Cuneyt Evren
Bakirkoy State Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
Suicidal Behavior in Alcohol and Drug Abuse and Dependence. Hauppauge, New York: Nova Science Publishers, 2010, 540 pages.

Self-injurious behavior (SIB) is frequently seen in the clinical practice and negatively effect the course of the treatment and the attitude of the caregivers. Nevertheless a basic understanding of SIB, including its classification, diagnosis, and treatment, is still lacking. Although SIB is an explicit part of the DSM-IV diagnostic criteria for borderline personality disorder and impulse control disorder not otherwise specified, SIB is also quite frequently seen in other personality disorders (i.e. antisocial or borderline personality disorder) and Axis I disorders (i.e. eating disorders, dissociative disorders, substance use disorders and occasionally in depressive disorders and posttraumatic stress disorder). Since substance use disorders also have high comorbidity with mentioned disorders, in which SIB is common, it is obvious that SIB is an important issue to focus attention in individuals with alcohol and /or drug abuse. Although this relationship between substance use and SIB is generally accepted, there are few studies conducted within alcohol and /or drug abusing populations, and most of them included only males. These studies found that SIB is related with younger age, childhood physical abuse, suicide attempt history, having a personality disorder and drug dependency in heterogeneous group of substance dependents, whereas it was related with younger age, childhood abuse, early onset of alcoholism, suicide attempt history, dissociative taxon membership, hostility, negative affect (i.e. anxiety and depression) in homogeneous groups of alcohol dependents. Predominate function of SIB in opiate dependents were both affect-regulation and than secondly self-punishment, although other functions (i.e. anti-suicide, anti-dissociative and anti-hostility) for SIB may also have their place in alcohol and /or drug dependents. Findings suggest that a history of SIB may alert clinicians to patients with difficult and complex psychopathology who may have more severe and chronic illness. By identifying factors that have led to the SIB in alcohol and/or alcohol use disorders, these adults can obtain appropriate psychotherapy and/or pharmacotherapy and deal in a more productive and beneficial manner with the pain that underlies their self-injurious impulses.