Different Ways to Drown Out the Pain: A Meta-Analysis of the Association Between Nonsuicidal Self-Injury and Alcohol Use

Abstract

Objective

There is a significant overlap in the motivations for nonsuicidal self-injury (NSSI) and alcohol use. Moreover, several theories would predict that more frequent alcohol use is likely associated with more NSSI engagement. Still, the size and direction of this association has not been well documented in the literature.

Method

To address this gap, the goal of this article was to conduct a meta-analysis of the relation between alcohol use and NSSI.

Results

Across 57 samples and 141,669 participants, we found that there was a significant positive association between NSSI and alcohol use, odds ratio = 1.78, 95% confidence interval [1.53, 2.07], k = 64, m = 52. Moderator analyses found that this effect was stronger for younger samples and samples with more severe alcohol use problems.

Conclusions

These results help establish a link between NSSI and alcohol use. Implications and future directions for NSSI research and intervention are discussed.

Highlights

• There are several reasons to think that NSSI and alcohol use are linked.

• No reviews or meta-analyses have been conducted.

• We found a significant and small effect linking greater NSSI with greater alcohol use.

Keywords:

• Binge drinking
• NSSI
• self-harm
• self-injury
• substance use

DISCLOSURE STATEMENT

None.

Notes

1 Searches in PsycINFO were conducted between March and July of 2019. Searches in PubMed and Web of Science were conducted in April of 2020 as part of the review process; however, only articles published before July 2019 were included.

2 One paper, MacLaren and Best (2010), had enough data to calculate an effect size; however, because this study created extreme groups for alcohol use, the effect size was more than 3 standard deviations above all others (OR = 32.21). The authors were contacted for the correlation between NSSI and alcohol use, and the authors no longer had access to the data. This study was excluded because of the unusually large effect size. The inclusion of the study led to a similar meta-analyzed effect size estimate.

Additional information

Notes on contributors

Konrad Bresin

Dr. Konrad Bresin is a postdoctoral fellow at Georgia State University. His program of research seeks to identify mechanisms that are involved in the initiation and continuance of behaviors that lead to short-term relief but have long-term negative consequences such as nonsuicidal self-injury, substance use, and aggression. Specifically, his work examines the roles of emotions, cognitions, and their interaction as antecedents to these behaviors and how engaging in these behaviors affect emotion. His work uses multiple methods including laboratory-based experiments, ambulatory assessment, and meta-analysis. The majority of his work has focused on understanding the role of negative emotion in dysregulated behaviors.

Yara Mekawi

Dr. Yara Mekawi is a postdoctoral fellow at Emory University. Her main lines of research focus on the perpetration and consequences of racial/ethnic discrimination and prejudice. In terms of perpetration, she studies why and how individuals engage in intentional or unintentional prejudice (e.g., shooter biases, racial microaggressions). In terms of consequences, she is interested in how racial discrimination may lead to negative mental health outcomes for racial/ethnic minorities (e.g., anxiety, depression). She also has expertise in meta-analysis.