The researchers didn’t see this kind of relationship with any other drug in the study.
Findings from a new study of hundreds of suicidal emergency department (ED) patients from around the United States has identified the use of cocaine and alcohol together as a “red flag.”
Previous medical studies have linked suicidal behavior with substance misuse, but the relationship between the two isn’t so cut-and-dry — the link between the two can vary with age, gender, and race.
Led by Sarah Arias, an assistant professor of psychiatry and human behavior at Brown University’s Alpert Medical School, the research team looked at 874 men and women who received care at emergency departments around the country between 2010 and 2012. The patients took part in the Emergency Department Safety Assessment and Follow-up Evaluation Study, led by the University of Massachusetts Medical School.
The volunteers either reported a recent suicide attempt or were actively engaged in suicidal thoughts at the time of their visit to the ED, and they received standard care. Through the analysis, the researchers came to some intriguing findings about suicidal behaviors and drug use.
"One unexpected finding was that, when examined independently, alcohol use had no significant association and cocaine use had a borderline significant association," the study authors wrote in the journal Crisis. "However, reporting both alcohol misuse and cocaine use was significantly associated with a future suicide attempt."
Additionally, the team found that although people in the study reported misusing a number of substances, like marijuana, prescription painkillers, stimulants, and tranquilizers, only cocaine and alcohol appeared to have a significant link with suicide risk.
“Specifically, of those using both [cocaine and alcohol], the chance of attempting suicide again was 2.4 times greater than among people in the study who were not,” according to the press release.
Interestingly, the researchers discovered that substance misuse was less likely to be an indicator of suicide risk among whites and women. On the contrary, older people were more likely to have a link between substance misuse and suicide.
The researchers note that women are not less likely to be suicidal — in fact, they were more likely to have reported prior suicide attempts than men — but the data showed that substance abuse was less likely to be a factor among women.
The researchers didn’t specify whether substance abuse causes suicidal behavior or whether it’s vice versa — the link between the two is highly complex.
"It's not a clear-cut, straightforward association," Arias said. "Even though substance use is often touted as a very strong predictor of suicidal intentions and behaviors, when we look at individual substances we're seeing that there's not that consistency in the future association with behavior."
Nonetheless, Arias and her team hopes that the new data will lead to an improved understanding of how misusing particular substances can affect the risk of suicide among particular patients. Figuring out how to better predict these behaviors could save lives.
"We're on our way to trying to identify factors that can be used to better assess and identify people who are at risk for suicide, and ultimately I think this is a step in the right direction to get a better picture," she said. "Patients who have potentially comorbid alcohol and cocaine use may be at a higher risk.”