Newly confirmed links between suicide and alcohol abuse raise questions about the separation of New Zealand’s suicide prevention strategy and approach to drinking
Researchers are calling on the Government to address the disconnection between how it deals with alcohol use disorder and suicide.
New research from the University of Otago has shown alcohol abuse or dependence significantly increases the risk of suicidal thoughts in adults.
The study, lead by Dr Rose Crossin of the School of Population Health, examined data from the longitudinal study of 1265 children born in 1977.
Before controlling for other suicide risk variables such as trauma, physical, mental health and substance abuse, alcohol dependence almost tripled the risk of suicidal thoughts. While controlling for these factors, alcohol dependence raised that risk by 50 percent.
Despite this, New Zealand’s national suicide prevention strategy has little focus on alcohol abuse. Crossin asked why the two have been kept so separate in the Government’s approach to these entangled public health battles.
It’s a division exemplified by the two being given to completely different ministries to tackle - alcohol regulatory and licensing being handled by the Ministry of Justice, and suicide on the Ministry of Health’s plate.
Meanwhile, the official document outlining the country’s suicide preventions strategy mentions alcohol just five times - a stated desire to improve support for people impacted by alcohol and drug use at the beginning, and then the provision of the number for alcohol and drug helplines at the end.
Crossin said the findings of the study shouldn’t be taken lightly for New Zealand, a country with high rates of both dangerous drinking and suicide risk.
In 2020, 21 percent of adults met hazardous drinking criteria, while 607 New Zealanders took their own lives in the year to June 2021.
“Our suicide prevention strategy has some really good stuff, but this is a big part that’s missing,” she said. “We recommend including alcohol-related interventions in it.”
These could come in the form of interventions targeted at a population level, which Crossin said the research backs up the most. This could be reducing marketing of alcohol, or pushing the drinking age back up to 20.
On a more individual level, she said the way to go would be making sure screening for alcoholism is a consistent part of mental health treatment, and vice versa.
She pointed to the work of her Australian colleague Dr Katrina Witt, whose research uncovered a trend of restrictions of access and increased cost of alcohol being related to a reduction of suicides in the US and Europe.
In an overview of mental health service users who have died by suicide between 2001 and 2018, the Ministry of Health found 819 of 3314 people had been treated for alcohol or drug abuse in the 12 months before their death - just less than a quarter.
Crossin said alcohol abuse disorder is one of the most firmly established risk factors for suicide after major depressive disorder, while the fact that alcohol abuse can contribute to depression and vice versa means the two factors are firmly entwined.
This makes it hard to establish strictly causal reasons why alcohol and suicide are connected.
“The reason that alcohol use disorder impacts on suicide is quite complex,” Crossin said. “One aspect is that alcohol is a depressant, so if you drink alcohol over a long time, it’s associated with depression, which is associated with suicide.”
Other reasons include alcohol abuse cutting people off from protective factors that decrease the likelihood of suicide, such as employment, strong family ties or social support systems.
Then there’s long-term alcohol use potentially causing cognitive impairments that can have disastrous flow-on effects.
“That means people’s ability to cope with issues is impaired,” Crossin said. “Whether that’s being able to have really good coping strategies, or mechanisms for dealing with life’s stresses.”
Another aspect is the acute effects of being drunk, which can increase impulsivity and aggression that may be turned inwards in some people. Crossin’s next piece of research hopes to look into this.
“That’s the second part of the study - looking at the acute relationship between alcohol and suicide,” she said. “It can also affect someone in the immediacy of being intoxicated and disinhibited and not making clear and reasoned judgments.”
Dr Nicki Jackson is the executive director of Alcohol Healthwatch, a charity funded solely by the Ministry of Health. She said the group was disappointed to see no specific plans around alcohol in the national suicide prevention strategy.
"When you're talking about one of the biggest contributors to suicide in our country, we need specific actions," she said. "It's like trying to reduce the road toll without reducing alcohol."
Jackson said access needs to be reduced, prices raised and marketing restricted.
"These are interventions that numerous government-commissioned enquiries have been calling for since 2009," she added.
"The Law Commission's recommendations weren't taken up in 2010, followed by the Mental Health and Addiction Enquiry. If you got to their 40 recommendations around improving mental health and reducing addiction, it's the alcohol recommendations that weren't given priority. They stood out like a sore thumb."
Recently, with the rise of alcohol delivered right to the door and a population that has been living through the mental health strains of an ongoing pandemic, it's an issue that doesn't seem to be going away.
"Here we are in 2022," Jackson said. "Alcohol is more affordable than ever before, it's widely available, whether that's late into the night or due to a large saturation of alcohol outlets in our communities. The marketing is pervasive, whether that's on digital marketing, on billboards or on your TV."
She said alcohol needs an approach similar to that of the Smokefree Aotearoa 2025 campaign, where actions on price, availability and marketing are the focus.
The longitudinal study used was the University of Otago’s Christchurch Health and Development Study (CDHS), which has provided data on Kiwis’ life paths through infancy, adolescence and adulthood.
Professor Joe Boden is a co-author of Crossin’s study and a director of the CDHS. He said while other similar studies overseas have typically recruited adult patients, the CDHS uses data from infancy meaning they could control for key childhood risk factors.
Data from the Ministry of Health shows around four in every five adults drank alcohol in the past year, while one in five New Zealanders reported they had drunk alcohol in a hazardous way over the last year.
Hazardous drinking was defined as an established alcohol drinking pattern that carries a risk of harming the drinker’s physical or mental health or having harmful social effects on the drinker or others.
Where to get help:
Safe to Talk national helpline 0800 044 334 or www.safetotalk.nz
Women's Refuge (For women and children) - 0800 733 843.
Shine (For men and women) - free call 0508-744-633 between 9am and 11pm.
1737, Need to talk? Free call or text 1737 any time for mental health support from a trained counsellor
What's Up – 0800 942 8787 (for 5–18 year olds). Phone counselling is available Monday to Friday, midday–11pm and weekends, 3pm–11pm. Online chat is available 7pm–10pm daily.
Kidsline – 0800 54 37 54 for people up to 18 years old. Open 24/7.
Youthline – 0800 376 633, free text 234, email talk@youthline.co.nz, or find online chat and other support options here.
National Rape Crisis helpline: 0800 88 33 00
If you or someone else is in immediate danger call 111.
