The effects of childhood trauma on suicide risk are discussed in Chapter 5.

As of 1999, 64 percent of all American adults report some use of alcoholic beverages (non-abstention), and this has not changed appreciably since 1939 (The Gallup Organization, 2001). Annual consumption currently averages to the equivalent of approximately 2.2 gallons of pure ethanol per capita (NIAAA, 2001). Approximately 15–18 million Americans have an alcohol abuse disorder (NIAAA, 2001) with 8.2 million Americans dependent on alcohol in a 1999 government survey (SAMHSA, 1999).

Alcohol-related suicides vary by state and jurisdiction, from 28 percent in Ohio to 53 percent in Alaska (Table 3-1), consistent with increased frequency of alcohol associated suicides reported for the western “frontier” states (Hlady and Middaugh, 1988; May, 1995). Alcohol-related suicides are more frequently associated with death by firearms (Brent et al., 1987; Hlady and Middaugh, 1988). However, among some subpopulations of American Indians (May et al., In press), and in other countries such as Australia (Hayward et al., 1992), alcohol-related suicides are no more likely to be associated with firearms than with other methods (e.g., hanging and carbon monoxide poisoning).

As with the psychiatric disorders, the majority of those who consume alcohol and/or meet diagnostic criteria for alcohol abuse disorders do not attempt or complete suicide. Alcohol use, particularly heavy use and alcohol dependence, is highly associated with suicide in three ways:

• Alcohol through its disinhibiting effects is related to suicide attempts and completions

• Individuals with alcohol use disorders are at an increased risk of suicide as compared to the population at large

• At the population level (nationally and internationally) alcohol consumption is correlated with suicide rate

Acute alcohol intoxication acts as a disinhibitor in impulsive, angry suicides, often precipitated by loss of a relationship (Mayfield and Montgomery, 1972). On average (see Table 3-1) almost 25 percent of suicide victims are intoxicated (generally 0.10 gm/dl blood alcohol concentration or greater) at the time of death. The highest prevalence of intoxication is generally found among males under the age of 50 in most every popula-