Substance Use, Age of Initiation, and Suicidal Behaviors: A Multi-Substance Comparison of Risk

Results from previous analyses have identified significant associations between age of first alcohol use and risk for suicide attempts among both nationally representative and high-risk samples of youth. Existing studies have also identified strong associations between use of illegal drugs and risk for suicidal behaviors among high school students. The objective of the current study was to compare risk for thoughts of death, suicidal ideation, and suicide attempts among youth (less than 19 years of age) who participated in the 2005 National Survey of Drug Use and Health. Risk for suicidal behaviors among youth who reported no drug or alcohol use, early initiation (≤12 years of age), or teen initiation was compared across multiple substances (including inhalants, marijuana, narcotics, and prescription drugs). Results suggest that risk for suicidal behaviors was not equally distributed across substances and was strongest among those reporting a suicide attempt (versus thoughts of death or ideation). Early substance use was also associated with an increased likelihood of a suicide attempt among those who reported use of alcohol (ORadj. 2.17, 95%CI:1.78-2.66) or narcotics (ORadj. 3.06, 95%CI:1.27-7.37) when compared to youth who reported later initiation (≥13 years). Additional comparisons between early alcohol and other non-narcotic substances and fully adjusted models including multiple substances suggest that early use of alcohol may be disproportionately associated with risk for suicidal behaviors. Results from our analyses reinforce findings from previous studies of the importance to prevent and delay substance use among youth and that particular attention to alcohol is warranted.