Caitlin Clevenger, Ph.D., received a five-year, $750,000 mentored award from the National Institute on Alcohol Abuse and Alcoholism.About a third of people who die by suicide consumed alcohol immediately prior to their death. "However, not everyone who drinks alcohol becomes suicidal," said Caitlin Clevenger, Ph.D., assistant professor in the Department of Psychiatry and Behavioral Neurobiology. With a new five-year, $750,000 grant from the National Institute on Alcohol Abuse and Alcoholism, part of the National Institutes of Health, Clevenger is exploring "what factors may increase suicide risk when a person drinks alcohol."
Clevenger is a member of the School of Medicine's Center for Addiction and Pain Prevention and Intervention (CAPPI), which is focused on cutting-edge research that can lead to improved treatments for addiction and pain.
Clevenger’s award, Acute Use of Alcohol and Attentional Bias towards Suicide: An Experimental Test of the Attention-Allocation Model, has two major goals. The first "is to explore under what circumstances drinking alcohol might lead to increased suicide risk," Clevenger said. "In particular, the study will examine whether, at the time of drinking, a person's mood (e.g., sad mood) or beliefs about alcohol (e.g., believing alcohol will make them aggressive) increases suicide risk."
The attention-allocation model "makes predictions about how people behave when they drink," Clevenger explained. "Drinking limits your brain's capacity to process and respond to your surroundings; therefore, you will only focus on what stands out to you the most. Because of this, the model predicts that alcohol amplifies what mood or thoughts you are experiencing at the time of drinking." Someone who drinks because they are sad about a breakup "may end up feeling worse and cry more about the breakup," Clevenger said. "Some refer to this as the tears-in-the-beer effect. Similarly, if someone expects that alcohol will make them mean, drinking might amplify this belief and increase risk that they will say hurtful things or become aggressive."
To study the link between alcohol use and attentional bias towards suicide, Clevenger is recruiting healthy adults with no psychiatric diagnoses, alcohol problems or suicidal history. "We administer alcohol to some participants — equivalent to two standard drinks — and placebo alcohol to others,” she said. “Then we play music and have them read statements that help them to slightly change their mood state to be more negative or positive." These are mild mood states "that are temporary and not harmful to the participant," Clevenger pointed out. "Then we have them complete a computer task that measures how long they attend to suicide-related words (e.g., death) versus neutral words (e.g. chair). We expect the people who drank alcohol and were in sad mood conditions to show the greatest attentional bias towards suicide. We are also asking people about their beliefs about alcohol (e.g., believing that alcohol makes them happier, sad, aggressive, etc.) and examining whether this increases their attentional bias towards suicide."
| "Drinking limits your brain's capacity to process and respond to your surroundings; therefore, you will only focus on what stands out to you the most. Because of this, the model predicts that alcohol amplifies what mood or thoughts you are experiencing at the time of drinking." |
It is important to note that "we are not examining suicide risk specifically — this would be unethical and unsafe to do experimentally," Clevenger said. "However, we are instead examining a factor that might be a subtle indicator of someone's suicide risk. The study is essentially examining under what conditions alcohol may increase suicide risk by using a proxy for suicide risk, that is, someone’s attentional bias towards suicide-related words."
Another goal of the award, Clevenger noted, "is to facilitate my development as an independent investigator in suicide and alcohol research. The award protects time for me to take courses and receive mentorship from experts in the field." This includes Karen Cropsey, Psy.D., co-director of CAPPI, and Richard Shelton, M.D., vice chair for research in the Department of Psychiatry, and Dominic Parrott, Ph.D., of Georgia State University, who has extensive experience in alcohol-administration studies (and the attention-allocation model) and Mitchell Berman, Ph.D., of Mississippi State University, who has extensive experience in experimental studies of suicide-related constructs. Other mentors include Clara Bradizza, Ph.D., who studies alcohol-use disorder co-morbidity and affect regulation at the University of Buffalo, and Andres Azuero, Ph.D., in the UAB School of Nursing, who will mentor Clevenger on statistical analysis and data management.
Clevenger's interest in reducing suicide risk began as an undergraduate, when she volunteered as a rape crisis counselor. "Many victims would have thoughts of suicide and self-injury, and I became interested in how trauma affects suicide risk," she said. The more she learned about suicide risk, the more curious she became about how alcohol and other substances can help suicidal individuals overcome the fear of death.
The award is the first step to a larger research program, Clevenger said. "Ultimately, I would like to develop or revise existing treatments that could treat alcohol-use disorder and related suicide risk. The treatments we have right now are usually focused on just alcohol-use disorder or just suicide, but there is a movement to treatments that cover more ground than a single issue."
