Applying the reinforcer pathology model to alcohol use and suicide risk: An initial test

Alcohol use and suicide risk have a well-established relation. In the United States, up to a third of suicide decedents have alcohol in their blood at the time of death and half of those have a blood alcohol level above the legal driving limit (i.e., 0.08% blood alcohol content). Despite the established relation, the mechanisms linking alcohol and suicide risk are unclear. The reinforcer pathology framework of addiction, pioneered by Warren Bickel, can be adapted to make predictions about suicide risk among those who use alcohol. To assess this, we conducted two crowdsourced studies (using Amazon Mechanical Turk and Prolific) that consisted of assessments of demand for alcohol, discounting of delayed monetary gains, and suicide risk (assessed by the Columbia-Suicide Severity Rating Scale). Demand for alcohol was generally higher as suicide risk increased, and discounting for delayed gains was higher for recent suicide preparations but not suicidal ideation. Further formalization of reinforcer pathology frameworks will allow for more rigorous control of variables that affect alcohol use and suicide risk both individually and together.