CNS Drugs

, Volume 18, Issue 7, pp 423–436 | Cite as

Suicide in Alcohol-Dependent Individuals

Epidemiology and Management
  • Sami P. Pirkola
  • Kirsi Suominen
  • Erkki T. Isometsä
Therapy in Practice

Abstract

The association of alcohol dependence with suicidal behaviour is well established although complex. On the basis of epidemiological and clinical evidence, alcohol dependence is known to increase the risk for suicidal ideation, suicide attempts and completed suicide. However, this risk is modulated by a wide variety of factors including sociodemographic, clinical, treatment-related and life situa-tional characteristics as well as current drinking status and the effect of inebriation. Treatment and management of patients with alcohol dependence and concomitant suicidal communication or suicide attempts is crucial, as is the recognition of these patients in emergency and other healthcare service contacts. The treatment strategies cannot be based on evidence derived from randomised clinical trials as such data do not exist. They must rather be based on current knowledge of risk factors for suicidal behaviour, efficacy of treatment for alcohol dependence or relevant co-morbid conditions and problems known to be common in treatment settings. In this article, we review the essential literature on the epidemiological and clinical research in the areas of alcohol dependence and suicidal behaviour. On the basis of current data and clinical experience, we suggest the following principles be followed in the management of alcohol-dependent individuals: (i) suicidal threats or communication by alcohol-dependent individuals in emergency and other contacts should be taken seriously; (ii) other mental disorders should be well evaluated, a consequent treatment plan initiated and follow-up arranged; (iii) appropriate and up-to-date pharmacological treatment should focus on both reducing the amount of drinking and treating symptoms of other mental disorders; (iv) psychotherapeutic efforts should be focused on emerging symptoms of both alcohol use and other mental disorders; and (v) known epidemiological and clinical risk factors, adverse life events in particular, should be recognised and taken into account

Keywords

Suicidal Ideation Suicide Attempt Alcohol Dependence Suicidal Behaviour Personality Disorder 

Notes

Acknowledgements

The authors have provided no information on sources of funding or on conflicts of interest directly relevant to the content of this review.

References

  1. 1.
    Henriksson MM, Aro HM, Marttunen MJ, et al. Mental disorders and comorbidity in suicide. Am J Psychiatry 1993; 150: 935–40PubMedGoogle Scholar
  2. 2.
    Cheng AT. Mental illness and suicide: a case-control study in East Taiwan. Arch Gen Psychiatry 1995; 52: 594–603PubMedGoogle Scholar
  3. 3.
    Suominen K, Henriksson M, Suokas J, et al. Mental disorders and comorbidity in attempted suicide. Acta Psychiatr Scand 1996; 94: 234–40PubMedGoogle Scholar
  4. 4.
    Beautrais AL, Joyce PR, Mulder RT, et al. Prevalence and comorbidity of mental disorders in persons making serious suicide attempts: a case-control study. Am J Psychiatry 1996; 153: 1009–14PubMedGoogle Scholar
  5. 5.
    Haw C, Hawton K, Houston K, et al. Psychiatric and personality disorders in deliberate self-harm patients. Br J Psychiatry 2001; 178: 48–54PubMedGoogle Scholar
  6. 6.
    Pirkola S, Isometsä E, Heikkinen M, et al. Suicides of alcohol misusers and non-misusers in a nationwide population. Alcohol Alcohol 2000; 35: 70–5PubMedGoogle Scholar
  7. 7.
    Hufford MR. Alcohol and suicidal behaviour. Clin Psychol Rev 2001; 21: 797–811PubMedGoogle Scholar
  8. 8.
    World Health Organization. World report on violence and health. Geneva: WHO, 2002Google Scholar
  9. 9.
    Rosenberg ML, Davidson LE, Smith JC, et al. Operational criteria for the determination of suicide. J Forensic Sci 1988; 33: 1445–56PubMedGoogle Scholar
  10. 10.
    Neeleman J, Wessely S. Changes in classification of suicide in England and Wales: time trends and associations with coroners’ professional backgrounds. Psychol Med 1997; 27: 467–72PubMedGoogle Scholar
  11. 11.
    Öhberg A. Suicide methods in Finland: publications of the National Public Health Institute KTL A5/1998. Helsinki, Hakapaino Oy, 1998Google Scholar
  12. 12.
    Kessler RC, Borges G, Walters EE. Prevalence of and risk factors for lifetime suicide attempts in the National Comorbidity Survey. Arch Gen Psychiatry 1999; 56: 617–26PubMedGoogle Scholar
  13. 13.
    Hawton K. Suicide. In: Paykel ES, Jenkins R, editors. Prevention in psychiatry. Dorset: Gaskell, 1994Google Scholar
  14. 14.
    World Health Organization. Primary prevention of mental, neurological and psychosocial disorders. Geneva: WHO, 1998Google Scholar
  15. 15.
    Murray CJ, Lopez AD. Alternative projections of mortality and disability by cause 1990–2020: Global Burden of Disease Study. Lancet 1997; 349: 1498–504PubMedGoogle Scholar
  16. 16.
    van Heeringen K, Hawton K, Williams JMG. Pathways to suicide: an integrated approach. In: Hawton K, van Heeringen K, editors. The International handbook of suicide and attempted suicide. Chichester: John Wiley Sons, 2000Google Scholar
  17. 17.
    Suominen K. Attempted suicide in Helsinki: mental disorders and treatment received: publications of the National Public Health Institute NPHI A 24/1998. Helsinki: Hakapaino Oy, 1998Google Scholar
  18. 18.
    Beautrais A. Suicides and serious suicide attempts: two population or one? Psychol Med 2001; 31: 837–45PubMedGoogle Scholar
  19. 19.
    Hirschfeld RMA, Russell JM. Assessment and treatment of suicidal patients. N Engl J Med 1997; 337: 910–5PubMedGoogle Scholar
  20. 20.
    Lewis G, Hawton K, Jones P. Strategies for preventing suicide. Br J Psychiatry 1997; 171: 351–4PubMedGoogle Scholar
  21. 21.
    Hawton K. Assessment of suicide risk. Br J Psychiatry 1987; 150: 145–53PubMedGoogle Scholar
  22. 22.
    Schuckit MA. Alcohol-related disorders. In: Kaplan HI, Sadock BH, editors. Comprehensive textbook of Psychiatry. 6th ed. Baltimore: Williams & Wilkins, 1995: 775–91Google Scholar
  23. 23.
    American Psychiatric Association. Diagnostic and statistic manual of mental disorders (text revision). 4th ed. Washington, DC: American Psychiatric Association, 1994Google Scholar
  24. 24.
    World Health Organisation. International classification of disease. 10th rev. Geneva: World Health Organisation, 1992Google Scholar
  25. 25.
    Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry 1994; 51: 8–19PubMedGoogle Scholar
  26. 26.
    Blume SB. Women and alcohol: a review. JAMA 1986; 256: 1467–70PubMedGoogle Scholar
  27. 27.
    Gomberg ES. Women and alcohol: use and abuse. J Nerv Ment Dis 1993; 181: 211–9PubMedGoogle Scholar
  28. 28.
    Alexander MJ. Women with co-occurring addictive and mental disorders: an emerging profile of vulnerability. Am J Ortho-psychiatry 1996; 66: 61–70Google Scholar
  29. 29.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 3rd ed. Washington, DC: American Psychiatric Association, 1987Google Scholar
  30. 30.
    Bijl RV, Ravelli A, van Zessen G. Prevalence of psychiatric disorder in the general population: results of The Netherlands Mental Health Survey and Incidence Study (NEMESIS). Soc Psychiatry Psychiatr Epidemioly 1998; 33: 587–95Google Scholar
  31. 31.
    Andrews G, Henderson S, Hall W. Prevalence, comorbidity, disability and service utilisation: overview of the Australian National Mental Health Survey. Br J Psychiatry 2001; 178: 145–53PubMedGoogle Scholar
  32. 32.
    Kessler RC, Nelson CB, McGonagle KA, et al. The epidemiology of co-occurring addictive and mental disorders: implications for prevention and service utilisation. Am J Orthopsychi-atry 1996; 66: 17–31Google Scholar
  33. 33.
    Heizer JF, Pryzbeck TR. The co-occurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment. J Stud Alcohol 1988; 49: 219–24Google Scholar
  34. 34.
    Kessler RC. Epidemiology of psychiatric comorbidity. In: Tsuang MT, Tohen M, Zahner GEP, editors. Textbook in psychiatric epidemiology. New York: Wiley-Liss, 1995Google Scholar
  35. 35.
    Hasin D, Grant B. Major depression in 6050 former drinkers. Arch Gen Psychiatry 2002; 59: 794–800PubMedGoogle Scholar
  36. 36.
    Mayfield DG, Montgomery D. Alcoholism, alcohol intoxication, and suicide attempts. Arch Gen Psychiatry 1972; 27: 349–53PubMedGoogle Scholar
  37. 37.
    American Psychiatric Association. Practice guideline for treatment of patients with substance use disorders: alcohol, cocaine and opioids. Am J Psychiatry 1995; 152: 1–80Google Scholar
  38. 38.
    Wassermann D, Varnik A, Eklund G. Male suicides and alcohol consumption in the former USSR. Acta Psychiatr Scand 1994; 89: 306–13Google Scholar
  39. 39.
    Mäkelä P. Alcohol consumption and suicide mortality by age among Finnish men, 1950–1991. Addiction 1996; 91: 101–12PubMedGoogle Scholar
  40. 40.
    Murphy GE, Wetzel RD. The lifetime risk of suicide in alcoholism. Arch Gen Psychiatry 1990; 47: 383–92PubMedGoogle Scholar
  41. 41.
    Inskip HM, Harris C, Barraclough B. Lifetime risk of suicide foraffective disorder, alcoholism and schizophrenia. Br J Psychiatry 1998; 172: 35–7PubMedGoogle Scholar
  42. 42.
    Harris EC, Barraclough B. Suicide as an outcome for mental disorders. Br J Psychiatry 1998; 170: 205–28Google Scholar
  43. 43.
    Robins E, Murphy GE, Wilkinson RH, et al. Some clinical considerations in the prevention of suicide based on a study of 134 successful suicides. Am J Public Health 1959; 49: 888–99Google Scholar
  44. 44.
    Dorpat TL, Ripley HS. A study of suicide in the Seattle area. Compr Psychiatry 1960; 1: 349–59PubMedGoogle Scholar
  45. 45.
    Barraclough BM, Bunch J, Nelson B, et al. A hundred cases of suicide: clinical aspects. Br J Psychiatry 1974; 125: 355–73PubMedGoogle Scholar
  46. 46.
    Beskow J. Suicide in mental disorder in Swedish men. Acta Psychiatr Scand Suppl. 1979; 277: 1–138Google Scholar
  47. 47.
    Hagnell O, Rorsman B. Suicide in the Lundby study: a comparative investigation of clinical aspects. Neuropsychobiology 1979; 5: 61–73PubMedGoogle Scholar
  48. 48.
    Chynoweth R, Tonge JI, Armstrong J. Suicide in Brisbane: a retrospective psychosocial study. Aust N Z J Psychiatry 1980; 14: 37–45PubMedGoogle Scholar
  49. 49.
    Mitterauer B. Mehrdimensionale Diagnostik von 121 Suiziden im Bundesland Salzburg im Jahre 1978. Wien Med Wochenschr 1981; 131: 229–34PubMedGoogle Scholar
  50. 50.
    Shafii M, Carrigan S, Whittinghill JR, et al. Psychological autopsy of completed suicide in children and adolescents. Am J Psychiatry 1985; 142: 1061–4PubMedGoogle Scholar
  51. 51.
    Rich CL, Fowler RC, Young D. Substance abuse and suicide: the San Diego suicide study. Ann Clin Psychiatry 1989; 1: 79–85Google Scholar
  52. 52.
    Arato M, Demeter E, Rihmer Z, et al. Retrospective psychiatric assessment of 200 suicides in Budapest. Act a Psychiatr Scand 1988; 77: 454–6Google Scholar
  53. 53.
    Brent DA, Perper JA, Goldstein CE, et al. Risk factors for adolescent suicide: a comparison of adolescent suicide victims with suicidal inpatients. Arch Gen Psychiatry 1988; 45: 581–8PubMedGoogle Scholar
  54. 54.
    Runeson B. Mental disorders in youth suicide: DSM-III-R axes I and II. Acta Psychiatr Scand 1989; 79: 490–7PubMedGoogle Scholar
  55. 55.
    Åsgård U. A Psychiatric study of suicide among urban Swedish women. Acta Psychiatr Scand 1990; 82: 115–24PubMedGoogle Scholar
  56. 56.
    Conwell Y, Olsen K, Caine ED, et al. Suicide in later life: psychological autopsy findings. Int Psychogeriatr 1991; 3: 59–66PubMedGoogle Scholar
  57. 57.
    Marttunen MJ, Aro HM, Henriksson MM, et al. Mental disorders in adolescent suicide: DSM-III-R Axes I and II diagnoses in suicides among 13- to 19-year-olds in Finland. Arch Gen Psychiatry 1991; 48: 834–9PubMedGoogle Scholar
  58. 58.
    Apter A, Bleich A, King RA, et al. Death without warning?: a clinical postmortem study of suicide in 43 Israeli adolescent males. Arch Gen Psychiatry 1993; 50: 138–42PubMedGoogle Scholar
  59. 59.
    Henriksson MM, Aro HM, Marttunen MJ, et al. Mental disorders and comorbidity in suicide. Am J Psychiatry 1993; 150: 935–40PubMedGoogle Scholar
  60. 60.
    Brent DA, Perper JA, Moritz G, et al. Psychiatric risk factors for adolescent suicide: a case-control study. J Am Acad Child Adolesc Psychiatry 1993; 32: 521–9PubMedGoogle Scholar
  61. 61.
    Lesage AD, Boyer R, Grunberg F, et al. Suicide and mental disorders: a case-control study of young men. Am J Psychiatry 1994; 151: 1063–8PubMedGoogle Scholar
  62. 62.
    Conwell Y, Duberstein PR, Cox C, et al. Relationships of age and axis I diagnoses in victims of completed suicide: a psychological autopsy study. Am J Psychiatry 1996; 153: 1001–8PubMedGoogle Scholar
  63. 63.
    Shaffer D, Gould M, Fisher P, et al. Psychiatric diagnosis in child and adolescent suicide. Arch Gen Psychiatry 1996; 53: 339–448PubMedGoogle Scholar
  64. 64.
    Foster T, Gillespie K, McClelland R. Mental disorders and suicide in Northern Ireland. Br J Psychiatry 1997; 170: 447–52PubMedGoogle Scholar
  65. 65.
    Ripley HS, Dorpat TL. Life change and suicidal behavior. Psychiatr Ann 1981; 11: 32–47Google Scholar
  66. 66.
    Murphy GE. Suicide in alcoholism. New York: Oxford University Press, 1992Google Scholar
  67. 67.
    Duberstein PR, Conwell Y, Caine ED. Interpersonal Stressors, substance abuse, and suicide. J Nerv Ment Dis 1993; 181:80–5PubMedGoogle Scholar
  68. 68.
    Heikkinen ME, Aro HM, Henriksson MM, et al. Differences in recent life events between alcoholic and depressive nonalcoholic suicides. Alcohol Clin Exp Res 1994; 18: 1143–9PubMedGoogle Scholar
  69. 69.
    Murphy G, Wetzel R, Robins E, et al. Multiple risk factors predict suicide in alcoholism. Arch Gen Psychiatry 1992; 49: 459–63PubMedGoogle Scholar
  70. 70.
    Pirkola S, Isometsä E, Heikkinen M, et al. Female psychoactive substance dependent suicide victims differ from male: results from a nationwide psychological autopsy study. Compr Psychiatry 1999; 40: 101–7PubMedGoogle Scholar
  71. 71.
    Pages KP, Russo JE, Roy-Byrne PP, et al. Determinants of suicidal ideation: the role of substance use disorders. J Clin Psychiatry 1997; 58: 510–5PubMedGoogle Scholar
  72. 72.
    Hall DJ, O’Brien F, Stark C, et al. Thirteen-year follow-up of deliberate self-harm, using linked data. Br J Psychiatry 1998; 172: 239–42PubMedGoogle Scholar
  73. 73.
    Driessen M, Veltrup C, Weber J, et al. Psychiatric co-morbidity, suicidal behaviour and suicidal ideation in alcoholics seeking treatment. Addiction 1998; 93: 889–94PubMedGoogle Scholar
  74. 74.
    Cornelius JR, Salloum IM, Mezzich J, et al. Disproportionate suicidality in patients with comorbid major depression and alcoholism. Am J Psychiatry 1995; 152: 358–64PubMedGoogle Scholar
  75. 75.
    Weite J, Abel E, Wieczorek W. The role of alcohol in suicides in Erie County, NY 1972–84. Public Health Rep 1988; 103: 648–52Google Scholar
  76. 76.
    Hayward L, Zubrick SR, Silburn S. Blood alcohol levels in suicide cases. J Epidemiol Community Health 1992; 46: 256–60PubMedGoogle Scholar
  77. 77.
    Öhberg A, Vuori E, Ojanperä I, et al. Alcohol and drugs in suicides. Br J Psychiatry 1996; 169: 75–80PubMedGoogle Scholar
  78. 78.
    Pirkola S, Isometsä E, Heikkinen M, et al. Employment statusinfluences the weekly patterns of suicide among alcohol misusers. Alcohol Clin Exp Res 1997; 21: 1704–6PubMedGoogle Scholar
  79. 79.
    Mann JJ, Waternaux C, Haas GL, et al. Toward a clinical model of suicidal behavior in psychiatric patients. Am J Psychiatry 1999; 156: 181–9PubMedGoogle Scholar
  80. 80.
    Gorwood P. Biological markers for suicidal behavior in alcohol dependence. Eur Psychiatry 2001; 16: 410–7PubMedGoogle Scholar
  81. 81.
    Koller G, Preuss UW, Bottlender M, et al. Impulsivity and aggression as predictors of suicide attempts in alcoholics. Eum-Arch Psychiatry Clin Neurosci 2002; 252: 155–60Google Scholar
  82. 82.
    Preuss UW, Koller G, Soyka M, et al. Association between suicide attempts and 5-HTTLPR-S-allele in alcohol-dependent and control subjects: further evidence from a German alcohol-dependent inpatient sample. Biol Psychiatry 2001 Oct 15; 50: 636–9PubMedGoogle Scholar
  83. 83.
    Gorwood P, Batel P, Adés J, et al. Serotonin transporter gene polymorphins, alcoholism and suicidal behavior. Biol Psychiatry 2000; 48: 259–64PubMedGoogle Scholar
  84. 84.
    Oquendo MA, Mann JJ. The biology of impulsivity and suicidality. Psychiatr Clin North Am 2000; 23: 11–25PubMedGoogle Scholar
  85. 85.
    Runeson B. Psychoactive substance use disorder in youth suicide. Alcohol Alcohol 1990; 25: 561–8PubMedGoogle Scholar
  86. 86.
    Pirkola S, Isometsä E, Henriksson M, et al. The treatment received by substance dependent male and female suicide victims. Acta Psychiatr Scand 1999; 99: 207–13PubMedGoogle Scholar
  87. 87.
    Haw C, Houston K, Townsend E, et al. Deliberate self-harm patients with alcohol disorders: characteristics, treatment, and outcome. Crisis 2001; 22: 93–101PubMedGoogle Scholar
  88. 88.
    Schuckit MA. Primary men alcoholics with histories of suicide attempts. J Stud Alcohol 1986; 47: 78–81PubMedGoogle Scholar
  89. 89.
    Hesselbrock M, Hesselbrock V, Syzmanski K, et al. Suicide attempts and alcoholism. J Stud Alcohol 1988; 49: 436–42PubMedGoogle Scholar
  90. 90.
    Roy A, Lamparski D, DeJong J, et al. Characteristics of alcoholics who attempt suicide. Am J Psychiatry 1990; 147: 761–5PubMedGoogle Scholar
  91. 91.
    Preuss UW, Schuckit MA, Smith TL, et al. Comparison of 3190 alcohol-dependent individuals with and without suicide attempts. Alcohol Clin Exp Res 2002; 26: 471–2PubMedGoogle Scholar
  92. 92.
    Rossow I, Romelsjo A, Leifman H. Alcohol abuse and suicidal behaviour in young and middle aged men: differentiating between attempted and completed suicide. Addiction 1999; 94: 1199–207PubMedGoogle Scholar
  93. 93.
    Roy A. Relation of family history of suicide to suicide attempts in alcoholics. Am J Psychiatry 2000; 157: 2050–1PubMedGoogle Scholar
  94. 94.
    Aharonovich E, Liu X, Nunes E, et al. Suicide attempts in substance abusers: effects of major depression in relation to substance use disorders. Am J Psychiatry 2002; 159: 1600–2PubMedGoogle Scholar
  95. 95.
    Suominen K, Isometsä E, Henriksson M, et al. Hopelessness, impulsiveness and intent among suicide attempters with major depression, alcohol dependence or both. Acta Psychiatr Scand 1997; 96: 142–9PubMedGoogle Scholar
  96. 96.
    Preuss UW, Schuckit MA, Smith TL, et al. A comparison of alcohol-induced and independent depression in alcoholics with histories of suicide attempts. J Stud Alcohol 2002; 63: 498–502PubMedGoogle Scholar
  97. 97.
    Murphy GE. Psychiatric aspects of suicidal behaviour: substance abuse. In: Hawton K, van Heeringen K, editors. The international handbook of suicide and attempted suicide. Chichester: John Wiley & Sons Ltd, 2000: 135–46Google Scholar
  98. 98.
    Schmidtke A, Bille-Brahe U, De Leo D, et al. Attempted suicide in Europe: rates, trends and sociodemographic characteristics of suicide attempters during the period 1989–1992. Results of the WHO/EURO Multicentre Study on Parasuicide. Acta Psychiatr Scand 1996; 93: 327–38Google Scholar
  99. 99.
    Suominen K, Isometsä E, Henriksson M, et al. Treatment received by alcohol dependent suicide attempters. Acta Psychiatr Scand 1999; 99: 214–9PubMedGoogle Scholar
  100. 100.
    Suominen KH, Isometsa ET, Henriksson MM, et al. Inadequate treatment for major depression both before and after attempted suicide. Am J Psychiatry 1998; 155: 1778–80PubMedGoogle Scholar
  101. 101.
    Hawton K, Fagg J, McKeown SP. Alcoholism, alcohol and attempted suicide. Alcohol Alcohol 1989; 24: 3–9PubMedGoogle Scholar
  102. 102.
    Cornelius JR, Salloum IM, Day NL, et al. Patterns of suicidality and alcohol use in alcoholics with major depression. Alcohol Clin Exp Res 1996; 20: 1451–5PubMedGoogle Scholar
  103. 103.
    Rossow I, Romelsjö A, Leifman H. Alcohol abuse and suicidal behaviour in young men: differentiating between attempted and completed suicide. Addiction 1999; 94: 1199–207PubMedGoogle Scholar
  104. 104.
    Grant BF, Hasin DS. Suicidal ideation among the United States drinking population: results from the National Longitudinal Alcohol Epidemiologic Survey. J Stud Alcohol 1999; 60: 422–9PubMedGoogle Scholar
  105. 105.
    O’Connor PG, Schottenfield RS. Patients with alcohol problems. N Engl J Med 1998; 338: 592–602PubMedGoogle Scholar
  106. 106.
    Kurtz Z. Not God: a history of alcoholics anonymous. Center City (MN): Hazelden Educational Materials, 1979Google Scholar
  107. 107.
    Volpicelli JR, Volpicelli LA, O’Brien CP. Medical management of alcohol dependence: clinical use and limitations of naltrex-one treatment (rev). Alcohol Alcohol 1995; 30: 789–98PubMedGoogle Scholar
  108. 108.
    Gabbard GO. Psychodynamic psychiatry in clinical practice: the DSM-IV edition. Washington, DC: American Psychiatric Press, 1994Google Scholar
  109. 109.
    Tinsley JA, Finlayson RE, Morse RM. Developments in treatment of alcoholism. Mayo Clinic Proc 1998; 73: 857–63Google Scholar
  110. 110.
    Vaillant GE. A long-term follow up of male alcohol abuse. Arch Gen Psychiatry 1996; 53: 243–9PubMedGoogle Scholar
  111. 111.
    Volpicelli JR, Watson NT, King AC, et al. Effect of naltrexone on alcohol “high” in alcoholics. Am J Psychiatry 1995; 152: 613–5PubMedGoogle Scholar
  112. 112.
    O’Malley S, Jaffe AJ, Chang G, et al. Six-month follow-up of naltrexone and psychotherapy for alcohol dependence. Arch Gen Psychiatry 1996; 53: 217–24PubMedGoogle Scholar
  113. 113.
    Sass H, Soyka M, Mann K, et al. Relapse prevention by acamprosate: results from a placebo-controlled study on alcohol dependence. Arch Gen Psychiatry 1996; 53: 673–80PubMedGoogle Scholar
  114. 114.
    Ritson B. Pharmacotherapy in alcohol problems. Curr Opin Psychiatry 1998; 11: 285–8Google Scholar
  115. 115.
    Garbutt JC, West SL, Carey TS, et al. Pharmacological treatment of alcohol dependence. JAMA 1999; 281: 1318–25PubMedGoogle Scholar
  116. 116.
    Schuckit MA. Recent developments in the pharmacotherapy of alcohol dependence (rev). J Consult Clin Psychol 1996; 64: 669–76PubMedGoogle Scholar
  117. 117.
    Hughes JC, Cook CC. The efficacy of disulfiram: a review of outcome studies. Addiction 1997; 92: 381–95PubMedGoogle Scholar
  118. 118.
    Volpicelli JR, Alterman A, Hayashida M, et al. Naltrexone in the treatment of alcohol dependence. Arch Gen Psychiatry 1992; 49: 876–80PubMedGoogle Scholar
  119. 119.
    Anton RF. Pharmacological approaches to the management of alcoholism. J Clin Psychiatry 2001; 62: 11–7PubMedGoogle Scholar
  120. 120.
    Lhuintre JP, Moore N, Tran G, et al. Acamprosate appears to decrease alcohol intake in weaned alcoholics. Alcohol Alcohol 1990; 25: 613–22PubMedGoogle Scholar
  121. 121.
    Paille FM, Guelfi JD, Perkins AC, et al. Double-blind randomized multicentre trial of acamprosate in maintaining abstinence from alcohol. Alcohol Alcohol 1995; 30: 239–47PubMedGoogle Scholar
  122. 122.
    Mason BJ. Treatment of alcohol-dependent outpatients with acamprosate: a clinical review. J Clin Psychiatry 2001; 62: 42–8PubMedGoogle Scholar
  123. 123.
    Cornelius JR, Salloum IM, Ehler JG, et al. Double-blind fluoxetine in depressed alcoholic smokers. Psychopharmacol Bull 1997; 33: 165–70PubMedGoogle Scholar
  124. 124.
    Cornelius JR, Salloum IM, Ehler JG, et al. Fluoxetine in depressed alcoholics: a double-blind placebo-controlled trial. Arch Gen Psychiatry 1997; 54: 700–5PubMedGoogle Scholar
  125. 125.
    Kranzler HR, Burleson JA, Korner P, et al. Placebo-controlled trial of fluoxetine as an adjunct to relapse prevention in alcoholics. Am J Psychiatry 1995; 152: 391–7PubMedGoogle Scholar
  126. 126.
    Naranjo CA, Knoke DM. The role of selective serotonin reup-take inhibitors in reducing alcohol consumption. J Clin Psychiatry 2001; 62: 18–25PubMedGoogle Scholar
  127. 127.
    Pettinati HM. The use of selective serotonin reuptake inhibitors in treating alcoholic subtypes. J Clin Psychiatry 2001; 62: 26–31PubMedGoogle Scholar
  128. 128.
    Kranzler HR, Burleson JA, Del Boca FK, et al. Buspirone treatment of anxious alcoholics: a placebo-controlled trial. Arch Gen Psychiatry 1994; 51: 720–31PubMedGoogle Scholar
  129. 129.
    Malec TS, Malec EA, Dongier M. Efficacy of buspirone in alcohol dependence: a review. Alcohol Clin Exp Res 1996; 20: 853–8PubMedGoogle Scholar
  130. 130.
    Regier D, Narrow W, Rae D, et al. The de facto US mental and addictive disorders service system. Arch Gen Psychiatry 1993; 50: 85–94PubMedGoogle Scholar
  131. 131.
    Osher F, Drake R. Reversing a history of unmet needs: approaches to care for persons with co-occurring addictive and mental disorders. Am J Orthopsychiatry 1996; 66: 4–11PubMedGoogle Scholar
  132. 132.
    Rounsaville B, Dolinsky Z, Babor T, et al. Psychopathology as a predictor of treatment outcome in alcoholics. Arch Gen Psychiatry 1987; 44: 505–13PubMedGoogle Scholar
  133. 133.
    Weisner C, Schmidt L. Gender disparities in treatment foralcohol problems. JAMA 1992; 268: 1872–6PubMedGoogle Scholar
  134. 134.
    Lehman A. Heterogeneity of person and place: assessing cooccurring addictive and mental disorders. Am J Orthopsychiatry 1996; 66: 32–41PubMedGoogle Scholar
  135. 135.
    Swift W, Copeland J. Treatment needs and experiences of Australian women with alcohol and other drug problem. Drug Alcohol Depend 1996; 40: 211–9PubMedGoogle Scholar
  136. 136.
    Cornelius JR, Salloum IM, Lynch K, et al. Treating the substance-abusing suicidal patient. Ann N Y Acad Sci 2001; 932: 78–90PubMedGoogle Scholar
  137. 137.
    _Thase ME, Salloum IM, Cornelius JD. Comorbid alcoholism and depression: treatment issues. J Clin Psychiatry 2001; 62: 32–41PubMedGoogle Scholar
  138. 138.
    _Petrakis IL, Gonzales G, Rosenheck R, et al. Comorbidity of alcoholism and psychiatric disorders. Alcohol Res Health 2002; 26: 81–9Google Scholar
  139. 139.
    _Suominen KH, Isometsä ET, Lönnqvist JK. Comorbid substance use reduces the health care contacts of suicide attempters with schizophrenia spectrum or mood disorders. Schizophr Bull 2002; 28(4): 637–47PubMedGoogle Scholar
  140. 140.
    _Isacsson G, Rich CL. Management of patients who deliberately harm themselves. BMJ 2001; 322: 213–5PubMedGoogle Scholar

Copyright information

© Adis Data Information BV 2004

Authors and Affiliations

  • Sami P. Pirkola
    • 1
    • 2
  • Kirsi Suominen
    • 1
    • 3
  • Erkki T. Isometsä
    • 1
  1. 1.Department of Mental Health and Alcohol ResearchNational Public Health InstituteHelsinkiFinland
  2. 2.Development Centre for Welfare and HealthHealth and Social Services Division, STAKES National ResearchHelsinkiFinland
  3. 3.Department of PsychiatryJorvi Hospital, Helsinki University Central HospitalEspooFinland

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