The complex relationship between alcohol, self-harm, and suicide: challenges, solutions and hope

Lisa Schölin and Jane Brandt Sørensen reflect on a recent workshop exploring the connection between alcohol and suicide.

This article discusses suicidal behaviour. If you have questions on self-harm or feel suicidal, call 116 123 to speak to a Samaritan (UK) or use this link to find an international helpline.

What role does alcohol play in self-harm and suicide? This is a question we recently sought to address through a workshop at the European Symposium for Suicide and Suicidal Behaviour in Copenhagen.

Our invited speakers could not have given more diverse presentations. This included research from Greenland and Sri Lanka, along with a discussion on the role of the alcohol industry. However, with the help of our facilitator Professor Flemming Konradsen, we were able to draw parallels between these different themes.

All presenters spoke to the importance of social determinants of health, the cultural and geographical nature of problems stemming from alcohol consumption, and the need for adapting interventions and policies to the communities where these issues occur.

From Greenland to Sri Lanka – worlds apart but with similar problems

We were lucky to have two excellent speakers from two different places of the world; Dr Christina Viskum Larsen who works in Greenland and Professor Thilini Rajapakse from Sri Lanka. Both presented data on alcohol in relation to self-harm and suicide.

In Greenland, Christina and her team have monitored the high prevalence of Adverse Childhood Experiences (ACEs) and their link to suicide and suicidal behaviour. While suicide and suicidal behaviour are prevalent even in youth without ACEs, the research showed that among those who had three ACEs (one being problem alcohol use in the household) 66% had suicidal ideation and 58% had attempted suicide.

The statistics from Greenland are truly devastating and the number of individuals who have been affected by suicide (as many as 70%) affected all of us who listened to  Christina’s presentation.

In Sri Lanka, research has focused on alcohol misuse within communities, where the link with self-harm and suicide is clear. In one study, alcohol use disorder increased the risk of self-harm in men over 30 years by 21 times.

These issues have also shown to lead to domestic violence, which has damaging effects on families. Interpersonal conflict associated with alcohol use disorders also contributes to self-harm. Thilini cited an interview with a 40-year-old man who said:

My son told me – ‘ Thaththa, you get drunk and sleep all over the place – how do I face my friends?’ I felt I was a wrongdoer, ashamed.  But I can’t stop it, no. So I took the poison and went to the field.”

The need for support in these communities, as well as understanding the underlying factors contributing to problem alcohol use and self-harm, are clear. Compared to high-income countries, different issues are evident in these communities such as consumption of illicit alcohol which means measures adopted in high-income countries may be less effective in these settings.

Framing of alcohol-related problems

Within the session, Dr May van Schalwyk gave examples from the research she has done with other colleagues on the alcohol industry’s framing of alcohol-related problems.

She told us how alcohol-industry funded youth education programs purportedly aim to prevent youth drinking. However, they actually risk normalising drinking, for example, by promoting the industry-favoured concept of “responsible drinking”. They also teach children how alcohol is produced and how to pour a standard drink.

May furthermore highlighted how the alcohol industry frames harms from alcohol, such as cancer or drinking while pregnant, in a way that distorts the evidence and focuses on individuals as responsible for the problem.

She emphasised how this is relevant to suicide prevention, for example when the firearms or pesticide industry attempt to form partnerships with public health bodies. This perspective might be unfamiliar in the field, but audience members seemed interested to understand this in more depth.

Alcohol interventions and action through hope

Dr Lisa Scholin also presented summary findings from an ongoing scoping review on alcohol’s role in pesticide self-harm and suicide.

Along with evidence of the high prevalence of alcohol in self-harm and suicides, Lisa presented how a lack of recognition for alcohol interventions as a suicide prevention strategy were identified.

She emphasized how recent work has found that changes in availability or price of alcohol impact on suicide rates. Population level interventions could, therefore, help reduce suicide. But where would one start?

Christina explained about a shift in their research in Greenland to focus on protective factors and the resilience and support found in the Greenlandic communities, which have existed for thousands of years. Through participatory research, youth in Greenland have displayed the connection with elders and nature which Christina’s research has found are key protective factors.

In Sri Lanka, the solutions also focus on participation and engagement of communities. Thilini presented results from a pilot study where an intervention to reduce alcohol use is delivered through street theatre and other interactive measures, which is common in Sri Lanka.

The findings from the pilot work are impressive and a full-scale study is now ongoing, albeit with the challenges posed by Covid-19 which led to modifications.

Although diverse, the presentations all highlighted the need to consider alcohol alongside cultural differences when planning suicide prevention interventions.

Lisa Scholin

Dr Lisa Schölin

Research Fellow
Centre for Pesticide Suicide Prevention

Assistant Professor Jane Brandt Sørensen

School of Global Health, University of Copenhagen

The session took place on Wednesday 24 August at the European Symposium for Suicide and Suicidal Behaviour in Copenhagen, Denmark. It was organised by CPSP in partnership with the University of Copenhagen. Special thanks to Melissa Pearson and Flemming Konradsen for assisting in the planning of the workshop and to University of Sydney and the University of Bristol for supporting Prof Thilini Rajapakse to attend the conference.