A review of postmortem alcohol detection as a diagnostic test for substance abuse disorders in suicides

To assess the role of toxicologic detection of alcohol to diagnose substanc e abuse disorders in suicides, the author reviewed suicide studies with bot h comprehensive toxicologic and diagnostic data. The sensitivity of alcohol detection to diagnose alcohol and substance abuse disorders in suicides wa s low in all studies (range, 39%-42%), and the specificity was 80%-95%. A h igher cutoff level for alcohol did not increase diagnostic performance. The author concludes that toxicologic detection of alcohol is not a reliable i ndicator of alcohol and substance abuse disorders in suicides because of th e high rate of false-negatives. Most of the suicides with positive alcohol detection seem to suffer from chronic substance abuse problems. The role of intoxication is difficult to assess because of methodologic problems.