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Co-consumption of alcohol and psychotropic medications in episodes of non-fatal self-poisoning attended by ambulance services in Victoria, Australia: Evidence of potential modification by medical severity

Published online by Cambridge University Press:  02 January 2018

Katrina Witt
Turning Point, Eastern Health Clinical School, Monash University, Australia. Email:
Dan Lubman
Monash University, Australia
Belinda Lloyd
Monash University, Australia
Karen Smith
Monash University, Australia
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Copyright © The Royal College of Psychiatrists 2017 

Chitty and colleagues' recent investigation Reference Chitty, Dobbins, Dawson, Isbister and Buckley1 into the association between psychotropic medication use and alcohol consumption during emergency department presentations for self-poisoning raises an interesting perspective on the putative role of psycho-pharmacology in reducing risky alcohol use among those at risk of self-harm and suicide.

Episodes of attempted suicide resulting in hospital presentation may underestimate the true extent of psychotropic medication and alcohol co-ingestion across the community, given recent findings suggesting that just over half of patients treated by ambulance paramedics following an episode of self-harm and/or attempted suicide are transported to hospital. Reference Matsuyama, Kitamura, Kiyohara, Hayashida, Kawamura and Iwami2

Using data from our ongoing study of psychiatric presentations to ambulance services, Reference Lloyd, Gao, Heilbronn and Lubman3 we extracted information on all episodes of non-fatal self-poisoning in the state of Victoria, Australia, from January 2012 to December 2016 (N = 24 726). In contrast to Chitty and colleagues, we found that, overall, use of psychotropic medications was associated with an increased, not decreased, risk of alcohol co-consumption in the self-poisoning episode (odds ratio (OR) = 1.35, 95% CI 1.28–1.42).

While anticonvulsants (OR = 0.74, 95% CI 0.65–0.84), antipsychotics (OR = 0.81, 95% CI 0.75–0.86) and psychostimulants (OR = 0.52, 95% CI 0.32–0.85) were associated with a decreased risk of alcohol co-consumption, in contrast to Chitty and colleagues, we found that benzodiazepines (OR = 1.60, 95% CI 1.52–1.69) were associated with an increased risk of alcohol co-consumption. Additionally, we found no significant association between antidepressant use and risk of alcohol co-consumption for these presentations (OR = 1.04, 95% CI 0.97–1.11).

Importantly, however, we found that medical severity may modify these associations. Specifically, most associations were reduced to non-significance when considering those not requiring hospital treatment following the self-poisoning episode: all psychotropic medication classes (OR = 1.12, 95% CI 0.76–1.65), anticonvulsants (OR = 0.39, 95% CI 0.09–1.80), antidepressants (OR = 1.05, 95% CI 0.63–1.77), antipsychotics (OR = 0.81, 95% CI 0.48–1.36), benzodiazepines (OR = 1.40, 95% CI 0.94–2.07) and psychostimulants (OR = 0.44, 95% CI 0.02–9.21).

This highlights the importance of considering the breadth of services that people who engage in self-harm come into contact with, so as to provide a fuller picture of the treatment needs of this population and how these may vary as a consequence of medical severity.


1 Chitty, KM, Dobbins, T, Dawson, AH, Isbister, GK, Buckley, A. Relationship between prescribed psychotropic medications and co-ingested alcohol in intentional self-poisonings. Br J Psychiatry 2017; 210: 203–8.CrossRefGoogle ScholarPubMed
2 Matsuyama, T, Kitamura, T, Kiyohara, K, Hayashida, S, Kawamura, T, Iwami, T, et al. Characteristics and outcomes of emergency patients with self-inflicted injuries: a report from ambulance records in Osaka City, Japan. Scand J Trauma Resusc Emerg Med 2016; 24: 68.CrossRefGoogle ScholarPubMed
3 Lloyd, B, Gao, CX, Heilbronn, C, Lubman, DI. Self Harm and Mental Health-Related Ambulance Attendances in Australia: 2013 Data. Turning Point, 2015.Google Scholar
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