higher alcohol use, and individuals experiencing PTSD symptoms have more alcohol problems regardless of how much they drink.

PTSD and depression symptom severity is highest immediately post deployment.
Social Support has been proven effective in alleviating these symptoms along with reducing involvement in high-risk behaviors.[11] Therefore, LifeGuards can protect veterans against traumatic stresses and depressive symptoms by providing social support immediately post deployment, and continually thereafter depending on a veteran’s needs or suicide risk.

In addition, independently of both combat exposure and MST, veterans with dysregulated behavior (impulsivity, negative urgency, and poor emotional regulation) in response to intense negative effects, not only have greater PTSD symptoms but also experience alcohol problems in the absence of PTSD symptoms.  

Screening and intervention for both alcohol use and misuse, particularly following exposure to deployment related trauma, is clearly needed. Current suicide prevention and intervention protocols and programs do not include any type of alcohol screening or an alcohol countermeasure. 

Mixing Alcohol with Medications and Psychoactive Substances

Alcohol is widely available and socially tolerated substance. However, individuals at risk of suicide and those taking certain medications should not be consuming alcohol. Suicide toxicology finding suggest alcohol use is prevalent in deceased individuals along with other prescription medications including those that deal with stress/anxiety, sleep problems, pain management, and psychiatric/mental health problems. Alcohol increases the lethality of some medications, making an attempt via overdose more likely lethal. Alcohol is also a factor in overdose deaths attributed to other drugs. It is often consumed before, along with, or after other psychoactive substances, particularly with opioids and benzodiazepines, this creates a dangerous mixture with unpredictable results.[15]

Alcohol drinking can have negative effects on mental health, causing psychiatric disorders and increasing the risk of suicide.[16] Psychiatric disorders (particularly depression, anxiety, and alcohol dependence) are significantly associated with higher risk of suicide among service members.[17] In addition, there is a close link between alcohol abuse and depression, and it is often difficult to determine which of the two is the main leading condition. There is a direct link between alcohol dependence and impulsive suicide attempts.


[1] VA National Suicide Data Report (2005–2015).

[2] USA.Gov. "Suicide Facts at a Glance." Centers for Disease Control and Prevention (Accessed February 25, 2014). http://www.cdc.gov/violenceprevention/pdf/Suicide_DataSheet-a.pdf

[3] Returning home from Iraq and Afghanistan: Readjustment needs of veterans, service members, and their families.
Institute of Medicine (2013). Washington, DC: The National Academies Press.

[4] A Behavioral and Cognitive Neuroscience Perspective on Impulsivity, Suicide, and Non-suicidal Self-injury: Meta-analysis and Recommendations for Future Research (2017, Sept).

Richard Liu-Zoë Trout, Evelyn Hernandez, Shayna Cheek, Nimesha Gerlus. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5730462/

[5] Acute Use of Alcohol and Methods of Suicide in a US National Sample. Kenneth Conner, Nathalie Huguet, Raul Caetano, Norman Giesbrecht, Bentson McFarland, Kurt Nolte, Mark Kaplan (2014, January). - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3865232/#bib20

[6] Understanding Suicide Risk: Identification of High-Risk Groups During High-Risk Times (2011 Dec).

James Overholser, Abby Braden, Lesa Dieter. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3379545/#R44

[7] A meta-analysis of acute use of alcohol and the risk of suicide attempt (2016, Dec).
Borges, Gabriela & Bagge, Courtney & J. Cherpitel, C & Conner, Kenneth & Orozco, Ricardo & Rossow, Ingeborg. Psychological Medicine.

[8] Suicide Among War Veterans (2012, July). Vsevolod Rozanov, Vladimir Carli. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3407917/

[9] Military Sexual Trauma, Combat Exposure, and Negative Urgency as Independent Predictors of PTSD and Subsequent Alcohol Problems Among Veterans (2015, Nov). Austin Hahn, Christine Tirabassi, Raluca Simons, Jeffrey Simons. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4630825/

[10] The Associations Between Deployment Experiences, PTSD, and Alcohol Use Among Male and Female Veterans (2019, June).

Anne Banducci, Virginia McCaughey, Jaimie Gradus, Amy Street. - https://www.ncbi.nlm.nih.gov/pubmed/31336265

[11] How Does Social Support Enhance Resilience in the Trauma-exposed Individual? (2015).

Sippel, Lauren, Pietrzak, Robert, Charney, Dennis, Mayes, Linda, Steven. - https://www.ecologyandsociety.org/vol20/iss4/art10/

[12] Initial Validation of Brief Measures of Suicide Risk Factors: Common Data Elements Used By the Military Suicide Research Consortium (2017, Nov). Fallon Ringer, Kelly Soberay, Megan Rogers, Christopher Hagan, Carol Chu, Matt Schneider, Matthew Podlogar, Tracy Witte, Jill Holm, Denoma, E Plant, Peter Gutierrez, Thomas Joiner. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5949237/

[13] The Association of Alcohol Use Disorders with Suicidal Ideation and Suicide Attempts in a Population-based Sample with Mood Symptoms (2015, May). Yoon-kyu Sung, Lareina La Flair, Ramin Mojtabai, Li-Ching Lee, Stanislav Spivak, Rosa Crum. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5728356/

[14] Alcohol-Related Risk of Suicidal Ideation, Suicide Attempt, and Completed Suicide: A Meta-Analysis (2015, May)

Nahid Darvishi, Mehran Farhadi, Tahereh Haghtalab, Jalal Poorolajal - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4439031/

[15] A comprehensive model of predictors of suicide attempt in heavy drinkers: Results from a national 3-year longitudinal study (2018, May).
Nicolas Hoertel, Hadi Faiz, Guillaume Airagnes, Carlos Blanco, Rachel Pascal De Raykeer, Silvia Franco, Géraldine Ducoutumany, Cédric Lemogne, Frédéric Limosin. - https://www.sciencedirect.com/science/article/abs/pii/S0376871618301145

[16] Drugs most frequently involved in drug overdose deaths: United States, 2010–2014 (2016). Warner M, Trinidad JP, Bastian BA, et al.  National vital statistics reports; vol 65 no 10. Hyattsville, MD: National Center for Health Statistics.

[17] Combat Experience and Problem Drinking in Veterans: Exploring the Roles of PTSD, Coping Motives, and Perceived Stigma.

Stephen Miller, Eric Pedersen, Grant Marshall. - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5177488/

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