Leo Sher
Columbia University and New York State Psychiatric Institute,
New York, New York, USA
Suicidal Behavior in Alcohol and Drug Abuse and Dependence. Hauppauge, New York: Nova Science Publishers, 2010, 540 pages.

Humans have consumed alcohol for thousands of years. Alcohol and other drugs have a long history of remedial, recreational, and ceremonial functions. Nowadays, most adults in the Western countries drink alcohol. Because of its availability nearly every adult in the Western countries has tried alcohol at least once, and a sizable minority have serious problems from drinking. The conditions that lead to excessive alcohol consumption in some individuals and not in others are complex because they involve interactions among genetic, psychosocial, environmental, and neurobiological factors. The actions of alcohol that cause intoxication, initiate and maintain excessive drinking behavior, and promote relapse during abstinence occur primarily in the brain. The specific mental processes thought to underlie the development of alcoholism involve normal brain functions such as learning, attention, emotion, and cognition. Alcohol use is a major contributing factor for head injuries, motor vehicle accidents, violence, and assaults. The large population of individuals with alcohol abuse and dependence, the relative frequency of suicides and suicide-related behaviors in this population, and the devastating effects of attempted and completed suicides on individuals, families, and society make this an important area for research. Multiple lines of evidence suggest that lower serotonin activity is tied to increased aggression/impulsivity which in turn is presumed to enhance the probability of suicidal behavior. Dopaminergic dysfunction may play a role in the pathophysiology of suicidal behavior in alcoholism. Alcohol can damage the brain in many ways. The brain is vulnerable to the toxic effects of alcohol itself and can be affected by alcohol-related damage to other organs, including the liver, pancreas, and heart. Brain damage and neurobehavioral deficits are associated with suicidal behavior. It is possible that cognitive abnormalities contribute to increased suicidality in individuals with alcohol use disorders. Low selenium status is associated with depressed mood, anxiety, and cognitive decline. These symptoms are commonly observed in persons with alcohol use disorders. Selenium deficiency may play a role in the pathophysiology of depression and suicidal behavior in individuals who abuse alcohol. Understanding the integration of the interactions among multiple biological systems in the regulation of ethanol-seeking behavior and the development of ethanol dependence is an important challenge for future research. It is to be hoped that studies of the neurobiology of suicidal behavior in alcohol use disorders will improve treatment and prevention of suicidal behavior in individuals with alcohol abuse and dependence.