Suicide attempts predicted later substance dependence, but early substance use did not consistently predict suicidal behavior
People who attempted suicide were 1.4 to 1.6 times more likely to develop alcohol, nicotine, or cannabis dependence later, but early substance use showed limited evidence of predicting future suicidal thoughts or attempts.
Quick Facts
What This Study Found
In a prospective cohort of over 3,200 participants, suicide attempts were associated with significantly increased odds of subsequently developing dependence on alcohol, nicotine, or cannabis (odds ratios 1.44 to 1.61). This held after adjusting for family history of alcohol problems, major depression, and other psychiatric disorders.
Suicidal ideation showed a different pattern: it was associated with reduced odds (0.71 to 0.77) of initiating alcohol, nicotine, or cannabis use. In other words, people with suicidal thoughts were less likely to start using substances.
The reverse direction, whether early substance use predicted later suicidal behavior, showed limited evidence. Several sex and race differences emerged in the associations.
Key Numbers
Suicide attempts associated with 1.44-1.61 odds of later alcohol, nicotine, and cannabis dependence. Suicidal ideation associated with 0.71-0.77 odds of initiating substance use. Sample: 3,277 participants from COGA.
How They Did This
Prospective cohort data from the Collaborative Study of the Genetics of Alcoholism (COGA, N=3,277). Cross-sectional and discrete time survival analyses examined bidirectional associations between suicidal ideation/attempts and onset of substance use and dependence across alcohol, nicotine, and cannabis.
Why This Research Matters
This study challenges the simple assumption that substance use leads to suicidal behavior. Instead, it found that the stronger directional pathway runs from suicide attempts to subsequent substance dependence, suggesting that substances may be used as coping mechanisms after suicidal crises rather than primarily causing them.
The Bigger Picture
The finding that suicidal crises precede substance dependence more than the reverse has clinical implications. It suggests that suicide prevention could also be substance dependence prevention, and that treating suicidality in isolation without addressing the risk of subsequent self-medication may miss a critical pathway.
What This Study Doesn't Tell Us
The COGA sample was ascertained for family history of alcoholism, so it may not represent the general population. Not all participants were followed up, creating censored observations. Self-report of suicidal behavior and substance use may be subject to reporting bias. The study cannot establish causation.
Questions This Raises
- ?Why does suicidal ideation (without attempt) reduce the likelihood of starting substance use?
- ?Are specific substances preferentially used as coping mechanisms after suicidal crises?
- ?Would interventions targeting substance use risk after suicide attempts improve outcomes?
Trust & Context
- Key Stat:
- Suicide attempts increased odds of later substance dependence by 44-61%
- Evidence Grade:
- Prospective cohort study from a large genetics collaboration. The longitudinal design allows examination of temporal sequences, but the sample was enriched for alcohol family history.
- Study Age:
- Published in 2017. Bidirectional relationships between substance use and suicidality remain actively studied.
- Original Title:
- Reciprocal relationships between substance use and disorders and suicidal ideation and suicide attempts in the Collaborative Study of the Genetics of Alcoholism.
- Published In:
- Journal of affective disorders, 213, 96-104 (2017)
- Authors:
- Agrawal, Arpana(39), Tillman, Rebecca(4), Grucza, Richard A(9), Nelson, Elliot C, McCutcheon, Vivia V, Few, Lauren, Conner, Kenneth R, Lynskey, Michael T, Dick, Danielle M, Edenberg, Howard J, Hesselbrock, Victor M, Kramer, John R, Kuperman, Samuel, Nurnberger, John I, Schuckit, Marc A, Porjesz, Bernice, Bucholz, Kathleen K
- Database ID:
- RTHC-01321
Evidence Hierarchy
Enrolls participants and follows them forward in time.
What do these levels mean? →Frequently Asked Questions
Does cannabis cause suicidal thoughts?
This study found limited evidence that early cannabis use predicted later suicidal behavior. The stronger finding was the reverse: suicide attempts predicted later cannabis dependence. The relationship appears to be more about self-medication than substance-induced suicidality.
Why did suicidal ideation reduce substance use initiation?
The study did not fully explain this finding. It may be that suicidal ideation involves withdrawal from activities including social substance use, or that people experiencing ideation without attempts have different coping patterns than those who attempt suicide.
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Cite This Study
https://rethinkthc.com/research/RTHC-01321APA
Agrawal, Arpana; Tillman, Rebecca; Grucza, Richard A; Nelson, Elliot C; McCutcheon, Vivia V; Few, Lauren; Conner, Kenneth R; Lynskey, Michael T; Dick, Danielle M; Edenberg, Howard J; Hesselbrock, Victor M; Kramer, John R; Kuperman, Samuel; Nurnberger, John I; Schuckit, Marc A; Porjesz, Bernice; Bucholz, Kathleen K. (2017). Reciprocal relationships between substance use and disorders and suicidal ideation and suicide attempts in the Collaborative Study of the Genetics of Alcoholism.. Journal of affective disorders, 213, 96-104. https://doi.org/10.1016/j.jad.2016.12.060
MLA
Agrawal, Arpana, et al. "Reciprocal relationships between substance use and disorders and suicidal ideation and suicide attempts in the Collaborative Study of the Genetics of Alcoholism.." Journal of affective disorders, 2017. https://doi.org/10.1016/j.jad.2016.12.060
RethinkTHC
RethinkTHC Research Database. "Reciprocal relationships between substance use and disorders..." RTHC-01321. Retrieved from https://rethinkthc.com/research/agrawal-2017-reciprocal-relationships-between-substance
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.