As presenters noted at the conference "Who's killing our kids?" (see main article), youth problem behaviors often overlap: Bullies are likely to smoke and drink, for example, while teen drug users often have diagnosable mental health problems.

Now it appears some of the most worrisome teen behaviors--suicidal thoughts and attempts--are strongly related to alcohol use.

Young people who meet the criteria for alcohol use disorder (AUD) in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders are nearly three times more likely to have had suicidal thoughts and five times more likely to have made suicide attempts than those who don't have the disorder, finds psychologist Eric Goplerud, PhD, of George Washington University, whose research was cited at the conference. Put another way, 43 percent of all teens who attempt suicide have AUD, according to Goplerud, who gleaned the data from two large-scale public health databases, the National Survey on Drug Abuse and the National Comorbidity Survey.

Psychologist and conference presenter David Goldston, PhD, of Duke University, summarized more qualitative research on teen suicide and substance abuse, including AUD. He noted that:

* Substance abuse disorders, or SUDs, may be a suicide risk factor in their own right.

* Substance use can spark suicidal behavior by increasing impulsivity and decreasing inhibition.

* Substance use may provide a method--overdose--for attempting or completing suicide.

* SUDs can increase the likelihood of other suicide risk factors such as depression.

* People may engage in suicidal behavior and substance use for similar reasons--to escape or dampen experiences of distress.

"By considering factors that affect both substance use and suicidal behavior, we will be in a better position to develop interventions for young people with both sets of problems," he said.

Researchers may wish to look at a few key questions when conducting further research in the area, Goldston added. These include determining whether common factors affect both suicidal behavior and substance use trajectories over time; whether specific groups of substance-using or suicidal youth are at risk for both outcomes; and whether suicidality increases the risk of substance abuse, just as substance abuse increases the likelihood of suicidal behavior, he said.