Suicide prevention module superior to usual care for adults with substance use disorder
A treatment mode specifically targeting prevention of addiction-related suicide is superior to customary care for improving knowledge, behaviors and help-seeking, according to a randomized clinical trial published in JAMA Network Open.
“Suicide remains a serious public health issue, with numerous studies reporting that most suicides are related to mental disorders,” Richard K. Ries, MD, of the department of psychiatry and behavioral sciences at the University of Washington School of Medicine, and colleagues wrote.
“Less well-known is that the risk of suicide is 10-fold higher for individuals with alcohol use disorder, 14-fold higher for individuals injecting drugs and 17-fold higher for individuals who use multiple different drugs.”
Researchers sought to evaluate the effectiveness of Preventing Addiction Related Suicide (PARS) treatment module on a wide range of suicide-related outcomes compared with customary care for those dealing with substance use disorders (SUD).
The study was conducted from 2017 to 2020, with follow-up assessments conducted after treatment and at intervals of 1, 3 and 6 months. Participants included 906 adult outpatients (mean age, 37.5 years; 59.6% male) enrolled in SUD treatment at community intensive outpatient programs across western Washington.
Data were analyzed from July 1, 2020, to Jan. 20, 2022, regarding 478 patients receiving customary care and 428 receiving PARS, a one-session secondary prevention module administered by trained SUD counselors consisting of didactic presentations and group discussions about suicide risk factors, warning signs, and actions to take if suicide risk is observed in self or others.
Results showed, from baseline to conclusion of treatment, a significant improvement in suicide knowledge (d=0.15; 95% CI, 0.08-0.23) and a larger reduction in maladaptive attitudes (d=0.18; 95% CI, 0.14-0.25) among the PARS cohort compared with the control group.
Such improvements were maintained through the follow-up intervals for suicide knowledge (1 month, d=0.16; 95% CI, 0.07-0.22; 3 months, d=0.12; 95% CI, 0.05-0.19; 6 months, d=0.13; 95% CI, 0.06-0.20) and maladaptive attitudes (1 month, d=0.20; 95% CI, 0.12-0.23; 3 months, d=0.10; 95% CI, 0.05-0.16; 6 months, d=0.14; 95% CI, 0.09-0.19).
Data additionally revealed, from treatment initiation to the 6-month follow-up, a greater improvement in help-seeking from the PARS group vs. usual care (d=0.16; 95% CI, 0.01-0.32).
“As substance-related suicide and overdose numbers increase and overlap, prevention interventions are needed in SUD treatment settings with high acceptability and feasibility, PARS has the potential for wide impact,” Ries and colleagues wrote.