Alcohol, Suicide and Mental Health (Ireland)

Alcohol can contribute to the development of mental health problems as well as exacerbating pre-existing mental health difficulties.

Alcohol affects our ability to cope, manage and overcome everyday stresses and significant life events. It contributes to the development of mental health problems as well as exacerbating pre-existing mental health difficulties. It can also reduce inhibitions enough for an individual to act on suicidal thoughts which they might never have done if not under the influence of alcohol. Suicide is the leading cause of death among young Irish men aged 15-24. In 2011, 525 suicides were registered, an increase of 7% – 439 of those who died were men[i].

There exists a consistent trend for drunkenness when drinking among Irish young people, a trend that sets them apart from the majority of their European counterparts [ii]. Children and young people are particularly vulnerable to alcohol-related harms and risks due to the fact that their brains and bodies are still growing and developing:

Biologically teenagers’ brains are still developing – alcohol particularly affects the areas of the brain responsible for memory and impulse control.

Adolescence can be a challenging time as young people navigate new experiences and stresses for the first time: alcohol is being added to situations where there is no pre-existing “road map” and may render the individual particularly vulnerable to exploitation or danger.

Behaviour patterns that can last a life time are being established during this formative period. Adult heavy drinkers generally established their drinking patterns in their teens

Many people drink alcohol to help them cope with emotions or situations they would otherwise find difficult to manage. In other words, they drink to change mood or mental state. Alcohol is also used to self-medicate, to relieve the symptoms of anxiety and depression. In the UK, a country with similar drinking patterns to Ireland, a study found that stressed mood leads to increased alcohol consumption. Relaxation was also a key reason cited for people drinking [iii].

Tolerance of alcohol increases with use, so that an individual needs increasing amounts of alcohol to decrease their anxiety or to medicate their depression. Secondly, when self-medicating with alcohol it is difficult to know how much is enough. Following the initial feeling of well-being from the first drink, alcohol acts as a depressant, and feelings of anxiety and depression can quickly resurface. Alcohol use can exaggerate underlying feelings, which is why some people become angry, tearful, or aggressive after a few drinks.

Despite the contributory role alcohol plays in worsening or developing mental health problems, little research has been done in Ireland to explore the reasons why we drink and how this might link with rates of mental health problems such as anxiety, depression and self-harm.

The role of alcohol marketing is one that needs to be tackled. Alcohol marketing promotes positive, risk-free images of alcohol and its use 24/7 through sponsorship, pricing, product placement, branded merchandise and many other forms of promotion. Deeply discounted alcohol is widely available from numerous and varied outlets.

Marketing can shape youth culture by creating and sustaining expectations and norms about how to achieve social, sporting or sexual success, how to celebrate, how to relax and how to belong. Extensive scientific research has established that alcohol marketing influences young people to start drinking and if already drinking, to drink more [iv].

Although many factors are involved in suicide, the link between alcohol use and suicide has been well established, alcohol consumption considered to be a significant influence on the suicide rate of young men in particular [v]. Suicide is the leading cause of death among young Irish men aged 15-24 years with more than one in three deaths in that age group as a result of suicide.

A national study of youth mental health found strong links between excessive drinking and suicidal behaviour. The same study provided clear evidence that excessive drinking is associated with poor mental health and low self-esteem [vi].

The connection between alcohol use and suicide has been highlighted in numerous reports, both Irish and international. One Irish study of people from three counties who died as a result of suicide, found that more than half had alcohol in their blood; those aged less than 30 were more likely to have had alcohol in their blood at the time of death [vii].

The World Health Organisation has estimated that the risk of suicide when a person is currently abusing alcohol is eight times greater than if they were not abusing alcohol [viii]. Closer to home, a report from the UK Mental Health Foundation states that as many as 65% of suicides were related to excessive drinking, and identifies alcohol problems as one of the highest risk factors for suicide [ix]. That report identifies a strong link between alcohol use and thoughts of suicide, suicide attempts and completed suicides among young people under the age of 24. Alcohol use can act as a factor in suicide in a number of ways [x]:

A HSE report xi  states that “alcohol can facilitate suicide by increasing impulsivity, changing mood and deepening depression”

Self-harm or suicide can take place after just one drinking session. A person doesn’t have to be a heavy drinker or even a regular drinker: just one occasion of heavy drinking can reduce inhibitions enough to self-harm  or act on suicidal thoughts

Alcohol initially produces feelings of happiness and well-being but can lead to a significant lowering in mood hours after use or in the following days, an experience which is sometimes accompanied by feelings of hopelessness. If someone is already experiencing a degree of depression, the fall in mood can lead to suicidal ideas. xii

Ongoing abuse of alcohol is itself a major contributory factor in depression and suicidal behaviour. xiii

What needs to happen?In order to reduce the negative impact of alcohol on mental health and suicide, levels of alcohol consumption need to be reduced. The Steering Group Report on a National Substance Misuse Strategy makes a number of recommendations which would reduce the harms caused by alcohol. Alcohol Action Ireland calls for the recommendations of the Steering Group to be implemented in full. Key recommendations include the following:

1. Increase the price of alcohol over the medium term to ensure that alcohol becomes less affordable through excise duties and minimum pricing.

2. Introduce a statutory framework with respect to the volume, content, and placement of all alcohol advertising in all media in Ireland.

3. Progress the recommendations in A Vision for Change: Report of the Expert Group on Mental Health Policy.

In addition, Alcohol Action Ireland recommends the following action so as to provide consumers with information on the effects of alcohol on mental health:

4. Develop and launch a national social marketing campaign informing consumers of the negative impact of alcohol on mental health so as to facilitate consumers to make informed choices about how and if they drink.

Theresa Lowry-LehnenRGN, BSc (Hon’s) Nursing Science, PGCC, Dip Counselling, Dip Psychotherapy,

BSc (Hon’s) Clinical Science, PGCE (QTS), H. Dip. Ed, MEd, PhD Student Health Psychology

References

[i] www.cso.ie Vital Statistics: Fourth Quarter and Yearly Summary 2011[ii]Hibell B, Guttormsson U, Ahlström S, Balakireva O, Bjarnason T, Kokkevi A and Kraus L (2012) The 2011 ESPAD report: substance use among students in 36 European countries. Stockholm: The Swedish Council for Information on Alcohol and Other Drugs (CAN) and the Pompidou Group of the Council of Europe[iii] Cheers? Understanding the Relationship between Alcohol and Mental Health (2006) Mental Health Foundation: UK[iv] Scientific Opinion of the Science Group of the European Alcohol and Health Forum (2009) Does marketing communication impact on the volume and patterns of consumption of alcoholic beverages, especially by young people? – a review of the longitudinal studies Anderson, P. et al (2009) Impact of Alcohol Advertising and Media Exposure on Adolescent Alcohol Use: A Systematic Review of Longitudinal Studies. Alcohol and Alcoholism, pp.1-15, 2009[v] Walsh, Brendan M and Walsh, Dermot (2011) Suicide in Ireland: the Influence of Alcohol and Unemployment. Economic and Social Review, 42 (1). pp. 27-47[vi] Dooley, B. & Fitzgerald, A. (2012) My World Survey: National Study of Youth Mental Health in Ireland. Headstrong[vii] Bedford D, O’Farrell A, Howell F. (2004)  Blood alcohol levels in persons who died as a result of accidents and suicide in Cavan, Monaghan and Louth in 2001 and 2002. North Eastern Health Board[viii]WHO Global Status Report on Alcohol (2004) Geneva: WHO][ix] see [iii][x] Journal of the American Medical Association, October 26, 2005 – Vol.294, no.16[xi] Hope, A. (2008) Alcohol Related Harm in Ireland. HSE – Alcohol Implementation Group[xii] Farren C.K (2005)  Presentation on Suicide and Alcohol to Joint Oireachtas Committee on Health by Dr. C.K. Farren, Consultant Psychiatrist and Director of Dual Mood and Addiction Program at St Patrick’s Hospital, Dublin[xiii] Department of Health and Children (2005) Reach Out: National Strategy for Action on Suicide Prevention 2005-2014. Dublin: HSE

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Theresa Lowry-LehnenRGN, BSc (Hon’s) Nursing Science, PGCC, Dip Counselling, Dip Psychotherapy,

BSc (Hon’s) Clinical Science, PGCE (QTS), H. Dip. Ed, MEd, PhD Student Health Psychology