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., devaluing 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. Other behavior economic decision-making, such as demand for alcohol (i.e., continued purchasing and consumption a commodity as prices increase) has been related to increased discounting. Furthermore, 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 affect suicide risk. Together, excessive discounting and demand with losses of social reinforcers might be markers for suicide risk for those with excessive alcohol use. Behavioral economic decision-making has also been predictive of engagement and success of substance use treatment. The contextualized reinforcer pathology model allows for integration of these different factors to help better understand how alcohol use could influence suicide risk, as well as who might engage in treatment for alcohol use. Therefore, the purpose of this proposed K99/R00 is to determine relationships between alcohol use, behavioral economic decision-making, bereavement, and STBs within a contextualized reinforcer pathology framework. In Study 1 (K99) this will first be assessed within a group of adults with risky alcohol use (n = 100) to determine cross-sectional associations, prevalence of STBs in this sample, and determine factors that predict engagement with a remote intervention for alcohol and its effects on alcohol use. Participants will complete a baseline assessment and be given access for remote, self-guided CBT4CBT modules for alcohol use. Participants will also complete three follow- up assessments over three months to determine engagement with CBT4CBT and changes in alcohol use. In Study 2 (R00), adults with risky alcohol use without current STBs (n = 100) and with current STBs (n = 100) will be compared using a 2x2 design to further determine relationships between alcohol use and STBs (Study 2/R00). Half will be randomized to immediate access to CBT4CBT, while the other will be waitlist controls and receive access 28 days later, with remaining procedures being similar to Study 1. This allows for determination of predictors of engagement and efficacy of a remote intervention for alcohol use as a function of STBs. This will allow the candidate to develop skills in alcohol use and STB research and initiate an independent career path uncovering factors that underly the relationship between alcohol use and suicide risk.