1) Alcohol consumption is strongly associated with suicide and self-harm, especially among males. Higher national alcohol consumption from 1970-2000 correlated with increased suicide rates in Ireland. 2) Studies found that over half of young suicide victims in parts of Ireland were very drunk at the time of death, with blood alcohol levels over 160mg%. Alcohol use was also implicated in 40% of hanging deaths in another region of Ireland. 3) Acute intoxication, a history of heavy drinking, and alcohol dependence can all increase risk of suicide and self-harm by enhancing impulsivity, impairing problem-solving, causing emotional instability, and leading to adverse social consequences like relationship and job loss.

1. The role of alcohol in self-harm and
suicide - Males
Dr Bobby Smyth MRCPsych

2. Increase in per capita alcohol
consumption and Suicide in Ireland
1970 to 2000
0
2
4
6
8
10
12
1970 1975 1980 1985 1990 1995 2000
Suicide
Per capita
alcohol
Rate per
100,000
Litres
EtOH

3. • In NorthEast
– 58% of young people who died by suicide were
very drunk (i.e. BAC >160mg%)
– Bedford et al (2006). Blood alcohol levels in persons who died from accidents
and suicide. Irish Medical Journal, 99(3), 80-82.
• In South
– 40% of all deaths by hanging revealed alcohol use,
with mean BAC=200mg%
– Bellis M, Bolster MA & Doyle CT. (2009) The Role of Alcohol in Deaths
Presenting to the Coroner’s Service in Cork City & County. Irish Medical
Journal, 102, 13-15.

4. Alcohol & Suicide
• Acute Intoxication (i.e. drunk)
– Increased impulsivity
– Impaired problem solving
– Emotional lability
– Increased likelihood of embarrassing social act
• Background of heavy drinking
– Past ‘shameful’ behaviour while drunk
– Marginalised socially
• Alcohol dependence
– Depression
– Cognitive impairment
– Many adverse social consequences (loss of job,
relationship breakdown, poor friendships, failure to fulfil
role as parent, etc)

5. Learning which shoulder to cry on…..

7. Dr Bobby Smyth MRCPsych 2017
Frida Kahlo 1907-1954
“I tried to drown my
sorrows, but the
bastards learned how
to swim”

8. Young Adults, Alcohol and
Depression

9. Teens, Alcohol and
Depression

10. Per capita alcohol and Suicide rate
among 15-19yo in Ireland
5.00
6.00
7.00
8.00
9.00
10.00
11.00
12.00
13.00
14.00
15.00
1990 1993 1996 1999 2002 2005 2008 2011 2013
Ireland suicide 15-19yo
per cap consumption
http://www.oecd.org/els/family/database.htm table CO4.4

11. Suicide rate among 15-19yo
0.0
5.0
10.0
15.0
20.0
25.0
30.0
1990 2000 2013 or latest available year
Ireland
Iceland
OECD-33
average
http://www.oecd.org/els/family/CO_4_4_Teenage-Suicide.pdf

12. Past Month Drunkenness -ESPAD ‘95 to
‘15
0
10
20
30
40
50
60
1995 1999 2003 2007 2011 2015
Ireland
Iceland

13. Learning from success of
others - Iceland.......
How was this achieved?
1. Curfew on 13-16yo can’t be outside unaccompanied after 10pm (12pm in summer)
2. Prohibited sales of tobacco to minors and alcohol to anyone under 20.
3. Alcohol is only sold in state-run stores and taxed at more than 80 percent.
4. €300 per child 6-18yo to pay for extra-curricular activities, including sports.
5. Ban alcohol advertising and sports sponsorship
6. Build expectation that parents spend more time with their teenagers
From 1998 to 2014 – teens-
Past month drunk- 42% to 5%.
Daily smoking - 23% to 3%
Cannabis lifetime use 17% to 7%
Sports participation - 23% to 42%
14-16yo who Spent considerable time
with their parents - 23% to 50%
% of 14-16 years old outside after 10 pm
- 53% to 23%.

14. DSH
“Alcohol was significantly more often involved in male episodes of self-
harm than female episodes (42% and 36%, respectively).”

15. 14 ALCOHOL AND SUBSTANCE
ABUSE
To challenge permissive, harmful
attitudes to alcohol abuse, help to
reduce overall consumption rates
and raise awareness of the
association between alcohol and/
or substance abuse and suicidal
behaviour.
Action Areas

17. ’07 ‘12
•Mayo 30 79
•Dublin 37 84
•Waterford 222 310
•Donegal 250 289
ADS = circa 5000/100,000

18. http://www.nsrf.ie/statistics/3063-2/
Incidence rate of DSH Ireland, by age & gender

19. Rate of Suicide by age & gender
0
5
10
15
20
25
30
35
15-24yo 25-34yo 35-44yo 45-54yo 55-64yo 65+
Male
Female
Mean rate/100,000 averaged over 2013-2015

22. “I tried to drown my sorrows, but it taught the
b@$tards how to swim”