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Alcohol use disorder (AUD) is the most common substance use disorder (SUD) in the U.S., and rates of suicide are increasing in the U.S., especially among adolescent females, which raises the question: does this gender difference exist among adults with alcohol use disorder?

A study published in March 2024 called “Sex-Specific Association of Alcohol Use Disorder With Suicide Mortality: A Systematic Review and Meta-Analysis” contains answers. Here’s how they phrase the question:

Does alcohol use disorder (AUD) have a sex-specific association with suicide mortality?

The research team initiated the study because in recent years, various papers have reported gender differences in suicide risk among people with AUD, with some studies showing far greater risk for females than males. However, due to disparities in study design and quality, the research team sought to verify and clarify the available data on this topic.

In other words, they doubted the practical utility in the differences in risk claimed by some researchers, because those studies used methods that couldn’t determine causality, which can result in misunderstanding and misinterpretation.

Before we discuss how they clarified the data on this important question, let’s look at the prevalence of the disorders and behaviors related to this study: alcohol use disorder, suicidality, and fatal suicides.

Alcohol Use Disorder (AUD) and Suicide in the U.S.: Facts and Figures

First, let’s discuss the data that sparks – or rather increases – our general concern about suicide and gender. According to the CDC, suicide is now one of the leading causes of death among people 10-24 in the U.S.

Here’s the CDC data:

Suicide Fatalities, 2022

  • Total: 49,449
    • Male: 39,255
    • Female: 10,194
  • By age group:
    • 10-24: 6,529
    • 25-44: 16,843
    • 45-64: 15,632
    • 65+: 10,433

When we read this, we see that males die by suicide at far greater rates than females. Why are we more concerned about suicide rates among females, then? Because the 2023 Youth Risk Behavior Survey (YRBS) shows the following.

Suicidality Among High School Students: 2022

Seriously considered suicide in the last year:

  • Male: 14%
  • Female: 30%

Made a suicide plan in the past year:

  • Male: 12%
  • Female: 24%

Attempted suicide in the past year:

  • Male: 7%
  • Female: 13%

That data is virtually impossible to misinterpret. Female high school students are, on average, at twice the risk of attempting suicide, compared to their male peers. This explains the interest in potential differential rates in suicidality, by gender, among people with alcohol use disorder (AUD).

Now, let’s look at the most recent data on alcohol use disorder (AUD) in the U.S., as published in the 2022 National Survey on Drug Use and Health (2022 NSDUH).

Alcohol Use Disorder Prevalence 2022

  • Total 12+: 10.5% (29.5 million)
    • Male: 12.6% (17.3 million)
    • Female: 8.5% (12.2 million)
  • Total 12-17: 2.9% (753,000)
    • Male: 2.1% (281,000)
    • Female: 3.8% (472,000)
  • Total 18+: 11.2% (28.7 million)
    • Male: 13.6% (17.1 million)
    • Female: 8.9% (11.6 million)

We have one more set of data to share before we get into the details of the study we mention in the introduction: the latest data on AUD and suicidality, with data also published in the 2022 NSDUH, but with no information on gender or gender differences.

AUD and Suicidality: 2022

  • Serious thoughts of suicide, total population: 5.2% (13.2 million)
  • Serious thoughts of suicide, people with AUD: 11.8% (3.4 million)
  • Made a suicide plan, total population: 1.5% (3.7 million)
  • Made a suicide plan, people with AUD: 4.1% (1.1 million)
  • Attempted suicide, total population: 0.6% (1.6 million)
  • Attempted suicide, people with AUD: 1.8% (518,000)

We’d be remiss if we didn’t comment on one glaring takeaway from this data, although it’s unrelated to the topic of alcohol use disorder, suicide risk and gender: the difference between suicidality among people with and without AUD. As we can see, people with AUD had serious thoughts of suicide twice the percentage of those without AUD, people with AUD made a suicide plan at a percentage almost four times greater than those without AUD, and people with AUD attempted suicide at a percentage three times greater than those without AUD. In addition, a meta-analysis published showed that people with AUD across all demographics showed a risk of fatal suicide 2.6 times higher than people without AUD.

With those facts and figures in mind, let’s take a look at the new research on alcohol use disorder, suicide risk, and gender.

Alcohol Use Disorder, Suicide Risk, and Gender: The Study

To determine the association between AUD and suicide mortality by gender, researchers collected data from 24 studies with information on 37,870,699 participants ages 15-65. This enormous sample size – data from over 37 million participants – allows researchers to make population-level generalizations. That’s one reason why this study is important: we need to understand the data on suicide and gender in light of the dramatic increases in suicidality among adolescent girls, in order to assess suicide risk among adults in years to come.

As a reminder, the factors researchers examined were presence/absence of alcohol use disorder (AUD) and gender, and the outcome researchers determined through statistical analysis was risk of suicide attempt, expressed in terms of an odds ratio (OR).

Quick refresher: an odds ratio of 1.5, for instance, means a person has a 50 percent increased risk of the outcome in question, while an odds ratio of 2.5 would mean a 150 percent increased risk of the outcome in question.

Here’s what the research team found. First, the data from the long-term, longitudinal studies:

AUD, Suicide Risk, and Gender: By Study Design

  • Long-Term Studies:
    • Male: 2.68 OR
    • Female: 2.39 OR
Difference: 0.29 Not Statistically Significant
  • Cross-Sectional Studies
    • Male: 3.67 OR
    • Female: 6.88 OR
Difference: 3.21 Statistically Significant

While researchers identified statistically significant differences between males and females in cross-sectional analyses, these studies cannot determine causality, as they have no information on the sequence of events. They can say x person attempted suicide and had AUD in 2022, for instance, but the design doesn’t ask when they developed AUD in relation to when they attempted suicide. The cross-sectional studies explain why various research teams hypothesized a greater suicide risk for females with AUD compared to males with AUD.

However, the long-range studies disprove their hypotheses, since their study designs – which included control groups and information on sequence of events – allowed them to estimate causal relationships. With regards to gender and AUD, the research team determined that although AUD is significantly associated with increased suicide risk, there is no statistically significant risk in suicide for people with AUD based on gender.

Alcohol Use Disorder, Suicide, and Gender: Looking Forward

When we look at the suicide data we include in this article, one important question comes to mind:

Will the alarming differences in suicidality between male and female adolescents persist when these same adolescents become adults?

It’s relevant to our work in mental health and our work in AUD/SUD treatment. Suicide rates for adult males are far higher than for adult females, but risk of suicide among males and females with AUD is almost the same. That begs another question:

Will the suicide rate for females with AUD increase as this current group of female adolescents become adults?

In addition, we ask this question:

How can we use this data to support our current patients, some of whom have AUD, and some of whom report suicidality?

Here’s how the research team addresses this question:

  1. The relationship between AUD and suicide risk identified in the longitudinal studies foregrounds the necessity of implementing an approach to AUD treatment that prioritizes Suicide risk management.
  2. Managing the 2.6-fold increase suicide risk among people with AUD is only possible if mental health professionals identify the presence of AUD.
  3. Therefore, screening for AUD among people with mental health disorders with increased suicide risk – such as depression and others – is essential.
  4. This means that it’s also essential to screen for mental health disorders associated with suicidality – such as depression and others – among people diagnosed with AUD.

Implementing screens for suicidality among people with AUD and implementing screens for AUD among people with mental health disorders associated with suicidality is a relatively simple, straightforward step we can take to mitigate overall suicide risk. Therefore, what we can take away from this research is specific new information that may, ultimately, help us save lives.

Finding Support for AUD and Suicidality

To find help for AUD treatment, please consult the following online resources, or contact us here at Crownview Co-Occurring Institute:

Please remember: the best way to learn whether you need help for a mental health disorder or an alcohol use disorder is to get a professional assessment. If the assessment indicates the presence of a mental heath disorder or AUD, the next best step is to get professional support. Also remember this: evidence shows that the earlier a person who needs treatment for a mental health disorder or an alcohol or substance use disorder, the better the outcome.