Conceptual issues in understanding the relationship between suicidal behavior and substance use during adolescence

Alcohol and drug use are considered to be risk factors for suicidal behaviors in adolescence, but the precise nature of the relationship between suicidality and substance abuse, and the implications of this relationship for prevention and treatment interventions remain elusive. There are several conceptual issues that need to be addressed when considering the substance abuse-suicidality relationship. What are the most appropriate ways of defining suicidal behaviors? What are the best ways of assessing suicidal behavior and characterizing its course over time? Should adolescents who are suicidal be considered to be a single homogeneous population? What are the possible ways in which the course of substance abuse and suicidality over time are related? What factors potentially affect the trajectories of both substance abuse and suicidality? Does the relationship between substance abuse and suicidality change over time? And, to what extent can our knowledge of factors precipitating and maintaining the joint outcomes of suicidal and substance abuse behaviors be incorporated into interventions that target both? Careful consideration and exploration of these issues hopefully should improve our understanding the substance abuse-suicidality interrelationship, and ultimately the development of more effective prevention efforts and treatments for youths with both problems.