tion studied (Ford et al., 1979; Hayward et al., 1992) and in suicides that occur at night and on weekends (Smith et al., 1989; Welte et al., 1988). Alcohol was involved for 15–64 percent of attempters (Roizen, 1982).

Common among alcohol-related suicides are impulsivity and relationship loss, both in adults (Welte et al., 1988) and youth (Brent et al., 1987). Similar patterns of impulsivity have been linked to alcohol-related suicide in particular cultures such as younger adults in Finland (Makela, 1996) and Native Americans (Bechtold, 1988; Ward, 1984). Relationship problems are frequently precipitants in alcohol-related suicides (Miles, 1977; Murphy and Robins, 1967; Rich et al., 1988) especially when there is ready access to a high-lethality means (Hayward et al., 1992; Welte et al., 1988). Suicides associated with chronic conditions such as long-term depression or physical disability are less likely to involve alcohol (Welte et al., 1988).

… Mostly, I’m a social drinker. Like everyone else, I’ve been drunk in my time but it’s not really my style; I value my control too highly. This time, however, I went at the bottle with a pure need, as though parched. I drank before I got out of bed, almost before my eyes were open. I continued steadily throughout the morning until, by lunchtime, I had half a bottle of whiskey inside me and was beginning to feel human… The important thing was not to stop. In this way, I got through a bottle of whiskey a day, a good deal of wine and beer. Yet it had little effect. Toward evening, when the child was in bed, I suppose I was a little tipsy, but the drinking was merely part of a more jagged frenzy….

After that, I remember nothing at all until I woke up in the hospital and saw my wife’s face swimming vaguely toward me through a yellowish fog. She was crying. But that was three days later, three days of oblivion, a hole in my head…. only gradually have I been able to piece together the facts from hints and snippets, recalled reluctantly and with apologies. Nobody wants to remind an attempted suicide of his folly, or be reminded of it (Alvarez, The Savage God: A Study of Suicide, 1971/1990:294-297).

Interpersonal loss seems to be a major acute precursor of suicide among many with alcohol use disorders (Murphy, 1992; Murphy et al., 1979). Murphy and colleagues (1979) demonstrated that 26–33 percent of alcoholics had experienced a loss of affectional relationships within 6 weeks of suicide and 48–50 percent had similar losses within the previous year. Duberstein et al. (1993) more recently replicated these findings among alcoholics/substance abusing subjects in finding that interpersonal stressors were present within 6 weeks (77 percent) or 1 year (90



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