adulthood in longitudinal studies (Werner, 1995; Werner and Smith, 2001; Wyman et al., 1993).

Adolescents, Alcohol, and Substance Abuse

The relationship between alcohol and younger suicide victims (i.e., those younger than 35 years of age) is not simple. Brent et al. (1987) found a very strong link between alcohol use prior to suicide and firearm use among youth less than 20 years of age. Teenage suicide victims who use firearms to complete suicide are 4.9 times more likely to have been drinking than those who used other methods.

Substance abuse among youth is another of the most significant risk factors for suicidal behavior (for review, see Brent and Kolko, 1990). The 3-fold rise in adolescent suicide that occurred in the United States throughout the 1960s and 1980s has been attributed to a rise in use of alcohol and illicit drugs. Among the youthful suicides in San Diego, California, the occurrence of drug abuse was reported more frequently in the 1970s and early 1980s; it was the major difference between suicide precursors in younger and older victims (Rich et al., 1986). Multiple substance use or polysubstance abuse (alcohol and other drugs) was common among younger suicide victims in San Diego, although the direction of the relationship of substance abuse to other diagnoses such as depression was not clear (Fowler et al., 1986). Difficulty in pinning down the extant relationship between alcohol, drugs, and suicide has been noted elsewhere (Neeleman and Farrell, 1997).

Family dysfunction and personality traits can contribute to the effects of alcohol and substance abuse on suicide among youth. Frequent illicit substance abuse and intoxication with alcohol can be an important predictor of hopelessness, particularly among lonely youth (Page et al., 1993). A psychological autopsy of 20 adolescents revealed a history of drug or alcohol abuse in 70 percent of those completing suicide compared with 29 percent of controls (Shafii et al., 1985). Other significant risk factors were antisocial behavior, an inhibited personality, and previous suicide attempts or suicide communications. Surveys of youth, parents, and respondents in psychological autopsies of deceased youth in California point to alcohol and substance abuse as important risk factors for suicide. Family dysfunction, individual psychopathology and distress, and interpersonal problems were also cited as contributing factors (Nelson et al., 1988).

King et al. (1993) examined the relationship between alcohol consumption, family dysfunction, and depression to suicidality in adolescent female inpatients. Both alcohol consumption and family dysfunction predicted the severity of clinician documented suicidal ideation and behav-

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