High Prevalence of Suicidal Behavior in Severe Alcohol Use Disorder Linked to Specific Neurocognitive Deficits: The Cognition, Alcohol, Genes, and Environment Study

OBJECTIVE: Alcohol Use Disorder (AUD) and Suicidal Thoughts and Behaviors (STB) frequently co-occur. Their association could be explained by a causal pathway and/or a shared liability related to mechanisms involved in aberrant decision-making. These pathways of risk remain to be tested and characterized. METHODS: We introduce here the Cognition, Alcohol, Genes, and Environment (CAGE) study, a data collection project aiming to combine neurocognitive (cognitive and affective processes related to decision-making) and genetic data to study mechanisms contributing to the comorbidity of AUD and STB in persons recruited for a lifetime history of severe AUD. In this report, we conducted an interim analysis with the first 1,267 participants (68% females) to explore their alcohol use and the associations among AUD, STB, and neurocognitive mechanisms using correlation and regression analyses. RESULTS: The average alcohol consumption in the sample was high (Alcohol Use Disorder Identification Test [AUDIT] total score = 9.55 [SD = 8.16]), though some participants reported alcohol abstinence (N = 230). The prevalence of STB-related items was elevated relative to previously published population-based estimates, from ~65% reporting thoughts of death to ~24% reporting a prior suicide attempt. We investigated the roles of neurocognitive variables and found that alcohol problems (AUDIT-P) were associated with inhibition and delay discounting, while the co-occurrence of AUD and suicide attempt was related to inhibition and shifting abilities. CONCLUSIONS: These preliminary findings open research avenues to study the mechanisms related to the co-occurrence of AUD and STB, with the hope of reducing STB risk in this population.