130704 suicide3

“It’s Larry,” said the nurse, handing me the phone.

No other introduction was needed.  Larry was a Viet Nam vet who was a frequent patient at the hospital where I worked. It was 8 p.m., I had a unit full of psychiatric patients and he wanted to be admitted. Larry was drunk, which he and I both knew would keep him from getting a bed here tonight.  I wasn’t entirely conscious of it at the time, but something was different.   “I feel lost,” he said.

Thirty minutes later Larry shot himself in the head with his military revolver.

This was almost twenty years ago, but it feels no less tragic  today than it did then.  Suicide is a therapist’s worst nightmare, perhaps because so little is really known about why people kill themselves.

One thing that we do know for sure is that alcohol plays a role in suicidal thought, ideation and attempt. In 2009, the Centers for Disease Control and Prevention measured blood alcohol levels post mortem and found that one in four suicide victims were legally drunk.

Dr. Alex Crosby, the author of the CDC report, described the nature of the connection.  “It leads to disinhibition, and it can enhance feelings of hopelessness and depression,” he said,  “Alcohol impairs judgment and can lead to much more impulsive behavior.  Any suicide prevention efforts must take that into account and address alcohol and substance abuse as well.”

So you can add this to the list of dangerous side effects of drinking to excess: Statistically, one in ten people in the U.S. abuse alcohol, yet alcohol is implicated in 40% of all suicides. If you abuse alcohol, you’re four times more likely to die from suicide.  

Depression is the culprit, but the chicken and the egg argument pops up here, and in my years of treating alcoholics I still can’t always figure it out, at least at first.   What’s clear is that depression is found at clinical levels in 30% to 50% of active alcoholics. (Anecdotally, I think it’s higher.)   Women are more likely to self-medicate with alcohol than men.

In some people, heavy drinking brings on depression: sober them up and the depression goes away.  Others – and this may be the majority – drink alcohol to excess to self-medicate an un- or undertreated depressive episode.

Either way, the danger can’t be overstated.  You’re more likely to commit suicide from heavy drinking than you are to die driving drunk.

There’s a brain chemistry feedback loop that keeps you trapped in the cycle of relief drinking, even when you want to stop.  How can you tell if your drinking has become a problem?  If you can’t stop when you want to.  If you’re in doubt, ask a social drinker if he or she has trouble stopping drinking.  They’ll look at you, like, “Do have trouble stopping hitting yourself on the head with a hammer?”

It’s not a willpower problem.  Willpower doesn’t work on the brain disease of alcoholism any better than it does on any other disease.  Try willing your blood sugar to go down.  Will away that pesky toenail fungus.

If you’re drinking too much and feeling like life’s not worth living, ask for help.

Now.  Your life may very well depend on it.