Alcohol and Suicide - Durkheim

Revisited
Ole-Jørgen Skog
National Institute for Alcohol and Drug Research, Oslo

The paper reviews Durkheim’s theory of suicide, with particular reference to his treat-
ment of alcohol as a causal factor. It is argued that Durkheim views alcohol as an
individual-levelfactor, rather than as a socio-cultural factor on a par with other social
facts This conception is criticized, as is Durkheim’s analysis of his data It is argued that
the rate of alcohol abuse in society is a social fact that has an explanatory power beyond
the level of individual suicides. Some possible causal links between the social suicide
rate and rates of alcohol abuse are discussed.

Ole-Jørgen Skog, Institutt for samfunnsforskning Munthesgt 31 0260 Oslo 2, Norway.

1. Introduction be due to Durkheim’s insistence that alco-

Seen in the light of the rapid expansion
m social research on alcohol and alcohol-
related problems during the last two or
three decades, it is surprising how little has
been published about alcohol and suicide
in ’alcohol literature’. Moreover, m the
general sociological literature on suicide,
alcohol is hardly ever mentioned as a pos-
sible explanatory variable.’ In psychiatric
and epidemiological literature, on the other
hand, reference to alcohol is frequently
found. It has been demonstrated over and
over again that alcoholics have an elevated
risk of suicide.
Part of the explanation for this difference
may be that sociological and medico-epi-
demiological studies often address ques-
tions at different levels. While sociologists
mainly try to explain variations m the popu-
lation rate of suicide, medical epidemi-
ologists often focus on individual cases and
try to explain why some individuals commit
suicide while others do not. However, even
medical epidemiologists sometimes try to
explain variations in suicide rates, so this
is probably not the whole explanation.
As Norstrom (1990) has pointed out,
sociologists’ lack of interest in alcohol as an
explanatory variable may to a large extent
@Scandlnavwn Sociological Association,
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hol was of no, or very limited, importance
in relation to the social suicide rate. In this
article I will therefore review Durkheim’s
discussion of alcohol, and I shall try to show
that neither his data nor his theoretical
arguments are very convincing. In effect, I
shall argue that sociology needs to recon-
sider the role of alcohol in relation to the
social suicide rate, and I shall bnefly outline
some mechamsms linking the two.
2. Durkheim’s views on alcohol
Being one of the founding fathers of soci-
ology, Durkheim aimed at showing that so-
ciology was a subject on its own, and that
it could not be reduced to psychology.
Durkheim tned to demon-
Accordingly.
strate that individual level factors could not
explain variations in suicide rates.
For Durkheim, alcoholism was appar-
ently a psychiatric category, and hence an
individual level variable. In Book One,
entitled ’Extra-social Factors’, he discusses
alcohol as an explanatory factor, in the
chapter on ’Suicide and Psychopathic
States’, along with insanity and neuraes-
thenia.
According to Durkheim, most ills of civil-
ization, including insanity, pauperism and
crime, have been attnbuted to the psycho-
1991 pathic state called alcoholism.’Can it have
193
any influence on the increase of suicide? A
priori, the hypothesis seems unlikely, for
suicide has most victims among the most
cultivated and wealthy classes and alcohol-
ism does not have its most numerous fol-
lowers among them’ ( p. 77).
Durkheim does not give an extensive
theoretical analysis of the issue. Instead he
chooses an empirical approach, and starts
his analysis by presenting four maps show-
ing the geographical distribution of suicide,
prosecutions for drunkenness (delits
d’ivresse), alcoholic insanity (folies
alcooliques) and the per capita consump-
tion level (consommation de I’alcool) across
the French Departments.
He finds almost no connection between
suicide and prosecutions for drunkenness,
and states (pp. 77-78):
If the French map of suicides is compared with
that of prosecutions for alcoholism, almost no
connection is seen between them Charac-
teristic of the former is the existence of two
great centres of contamination, one of which
is the Ile-de-France, extending from there east-
ward, while the other lies on the Mediter-
ranean, stretching from Marseilles to Nice
The light and dark areas on the maps of
alcoholism have quite a different distribution.
Here three chief centers appear, one in Nor-
mandy, especially m Seme-Inferieure, another
m Fmsterre and the Breton departments in
general, and the third m the Rhone and the
neighbouring region. From the pomt of view
of suicide, on the other hand, the Rhone is
not above the average, most of the Norman
departments are below it and Brittany is almost
immune So the geography of the two pheno-
mena is too different for us to attnbute to one
an important share m the production of the
other.
I have reconstructed Durkheim’s data from
his maps and calculated the coefficient
of correlation between suicide and pros-
ecution rates. It is 0.40, which is not very
large, but still not to be ignored entirely. If
one uses the conventional statistical test
(N = 87), the correlation ishighly signifi-
cant (t 4.0), but such a
=
testignores the
spatial autocorrelations that are clearly
present in the data, so it is not entirely
adequate.
In the case of alcoholic insanity, Durk-
heim groups the departments according to
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their suicide rates and calculates the aver-
age number of ’insanity due to alcoholism’
in each class. The result is reproduced here
in Table 1, and on the basis of this table he
concludes (p. 78):
The two columns do not correspond. Whereas
suicides mcrease sixfold and over, the pro-
portion of alcoholic insane barely increases by
a few units and the growth is not regular; the
second class surpasses the third, the fifth, the
sixth, the seventh, the eighth. Yet if alcoholism
affects suicide as a psychopathic condition it
can do so only by the mental disturbance it
causes. The comparison of the two maps con-
firms that of the averages.
The correlation is in this case only 0.21,
which is a borderline case by the con-
ventional test (t = 1.98), and clearly insig-
nificant when the autocorrelation structure
is taken into consideration. Hence, it is
difficult to disagree with Durkheim’s con-
clusion in this particular case.
Concerning the alcohol consumption
level, Durkheim notes that at first sight
there seems to be a closer relation ( pp. 78-
79).
Indeed most alcohol is drunk m the northern
departments and it is also m this same region
that suicide shows its greatest ravages But,
first, the two areas have nothing like the same
outline on the two maps The maximum of
one appears m Normandy and the North and
dimmshes as it descends towards Paris, that
of alcoholic consumption. The other is most
intense m the Seine and neighbouring depart-
ments ; it is already lighter m Normandy and
does not reach the North. The former tends
westward, and reaches the Atlannc coast, the
other has an opposite direction It ends
abruptly m the West, at Eure and Eure-et-
Loire, but has a strong easterly tendency.
Moreover. the dark area on the map of suicides
formed m the Midi by Var and Bouches-du-
Rhone does not appear at all on the map of
alcoholism ’1
Although the correlation is far from
perfect, itis still quite respectable, being
0.55. Hence, 30 per cent of the regional
variations in suicide rates are statistically
’explained’ by alcohol consumption. Still,
Durkheim concludes that ’In short, even to
the extent that there is some coincidence it
proves nothing, being random.’ However,
the likelihood of observing a correlation of
0.55 by chance is fairly small, in spite of the
Table I Rates of alcoholic insanity If1 French
autocorrelation structure, and Durkheim
may be accused of doing away with alcohol
a little too easily.
Durkheim then turns to international
data, which he claims support his con-
clusion (p. 79):
Leaving France and proceeding farther North,
for example, the consumption of alcohol
increases almost regularly without the appear-
ance of suicide Whereas only 2.84 litres
of alcohol per inhabitant were consumed on
the average m France m 1873, the figure nses
in Belgium to 8.56 for 1870, m England to 9.117
(1870-7)). m Holland to 4 ( 1R7U), m Sweden
to 10.34 ( 187<», m Russia to 1t1.6y (IXó6) and
even, at Saint Petersburg, to 2U (1855). And
yet whereas, m the currespondmg periods, 15U
suicide> per million inhabitants occurred m
France, Belgium had only 68, Great Britain
711, Sweden 85, Russia very few Even at Saint
Petersburg from 1864 to 1868 the average
annual rate was only 6tri 8 Denmark is the only
northern country where there are both many
suicides and a large consumption of alcohol
(16 51 liters In IX4S) If then our northern
departmcnts are distinguished both by their
tendency to suicide and their addiction to alco-
hol, it is not because the former anses trom the
latter and is explained by it The conjunction i,
accidental In general, much alcohol is drunk
in the North because of the local ranty of wine
and its cost, and perhaps because a special
nuunshment calculated to maintain the organ-
ism’s temperature is more necessary there than
elsewhere; and on the other hand the ong-
inating causes of suicide are especially con-
centrated in the same region of our country.
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Departments grouped according to suicide rate (p. 78).
Here, Durkheim commits the error of
comparing consumption figures that are not
compatible. The French figure is con-
sumption of distilled beverages only, while
the remaining figures seem to include all
alcoholic beverages. Thus, according to
Ledermann (1956), distilled beverages
comprised only 15.6 per cent of the total
alcohol consumption in France m 1873. Per
adult (20 years and older), Ledermann’s
consumption estimate is 27.3 litres per year
for the period 1873-75, corresponding to
about 18 litres per capita. Hence, France
had one of the highest consumption levels
m Europe in the late 19th century, as is
still the case, and consumption therefore
decreases, rather than increases, as one
moves north. There are also reasons to
doubt the reliability of the remaining
figures. For instance, according to modern
statistical sources the consumption level in
Sweden in 1870 was 9.1 litres per adult (15
years and older), or 5.9 litres per capita
(Lenke 1989) - not 10.34 litres as Durkheim
claims.
Durkheim’> explanation of the high con-
sumption level m the North m terms of
’nourishment calculated to maintain the
organism’s temperature’ is quite bizarre by
modern standards. It is also surprising that
a man who su strongly stressed the need
for social explanations so easily lapses into
meteorological factors (or cosmic factors as
he called them, when they were discussed
in relation to suicide). This is obviously yet
195
another indication that he did not perceive
alcohol - in casu, the level of alcohol con-
sumption - as a social fact, as opposed to
most social scientists of our time.
Durkheim completes his statistical analy-
sis of alcohol by comparing the different
states of Germany, and concludes that the
results confirm his conclusion (p. 80). It is
difficult to disagree at this point, provided
that the data are good.
To sum up, the evidence presented by
Durkheim clearly shows no coherent
pattern. Some of his data suggest a decent
correlation, while the correlation is very
low in the rest of the data. However, the
quality of these data is questionable. It
therefore seems a little premature to con-
clude, as Durkheim does, that ’A society
does not depend for its number of suicides
on having more or fewer neuropaths or
alcoholics’ ( p. 81).
It appears likely that Durkheim’s rejec-
tion of alcoholism as an explanatory factor
in relation to the social suicide rate is due
to a common, but erroneous belief that
alcoholism rates do not vary to any signifi-
cant extent in response to socio-cultural
factors. This presumption would be intel-
ligible if alcoholism is conceived as an indi-
vidual defect, rather than itself being a
social fact. Durkheim does not explicitly
state this view, but the presumption can be
inferred from the fact that he admits that
alcoholism is quite important at the indi-
vidual level, but not at the aggregate level
(cf. pp. 147-148). Today, it is widely recog
nized that alcoholism rates vary strongly
across cultures and within cultures over
time (Popham 1970), and that these vari-
ations are social facts in Durkheim’s sense
(Bruun et al. 1975).
However, Durkheim also dismisses alco-
holism on purely quantitative grounds.
Arguing that even if it should be causally
relevant after all, its impact must be very
small. For instance, in the section on altru-
istic suicide, he claims that ( p. 231):
even according to those observers who attri-
bute most influence to alcoholism, only a tenth
of the cases can be ascribed to it. Thus, even
though alcoholic suicides were two or three
times as numerous among soldiers as among
civilians of like age, which is not proven, a
considerable excess of military suicides would
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still remain for which another cause would
have to be sought.
Since most modern studies seem to imply
that even classical Durkheimian variables
explain only a fairly modest fraction of the
variance in suicide rates (Stack 1982), this
is not a very good argument.
It is also worth noting that Durkheim
thinks of alcohol mainly in terms of alcohol-
ism when he discusses its (lack of) impact
on the suicide rate. Having analysed the
high excess mortality in the army (Book
two, chapter four on ’Altruistic Suicide’),
he wntes (p. 231):
Alcoholism has been suggested, which is said
to afflict the army more than the civilian popu-
lation But if, m the first place, as has been
shown, alcoholism has no definite influence on
the suicide-rate in general, it is unlikely to have
more on that of military suicides in particular.
Then, the few years of service, three m France
and two and a half m Prussia, could not create
a large enough number of mveterate alcoholics
for the enormous contingent contributed to
suicide by the army to be thus explained.
However, it appears possible that suicidal
impulses may occur during intoxication in
subjects who are not alcoholics. It can also
be imagined that suicidal impulses released
by other factors may have a higher like-
lihood of resulting in suicide if a person is
intoxicated than when he is sober. Hence,
intoxication could very well be an important
factor, in combination with other factors.
Apparently, the frequency of intoxication
varies tremendously from one culture to the
next, and these aggregate level variations
could potentially produce parallel vari-
ations in suicide rates - for instance in the
army. The shortness of the service is not
very relevant in relation to this mechanism.
3. The socio-cultural
foundation of alcoholism
As we have already noted, the conception
of alcoholism as an individual level entity
is Implicit in Durkheim’s discussion. In this
sectionI shall criticize this view in light of
modern theories. I shall argue that alcohol-
ism is a social fact, and that the alcoholism
rate vanes strongly in space and time.
As with most behaviour, drinking is
influenced both by nature and by nurture.
In particular, it is documented that gen-
etical factors to some extent increase the
risk that some individuals will become alco-
hol abusers (Partanen et al. 1966; Goodwin
1976; Cloninger et al. 1981). Here we shall
simply take for granted the fact that the
biological constitution plays a certain role,
but we will restrict ourselves to discussing
environmental factors, which undoubtedly
play the major role m relation to aggregate
level variations. We also note, without
further discussion, that it is widely recog-
nized today that there is no clear distinction
between alcoholism and normal dnnking.
Use and abuse vary continuously, and there
is no well-defined threshold separating nor-
mal and abnormal drinking (Bruun et al.
1975; Edwards et al. 1977).
Social and cultural change is clearly the
outcome of a highly complex process
involving different levels of social organ-
ization and different sectors of social and
economic life. One can describe and ana-
lyse these changes from many different per-
spectives. The approach chosen below
represents a kind of methodological indi-
vidualism. It is based on the regulative idea
that it should be possible to describe and
understand wholes in terms of dynamic
interactions between the elements of a
social structure. This idea does not imply
psychological reductiomsm in the sense that
these elements are presumed independent
of, and prior to, the whole. On the contrary,
the elements (i.e. individuals) are shaped
and reshaped in the process of interaction,
and they are therefore products of social
life as well as building blocks of social life.
However, individuals are observationally
distinct ’objects’, and from a method-
ological point of view they may serve as
units of observation in the study of social
and cultural phenomena. Social and cul-
tural change may therefore be described in
terms of interaction between these building
blocks, without presuming that they are
’atoms’ with fixed properties. Hence I shall
try to substantiate the claim that alcoholism
rates are social facts by starting at the indi-
vidual level and proceeding towards the
aggregate level.
I take as a point of departure the fact that
drinking behaviour is a social behaviour - it
is something we learn from and practise
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together with other people. It certainly
makes a difference to one’s drinking behav-
iour whether one was born in France, North
Carolina, Japan or Iran. And it makes a
difference if one’s family and friends are
teetotallers, moderate drinkers, or heavy
drinkers.
A corollary of these facts is that indi-
vidual drinkers tend to model and modify
each other’s drinking and hence that there
is a strong interdependence between the
drinking habits of individuals who interact.
This suggests a social network perspective
on drinking. Moreover, it suggests that an
individual’s behaviour can only be fully
understood as a part of a larger entity.
Firstly, his dnnking habits must be under-
stood in relation to his personal social net-
work - that is, the people with whom he
interacts. Secondly, since the individuals in
his network are influenced by still other
individuals, these indirect secondary con-
tacts may also have an impact on ego. And
so it continues. Potentially, each individual
is linked - directly or indirectly - to all
members of his culture, and perhaps even
beyond that. Since the same argument
works for every member of a culture, we
must conceive a population as an integrated
structure of individual drinkers.
It is possible to construct formal models
in order to investigate the implications of
such interdependencies of drinking behav-
iour more closely (Skog 1979). Such models
are technically complex, however, and only
selected results will be exemplified here.
The basic presumption of the model is
that an individual’s drinking habits are the
product of an interplay between three types
of factors: (1) individual characteristics,
including biological constitution, psycho-
logical factors, etc.; (2) his/her social net-
work, i.e. the persons he/she has ties to, in
one way or another; (3) general and specific
material (including availability) and socio-
cultural (including differential norms) con-
ditions in his environment.
Assume that we have a micro society
consisting of, say, 81 individuals, and that
these individuals form a social network that
has the form of a 9 x 9 square lattice.
Neighbours in the lattice influence each
other directly, so that individuals in the
intenor part of the lattice have four
’friends’, while those along the edges have
three and those in the corners only two.
If the mutual influence is very weak, the
pattern of consumption levels may appear
as in the top diagram in Figure 1, where
each column represents the consumption
level of an individual. As one can see, there
is no tendency for clustering of individuals
with similar drinking habits in this case.
High (dark columns) and low (light
columns) consumption levels are randomly
distributed in the network. In the bottom
diagram, however, there is a significant
interaction between neighbours’ consump-
tion levels. (The model on which these cal-
culations have been made is bnefly
described m Appendix 1.) This produces a
pattern where high and low consumption
levels tend to form clusters. Under these
circumstances potential heavy drinkers may
in some cases be effectively controlled by
their network. In other cases, potential
heavy drinkers may increase the dnnking
in their network, thus producing a sub-
culture of higher-than-average drinking
habits, as exemplified in the back corner of
the network. In still other cases, neither of
these modifications needs to occur, and we
may find a single heavy drinker in the
middle of a group of very light drinkers, as
exemplified by the ’monolith’ to the right
in the bottom diagram in Figure 1.
In the weakly integrated network, indi-
vidual changes in drinking behaviour would
remain local phenomena. However, in the
strongly integrated structure, changes in
some individuals’ drinking would have sev-
eral effects. Firstly, their increase would
be partly restrained by the informal social
control exerted by their friends. Secondly,
the changes that do occur will induce some
degree of change m the drinking of their
friends, and their inhibitory effect may thus
be slightly reduced. Further changes may
thus take place. Thirdly, the changes that
are induced among the ’friends’ of those
who initiated the process will typically
spread to friends of friends, and so on.
Therefore, a rather complex process is to
be expected.
The outcome of such a process is illus-
trated in Figure 2. This diagram has been
generated by letting eight randomly chosen
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individuals in the strongly interactive struc-
ture in Figure 2 increase their consumption
level, and then calculating the direct and
indirect effects of these changes on other
individuals in the network according to the
model. One observes from Figure 2 that
practically all members of the micro society
have increased their consumption level. By
and large, a displacement of the whole
population along the consumption scale has
taken place. Hence it appears that inter-
action, provided that it is not too weak,
may strongly regulate how the distribution
changes when the general consumption
level of the population changes. This con-
clusion is also valid for larger social struc-
tures (Skog 1985a, 1986), provided that
certain minimum requirements are
obtained.
Available evidence does in fact suggest
quite a strong interdependence of indi-
vidual drinking habits (cf. Skog 1980 for a
review). Hence, the social network per-
spective leads one to expect that changes
in population drinking typically may be a
collective phenomenon, and one would
expect that the individual drinker will
adjust his drinking according to the changes
in the overall level of consumption in his
culture. A similar argument should apply
for cross-cultural comparisons. These pre-
dictions are borne out in cross-cultural
studies, and studies of cultural change
(Skog 1985a). Differences between cultures
in terms of drinking are typically collective
differences, and changes are typically col-
lective as well. The whole population tends
to move up and down the consumption
scale more or less in concert when per capita
consumption changes. As a corollary of this
fact, and the fact that there is no qualitative
difference between normal and abnormal
dnnking, it follows that the prevalence of
very heavy drinking co-vanes quite closely
with the consumption level of ’normal
drinkers’. This is confirmed by survey data
(Skog 1985a) as well as by studies of co-
variation between the per capita con-
sumption of alcoholic beverages and liver
cirrhosis mortality rates (Popham 1970;
Skog 1985b).
Hence, heavy drinking and alcoholism is
closely related to drinking in general, and
it varies strongly across cultures and within
Figure1 Results from simulation experiment of indwldual drinking in a social network, with very
weak (top) and strong (bottom) interaction between ’neighbours’. Each bar represents an
Ùzdwldual. and its height measures his consumptIOn level.

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Figure 2. Correlation diagram showing direct and indirect changes in drinking in a simulation experiment
with the strongly interacting network. The consumption level was allowed to increase among
eight subjects (marked as stars), selected at random. The new equilibrium state for the whole
network was then calculated.

each culture over time. The collective nothing to prevent it. Here, isolation and
movements of the whole population up and inferior regulation is a cause, and drinking
down the consumption scale therefore an effect. This argument is in effect a vari-

imply that normal drinking represents the
cultural foundation of heavy drinking, and
that the consumption level - and hence the
nsk of drinking problems - for a drinker
with a given constitutional disposition, is
directly related to the amount of alcohol he
is exposed to in his cultural environment.
Therefore, the prevalence of persons with
such problems must be seen as a social fact.
4. Social types of alcoholism
It is a well-documented fact that alcoholics
and excessive users of alcohol tend to be
more socially isolated than others (Bacon
1945; Mowrer and Mowrer 1945; Singer et
al. 1964). This may be explained by two
distinct mechanisms, which may very well
be operating simultaneously.
First, people who are poorly socially inte-
grated are also weakly controlled by their
environment. They may therefore run the
risk of developing a drinking problem, par-
ticularly if a strong psycho-social dis-
position is present, simply because there is
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ant of Durkheim’s concept of anomy
Second, isolation may also be a conse-
quence of alcoholics’ deviant drinking.
However, this does not rule out the possi-
bility that isolation also existed prior to the
drinking problem, at least in some cases.
Conceivably, isolation may sometimes lead
to heavy drinking, which in due course may
increase isolation even further, i.e. a posi-
tive feedback mechanism could be oper-
ating.
Although those who were socially iso-
lated early stage are probably over-
at an
represented among heavy drinkers, one
would also expect that a large number of
heavy drinkers started out with normal
social relations. The social network model
predicts that such persons will be heavy
drinkers if they live in a wet environment
and have many heavy drinking friends. In
effect, the model predicts that heavy
drinkers and alcoholics may form a fairly
heterogeneous group, and we can dis-
tinguish two main ’types’ of alcoholics
(Skog 1980, 1989): type A - those who
dnnk heavily because they are integrated
into a heavy drinking subculture, type B -
those who are heavy drinkers because they
are poorly integrated.
Type A become heavy drinker not pn-
marily because of a high psycho-biological
disposition, but because they live m a wet
environment. They will be most numerous
in countnes with a high per capita con-
sumption level. In fact, the empirical
relationship between per capita consump-
tion and prevalence of heavy drinking can
be seen as a direct manifestation of this
type.
Type B - the poorly socially integrated -
would typically be persons with a high dis-
position. Their disposition is allowed to
mamfest itself due to lack of informal social
control, restraining their drinking. While
the strongly socially integrated person is
effectively controlled by his environment,
those who are weakly integrated are less
effectively controlled. This type would be
expected to be most numerous, relatively
speaking, m low-consumption countnes,
since type A would be rare in these coun-
tnes.
It should be noted that there are some
similarities between this social typology and
Jellinek’s classical typology of alcoholism
(Jellinek 1960), as well as with Cloninger
et al.’s (1988) type 1/type 2 scheme. Type
1 alcoholics are characterized by a late onset
of drinking problems, which are reinforced
by external circumstances, and few social
complications. Type 2 alcoholics have an
early onset of drinking problems, regardless
of external circumstances, and have mul-
tiple social problems. According to the
authors, type2 subjects are typically anti-
social, aggressive, high on novelty seeking,
but low on harm avoidance and reward
dependence, and frequently show signs of
antisocial behaviour, while type 1 subjects
typically have opposite characteristics
(Cloninger et al. 1988). Hence, type 1 may
resemble type A above, while type2
resembles type B.
These predictions find support in a pro-
spective, longitudinal study of alcoholics
(Skog 1989). The two groups with the most
unfavourable prognosis m terms of con-
sumption level were those with a poor social
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integration and those integrated into a wet
environment.
Being poorly socially integrated is likely
to be a nsk factor, not just because of weak
informal social control, but also because it
often implies loneliness. As many studies
have shown, a considerable fraction of
alcoholics report feelings of loneliness, and
it is tempting to suggest that excessive
drinking may, m many cases, be a way
of ’copmg’ with feelings of loneliness and
inadequate social relations. It is of interest
to note that Hornqvist et al. ( 1988) in a
prospective, longitudinal study of Swedish
alcoholics, do m fact suggest that the two
most important prognostic factors are an
alcoholic’s feeling of loneliness and whether
he has a ’drinking buddy’. In our termm-
ology, the factors would be called poor
social integration and integration mto a wet
environment, respectively.
Integration and regulation through infor-
mal social control are fundamental ideas m
this theory. Hence, it is easily recast m
Durkheimian terms. In cultures where
drinking is integrated mto daily life, there
are few restrictions to prevent heavy dnnk-
ing, while m low consumption cultures
these regulations are quite effective. High
consumption countries may therefore be
called anomic with respect to the use of
alcohol. Furthermore, people who are
weakly integrated are also at high rmk, even
m low consumption countnes. In effect,
there are considerable overlaps between
this theory of alcohol abuse and Durk-
heim’s theory of suicide.
5. Possible relations between
alcohol abuse and suicide
In preceding sections I have already hinted
at a few possible causal mechamsms that
could serve as links between suicide and
alcohol abuse. In this section I shall discuss
these mechamsms more closely. As already
noted, for this purpose it is useful to dis-
tinguish between acute intoxication and
chromc abuse. Both may be causally related
to suicide, but the mechamsms be may
somewhat different. I shall start dis- by
cussmg chronic abuse and its Implications
for suicides.
 The first link may be called the mech-
anism of social deterioration. It seems clear
that chronic alcohol abuse may have quite
destructive effects on social relations (Cah-
alan and Room 1974). There is also evi-
dence that extended abuse may produce
severe anomy in a significant number of
cases, and that severe anomy increases with
the length of the drinking career (Phillips
1976). Those whose social relations were
weak from the beginning may be even
worse off, and those with normal social
relations from the start may often experi-
ence problems both in the family and at
work - both of which are important arenas
of social life. Since heavy drinking is to a
significant extent a cultural product, closely
related to the overall level of drinking in
society, one would expect that a high per
capita consumption level could produce a
large number of abusers with a reduced
level of social integration, an elevated level
of anomy and an increased nsk of suicide.
However, one could also argue for a quite
different relationship between alcohol
abuse and suicide, created by what may be
called the mechanism of alternative solu-
tions. Finding strong correlations at the
individual level, but practically no eco-
logical correlation between different meas-
ures of alcohol abuse and suicide rates in
regional data from Hungary, Elekes (1988)
has suggested that drinking and suicide may
perhaps be alternative ways of ’solving’
problems. Similar ideas were suggested by
Menninger (1938), who described alcohol-
ism as ’chronic suicide’. Elekes suggests
that the choice between these alternatives
may depend on cultural traditions. The
hypothesis is clearly speculative, but it is
compatible with Gove and Hughes’ (1980)
observation of a high correlation between
the proportion of single-person households
and both the suicide rate and liver cirrhosis
mortality. Social isolation apparently may
produce both alcohol abuse and suicide,
and it thus appears that the two phenomena
may sometimes have a common social aeti-
ology.
A priori, it does not appear unlikely that,
among people who are poorly socially inte-
grated and suffer from loneliness prior to
any alcohol problems, drinking and suicide
may be alternative ’solutions’. Rather than
202
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committing suicide, a person may try to
cope with his problem by drinking. The link
may be either direct or indirect. It is direct
if the person’s drinking is self-medication,
chosen in order to forget his loneliness or to
overcome his problems of making contact
with other people. It is indirect if the drink-
ing follows as a natural consequence of
steps taken to increase one’s integration.
For instance, bars and taverns can be seen
as arenas offering some sort of social inte-
gration to its patrons. Since these estab-
lishments are organized around dnnking,
patrons are exposed to a particularly wet
environment.
The mechanism of alternative solutions
apparently may produce a relationship that
is opposite to the first one. The higher the
level of consumption in a culture, the more
opportunities there would be for drinking
instead of committing suicide, and ceteris
paribus, the fewer suicides one could
expect. If both mechanisms are operating
simultaneously, but to varying degrees in
different regions, a quite incoherent pattern
may result.
Faced with this situation, it becomes per-
tinent to ask how the two mechanisms may
be disentangled, in the event that both
should be operating, and to clarify under
what circumstances they may be operating.
As to the problem of disentangling the
two; it should be noted that the mechanism
of alternative solutions is limited to people
who are poorly integrated from the begin-
ning, and that this relationship could there-
fore be tested on type B alcoholics. The
mechanism of social deterioration would
be particularly pronounced among type A
alcoholics.
As to the problem of circumstances; it
may be the case that the second mechanism
is constramed in terms of age, and that the
suicide of the poorly socially integrated may
only be somewhat delayed but not pre-
vented entirely, when drinking is an
alternative. Hence, if the second mech-
anism is in fact present, then one could
expect different relationships between
suicide rates and rates of alcohol abuse
among younger and older persons.
Besides long-term abuse, single cases of
intoxication could be linked to suicide.
Hence, one should not restrict the search
for links between suicide and alcohol to
alcoholism. First, many cases of alcohol-
related suicides may occur among people
who are not alcoholics. In many cultures,
a large fraction of the victims have been
reported intoxicated and this fraction may
be larger than the fraction that can truly be
called alcoholics. Second, the link between
alcoholism and suicide may often operate
via intoxication, the correlation being a
consequence of the fact that alcoholics
often have a high frequency of intoxication
(Mayfield and Montgomery 1972).
It is worth noting that intoxication can
be seen as an acute type of anomy. Drinking
to reach intoxication often has a ’time-out’
function, since ordinary rules for conduct
are set aside (MacAndrew and Edgerton
1969). People are allowed to do things that
they are normally not allowed to do in a
sober state. However, this time-out is not
a complete normlessness and the risk of
going too far is clearly present, since intoxi-
cation may induce a feeling of ’omm-
potence’.
The frequently reported individual level
correlation between intoxication and
suicide may have both trivial and non-trivial
explanations. A trivial explanation could
be that the victim drinks in order to sup-
press his own resistance. This link would
be teleological, rather than causal, and one
should probably not expect that it could
serve as a basis for a causal connection at
the aggregate level. This would be the case
only if the victim would not dare to take his
own life if alcohol was not available.
At least two non-trivial links can be
imagined. We shall name them mechanisms
of anomic I11to,ncation.
Presumably, intoxication may increase
the nsk of implementing suicidal impulses
created by other mechamsms. For instance,
it can be imagined that intoxication plays a
role in connection with imitation effects
created by the mass media. It seems likely
that an intoxicated person may be more
easily influenced by suggestions, compared
to a sober person. More generally, persons
who already possess strong suicidal
impulses may be less likely to resist and
more likely to carry out their intention
when intoxicated, whatever the origin of
the impulse may be.
203
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An even more direct connection would
result if intoxication and drunken com-
portment produced situations that have
destructive consequences for social re-
lations. Violence is very often connected to
intoxication (Gustafson 1986; Lenke 1989),
and the evidence suggests that the relation-
ship is at least partly of a causal nature. At
a more general level, intoxicated persons
often do things that they regret. One can
also imagine that frustration typically fol-
lows ’omnipotence’ induced by intoxi-
cation. Both effects may contribute to the
wish to end one’s life.
The individual level mechanisms of
anomic intoxication may also have effects
for the population at large. Dunking pat-
terns in general and the overall frequency
of intoxication in particular, as well as the
cultural rules of drunken comportment,
vary a lot across cultures, and to some
extent within each culture over time. The
amount of interpersonal conflict created by
alcohol may therefore vary (cf. Lenke
1989), and the same applies to the pro-
portion of time the members of a culture
are in a state of intoxication, and thus vul-
nerable to suicidal impulses.
In conclusion, there are many reasons for
expecting that alcohol may be a relevant
causal factor in relation to the suicide rate.
The relationship is likely to be a complex
one, however, and the resulting pattern
may easily appear mcoherent at first sight.
Therefore, it is necessary to approach the
problems with great care, using measures
that distinguish between different types of
dnnking and different groups of drinkers.
These difficulties are perhaps illustrated
by the following example. Norstrom (1988)
has analysed trends in overall suicide rates
in relation to per capita alcohol con-
sumption m the Scandinavian countries,
using sophisticated statistical techmques.
He reports positive relationships for
Sweden and Norway, to the effect that
changes in alcohol consumption appear to
have had a substantial impact on suicide
rates. However, for Finland and Denmark
he finds no significant effects. This is quite
a confusing state of affairs. Norstrom’s alco-
hol measure is per capita alcohol con-
sumption. This is probably a good proxy
for the frequency of intoxication and also
for the prevalence of chronic heavy drink-
ing in Norway and Sweden, since changes
have been gradual in these countries. In
Finland, however, consumption increased
dramatically during the late 1960s and early
1970s. The rate of intoxication and the
prevalence of heavy drinking increased
accordingly (Makela 1975), but the preva-
lence of chronic heavy drinking (alcohol-
ism) wasnecessarily lagged compared to
per capita consumption. This may - at least
partly - explain the Finnish case. Intro-
ducing indicators of chronic abuse, in
addition to per capita consumption, would
be necessary in this case. In Denmark,
heavy intoxication is much less common
than in the other three countries. Hence,
chromc heavy dnnking is a more likely
mechanism linking alcohol to suicide in
Denmark. If there is a more pronounced
tendency for Danes to use chronic heavy
drinking as an alternative to suicide, a
relationship might only show up among
older age groups. In the overall suicide
rates the alleged relationship could easily
’drown’, and it would be useful to analyse
different age groups separately.
6. Conclusion
Durkheim’s arguments against alcohol as a
causal factor in relation to the social suicide
rate are undoubtedly weak. His statistical
‘proof’ is unreliable, and he does not
present any convincing theoretical analysis
supporting his view. In fact, his discussion
of alcohol is surprisingly a-theoretical, and
is based more on everyday prejudice than
on sociological insight. This is surprising,
since alcohol can easily be incorporated
into his theory of suicide using the same
theoretical ideas as he applies to suicide
itself.
Three main mechanisms linking alcohol
to suicide have been suggested here. First,
chronic abuse may weaken social inte-
gration. According to Durkheim’s own the-
ory, increased suicide rates would then be
expected as rates of chronic abuse increase.
Since the rates of chromc abuse vary
strongly both historically and cross-cul-
turally, this mechanism of social deterior-
ation could significantly affect suicide rates.
Second, weak social integration (e.g. due
204
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to childlessness) increases the risk of both
suicide and alcohol abuse. Hence, both
problems sometimes have a common cause,
and as Elekes (1988) has suggested, the
’choice’ between drinking and committing
suicide may vary according to cultural tra-
ditions. If abuse is chosen more frequently
where alcohol is freely available and inte-
grated into daily life, this mechanism of
alternative solutions may produce a nega-
tive relationship between aggregate con-
sumption and suicide rates. However, this
effect may be limited to special groups,
such as younger age groups. Third, severe
intoxication may produce an anomic state,
the effect of which may be suicide. This
could produce a positive relationship
between the rate of intoxication m society
and the suicide rate. These hypotheses need
to be tested empirically.
Conventional ’sociological variables’
explain only a moderate fraction of the
vanance in suicide rates. One of the missing
variables in conventional sociological
analyses may very well be alcohol. I would
therefore argue that sociologists can no
longer afford to ignore alcohol as a poten-
tially important factor m relation to suicide.
As Norstrom (1990) points out, it may also
be the case that some of the correlations
found m many conventional studies are spu-
nous, and due to omitted variable bias.
Norstrom (1990) mentions divorce and
suicide as an example, and argues that alco-
hol abuse may often be the real cause.
Unless alcohol is explicitly contiolled in
such analyses, this possibility remams open.
Appendix: A social network
model of drinking
Assume that an individual’s consumption
level, which is denoted X, is the result of
three types of ’forces’:
-
external factors, i.e. social norms,
environmental factors like availability,
etc. Let Z denote the consumption level
prescribed by external factors. This is
allowed to vary across individuals and m
’
time.
-
internal factors, i.e. personal factors like
physiological and psychological make-up,
level of income, etc. Let W denote the
 level prescribed by internal
consumption
factors. This is also allowed to vary across
individuals and in time.
- Social interaction effects, i.e. influence
from friends, etc. Let q be a measure of
the effect an individual has on another.
This is allowed to vary across all pairs of
individuals, and is not necessarily sym-
metncal. If two individuals do not interact
directly, the measure is equal to zero.
The fundamental equation of the model
can be written as follows (logarithmic
scale) :
The equation says that individual i will
change his consumption level from time
T=ttoT=t+1:
-
if there is a discrepancy between his actual
consumption level and the level pre-
scribed by external factors at time T t
-
if there is a discrepancy between his actual
consumption level and the level pre-
scnbed by internal factors at time T =t
-
if there is too much discrepancy between
his own drinking and the drinking of his
friends at time T t.=
This equation can be simplified and
written as
or in matrix notation
Here, V is a combined measure, including
both external and internal factors, while 6
is the sum a + {3. The p’s are identical to
the q’s, except that p(i,i) is calibrated so as
to make the p’s sum to (1 - b) (cf. Skog
1979: 101).
In a stable culture (i.e. V independent of
time), the population will reach an equi-
librium X
provided that ~7 fulfils certain requirements
(Skog 1979). The diagrams in Figures 1 and
2 have been constructed on the basis of this
equation.
Downloaded from asj.sagepub.com at RYERSON UNIV on June 18, 2015
First version received March 1991
Final version accepted July 1991
Notes
’
In Abstracts 1974-90, 741 ref-
Sociological
erences on suicide are listed, 2 per cent (17)
of which mention alcohol. Most of these are
individual level studies, however, and only a
handful are concerned with aggregate relations.
2Quotations are from the Free Press paper-
back edition of 1966, translated by Spaulding and
Simpson.
’I cannot resist the temptation to mention
that m a footnote to the last paragraph quoted,
Durkheim notes that ’The consumption of wine
mdeed vanes rather inversely to suicide Most
mne is drunk m the Midi where suicides are
least numerous.’ However, Durkheim cautiously
points out that wine is ’not to be regarded as a
guarantee against suicide for this reason’ .
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