Associations between suicide ideation, craving, and alcohol use across 12 weeks of outpatient treatment for alcohol use disorder.

Abstract

Objective: Suicide and alcohol use disorder (AUD) are entwined public health crises; yet, no research on associations between suicide ideation and AUD treatment outcomes exists within dual-diagnosis AUD and posttraumatic stress disorder samples, a group with elevated rates of suicidal thoughts and behaviors compared to either diagnosis alone. This study examined associations between suicide ideation and alcohol-related outcomes during receipt of cognitive behavioral therapy for AUD.

Method: Data were drawn from a 12-week randomized controlled trial examining the efficacy of cognitive behavioral therapy for AUD combined with N-acetylcysteine or placebo among 182 adults with AUD and posttraumatic stress disorder. Multivariable mixed logistic regression models were used to identify associations between suicide ideation and AUD-related variables (i.e., craving severity, total standard drinks, average drinks on drinking days, percent of total days drinking, percent of heavy drinking days) assessed weekly during treatment.

Results: During treatment, the odds of suicide ideation increased 1.16 times for each one-unit increase in craving severity, 3.13 times for each one-unit increase in percent of heavy drinking days, and 5.04 times for each one-unit increase in percent of total days drinking. No significant associations were observed between the odds of suicidal ideation and the number of total standard drinks or average drinks on days drinking.

Conclusions: Suicide ideation is more likely to occur during weeks of heightened craving and during weeks of a greater percentage of time spent drinking alcohol, suggesting a need for continued suicide assessment throughout the course of outpatient AUD treatment, particularly for individuals with AUD and posttraumatic stress disorder. (PsycInfo Database Record (c) 2026 APA, all rights reserved).