Adolescent substance use and suicidal behavior: a review with implications for treatment research

Adolescent substance use (alcohol and other drugs) and suicidal behavior, independently, pose serious public health problems. Youths who report co-occurring substance use and suicidality are a particularly high-risk group. In this review, we explore four areas that are pertinent to research with substance-abusing and suicidal adolescent populations. First, we review epidemiological research that is relevant to the association between substance use and suicidal behavior. Results suggest that substance use heightens statistical risk for suicidal behavior in adolescent clinical and community populations. Alcohol intoxication may serve as a proximal risk factor for suicidal behavior among distressed youths through its psychopharmacological effects on the brain. Substance use may also serve as a distal risk factor for suicidal behavior by increasing stress and exacerbating co-occurring psychopathology. Second, we propose different theoretical models that might explain the high rates of co-occurring substance use and suicidal behavior among adolescents. Substance use may stem from an underlying syndrome of problem behavior among impulsive suicide attempters with predominant externalizing symptoms. In contrast, nonimpulsive suicide attempters with predominant internalizing symptoms may use substances to cope with negative affective states. Third, we explore the status of treatment research with substance abusing and suicidal adolescent populations. Studies of substance abuse treatment and suicidal behavior have neither adequately assessed nor incorporated treatment of the other co-occurring problem. Finally, we conclude with proposed directions for future research, including the development of integrated interventions tailored to adolescents with these co-occurring problems.