Examining the Relationship Between Ongoing Alcohol Use, Suicidal Thoughts and Behaviors and Related Constructs, and Behavioral Economic Decision-Making

PROJECT SUMMARY Factors that lead to suicidal thoughts and behaviors (STBs; i.e., passive or active suicidal ideation, behaviors, plans, gestures, or attempts) are complex. An important factor in suicide deaths and attempts is alcohol use; up to 36% of completed suicides involve acute alcohol use, while those with AUD may account for up to 20-40% of suicides. Despite this relationship, processes that may underlie the two are unclear. A common variable between alcohol use and STBs appears to be behavioral economic decision-making such as delay discounting (i.e., the devaluing of a commodity as a function of time). However, other forms of discounting (i.e., probability; devaluing an outcome based on its likelihood, social; devaluing an outcome based on the closeness of another) have not been explored in their relation to alcohol use and STBs despite their potential relevance to alcohol use and STBs. Probability discounting, considered a proxy of risky choice, should be related to increased alcohol use and more severe STBs due to the inherent risk involved in a suicide attempt. Social discounting, a proxy of altruistic choice, should have relations to broader theories of addiction such as the contextual reinforcer pathology model. Losses of close social supports, through suicide or overdose death, could result in allocation towards further alcohol use, which could affect decision-making and therefore increase suicide risk. Behavioral economic demand (i.e., higher willingness to continue to purchase and consume a commodity at increasing prices) for alcohol may also be an indicator of STBs and suicide risk. Furthermore, behavioral economic decision-making has been predictive of engagement with and success of substance use treatment. Therefore, the purpose of this proposed K99/R00 is to (Aim 1/K99) determine relationships between alcohol use, behavioral economic decision-making, bereavement, and prevalence of STBs in a community sample (N = 100) of adults with heavy alcohol use, (Aim 2/K99) determine factors that predict engagement with a remote intervention for alcohol and its effects on alcohol use, decision-making with those same adults, and (Aim 3/R00) will compare groups of adults with heavy alcohol use (n = 100) to adults with heavy alcohol use and passive/active suicidal ideation (n = 100) on behavioral economic decision-making, bereavement, treatment adherence, and changes in alcohol use based on treatment adherence. Participants will complete a baseline assessment and be given access for remote, self-guided CBT4CBT modules for alcohol use. Following this, participants will remotely complete three follow-up assessments over three months. This will allow for determination of incidence in heavy alcohol users and predictors of alcohol use and STBs and determination of predictors of engagement and efficacy of a remote intervention for alcohol use those with and without passive/active ideation. This sequence of studies will allow the candidate to develop skills in alcohol use and STB research and initiate an independent career path uncovering mechanisms and contextual factors that underly the relationship between alcohol use and suicide risk.