Between 1984-88 in USSR male suicide rates decreased by 40% and female by 18%, as compared with 22 European countries where the decrease was 3% and 7% respectively. Decreases in suicide rates occurred in all republics and for both sexes, but most in the republics where alcohol consumption was high and for men aged 25-54 years. Analyses of the impact of restrictive anti-alcohol policy during perestroika on suicide rates showed that alcohol has a considerable explanatory value for falling suicide rates during this period. The estimated attributable fraction of alcohol in the whole USSR in this period was approximately 50% for male, and 27% for female suicides.

The natural experiment that took place in all 15 republics of the former USSR during perestroika (“restructuring", 1985-90) appears to have been one of the most effective programmes for suicide prevention in modern history.

The results of a case-control study psychological autopsy study performed with relatives of people who committed suicide and with controls confirmed our previous results on the aggregate level and showed that alcohol abuse and dependence (AAD) was diagnosed in 68% of male and 29% of female suicides.

35-59-year old males who committed suicide had the highest risk of alcohol dependence. Among suicide cases only 29% had received life-time diagnoses of alcohol abuse and dependence.

AAD is markedly underdiagnosed by general practitioners and clinicians. In suicide prevention it is important to screen for AAD among patients in both general practices and in psychiatric out- and in patient clinics.