In 1995, when Sri Lanka had the highest rate of suicide in the world, pesticide ingestion was widely thought of as the leading method used. By 1995, the import of class one pesticides was banned, and a ‘Presidential Task Force’ was set up in 1997 to mitigate or prevent suicide in the future. Important decisions implemented included decriminalising the act of suicide in 1998. What was also happening at that time, which was not addressed or discussed, was that alcohol was co-ingested alongside pesticides by farmers. Alcohol is well established to cause impulsiveness and to give a person the courage to indulge in risky behaviour.

Sometime ago, I came across a very important document: ‘Annual Health Statistics 2017’. In that, it was recorded that 75,486 patients (352/100,000) were admitted to hospitals around Sri Lanka for ‘poisoning’, resulting in 584 deaths. The toxic substances used included pesticides, insecticides and other non-medical substances. It is fair to question whether a big percentage (or all) of these admissions were actual attempts at suicide and whether their blood alcohol levels were checked upon admission. The fall in the suicide rate post 1995 is well documented, but, without comparable data on attempts and ideation, we simply cannot say whether the underlying human distress has fallen at all: only that fewer of those episodes now end in death. This is said while evidence reflects that for every death by suicide there are up to 20 attempts to die by suicide. 

This may precisely be the gap that existing research has begun to fill. It has been established via a scoping review published in Heliyon in 2023 that, of all the substances examined in Sri Lankan (English Language) research, alcohol has the strongest and most consistently reported connection to self-harm and suicide. The emerging picture was one of a substance woven into the very fabric of self-destructive behaviour across the island.

Limits of a scoping review

The review also detailed how alcohol shapes self-harm around three recurring themes. Through a spouse's or father's drinking rather than the drinking of the person who eventually harms themselves (gendered or relational). Diagnosis and treatment is complicated in hospital toxicology wards when patients arrive after having co-ingested alcohol alongside pesticides. Tackling alcohol, self-harm and suicide together rather than as separate public health problems.

Noting the limits of what a scoping review can claim, the authors call for more systematic reviews and for research conducted in Sinhala and Tamil, not only in English, since much of the lived experience of alcohol-related self-harm in Sri Lanka is presently not being captured in English at all.

In a Sri Lankan study of 159 acute self-poisoning cases, it was found that 32 per cent were visibly affected by alcohol when admitted to hospital, which was confirmed by family and bystanders. Another study conducted a psychological autopsy of 372 suicides in rural Sri Lanka and found that problem drinking, or alcohol dependence was common among male suicides in 61% of the cases while alcohol misuse in another family member contributed to 14% of female suicides. None of these studies thoroughly investigated the dynamics and complex inter-linkages between alcohol and self-harm and researchers have called for further investigation of the links between alcohol, impulsive behaviour and self-harm in Sri Lanka.

Harm caused by alcohol use and misuse can radiate outward into the household, shaping the mental health and safety of partners, children and other relatives, often falling the hardest on those with the least power to change the drinking behaviour driving it. A person does not need to drink themselves to be placed at elevated suicide risk by alcohol. Living with someone who drinks heavily can be enough. Echoing comparable findings from India, a study of attempted suicide in Sri Lanka also found that women in households where another member misused alcohol faced nearly double the risk of attempted suicide compared with women in households without that pattern. This is consistent with earlier Sri Lankan research pointing to alcohol misuse by a husband or father as a factor that precedes suicidal behaviour in women. An individual's suicide risk is determined not only by personal characteristics but is also influenced by their environment. 

The withdrawal stages

Beyond the role of alcohol and illicit drugs in the household, the physiology of addiction itself carries its own suicide risk. The withdrawal stage is one of the characteristics of addiction where the body craves for a ‘fix’ of either alcohol or substances when the effects wear off. During this stage, the person is severely agitated and in distress with symptoms that can vary from substance to substance. Some of them are tremors, hallucinations, unbearable aches and pains, nausea, vomiting or diarrhea, psychosis. Unpredictable behaviour ensues. At this stage, when access to the substance is denied or beyond reach, the person can question the futility of living and wish to cut out the pain with either self-harm or suicide. Eventually, if obtained and consumed, the person takes the substance not to get “high”, but rather to escape the “low” feelings to which chronic alcohol and drug use has contributed.

Reviewers have repeatedly noted that the illicit drug-suicide link (as opposed to alcohol-suicide) is under-studied in Sri Lanka. But, in a descriptive cross-sectional study carried out among 205 individuals engaged in residential treatment at six Governmental and private rehabilitation centres: of the participants, 43.4% had suicidal ideation and 21.5% of them attempted suicide.

In 1984, the visionary founder of Sumithrayo, Joan De Mel, realised the connection between addiction and suicide and gave her ancestral home at Horton Place, Colombo 7, for the setting up of the ‘Sumithrayo Drug Demand Reduction Program’ also known as ‘Mel Medura’.

The World Suicide Prevention Day of this year (2026) is observed on 10 September, coordinated globally by the World Health Organisation and the International Association for Suicide Prevention. Triennial Theme (2024–2026): "Changing the Narrative on Suicide". Start the Conversation: This theme calls on us all to challenge harmful myths, reduce stigma, and foster open, compassionate conversations about suicide. It is about shifting from silence and misunderstanding to openness, empathy, and support, creating environments where people feel able to speak up and seek help.

Changing the narrative also means driving systemic change. It calls for suicide prevention and mental health to be a priority in public policy, urging Governments and institutions to take action. This includes developing and implementing evidence-based strategies, improving access to quality care, and ensuring that those in distress receive the support that they need.

The writer is the chief executive officer of a corporate entity

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The views and opinions expressed in this column are those of the author, and do not necessarily reflect those of this publication

Alcohol, substance or behavioural addiction

Can access the free service offered at: 

Sumithrayo Drug Demand Reduction Program (Mel Medura),

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If you are distressed and hopeless 

Contact: Sri Lanka Sumithrayo, 

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