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Assess routinely for suicide risk

November 1, 2009
by Julie A. Niven, LCSW, DCSW, MAC
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Addiction professionals carry an equal responsibility to monitor patients for suicidality

The January/February 2009 issue of the Substance Abuse and Mental Health Services Administration's SAMHSA News announced the publication of a white paper on the relationship among substance abuse, untreated mental illness, and suicide.1 As a dual certified mental health and substance abuse clinician, I know firsthand the deadly interrelatedness of these three factors.

During my employment at an Arizona Indian Health Service hospital and with a tribal organization in western Alaska, I witnessed time and again the impact that substance misuse (primarily of alcohol) and untreated mental distress had on suicidal ideation, suicide attempts, and completions. Despite the fact that the native people themselves had placed prohibitions on alcohol availability within their own communities, alcohol was frequently present when intervening with self-harming patients in the emergency room, at their homes, or in the office.

I applaud the efforts of SAMHSA, one of our most trusted authorities, in refocusing our attention on this deadly relationship so that we in the substance abuse and mental health fields can more effectively work to alleviate suffering and prevent suicide. I fully believe that if workers can incorporate this vital information into routine practice, it will have a transforming effect on both fields.

SAMHSA's choosing a white paper as the format in which to present its findings speaks to the fact that the paper's topic has not yet been fully translated into common practice. This is difficult to understand given the multitude of sources reporting the relationship among substance use, untreated mental illness, and increased suicide risk. Three years ago after daily practice illuminated the interconnectedness of the factors in my own work, I gathered research for a proposal to increase the number of self-help sobriety groups in native Alaskan villages in an effort to reduce alcohol use and suicidality.2 I gathered much of my research from well-recognized authorities such as the National Institute of Mental Health (NIMH), the American Journal of Public Health, Suicide Prevention Action Network USA, Suicide Prevention Resource Center, the Department of Health and Human Services (HHS), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA). Working at the time with the Alaska Native people, I targeted this group for my proposal.

However, native people are by no means the only vulnerable population at higher risk for suicide. Other particularly high-risk groups include white males over age 753; gay, lesbian, bisexual, and transgender individuals; individuals with borderline personality disorder or schizophrenia; white males ages 24 to 55; and the incarcerated.4

Important statistics

Here are a few salient statistics regarding suicide, mental illness, and substance use:

  • One life is lost to suicide approximately every 16 minutes.5

  • For the 33,000 lives lost by suicide in the United States annually, there are an estimated 1 million suicide attempts.5

  • Suicide is the third leading cause of death for those between ages 15 and 24, the fourth leading cause of death for those ages 25 to 44, and the eighth leading cause of death for those ages 45 to 64. For those 65 to 74, there are 12.6 deaths by suicide per 100,000. For those 75 and older, the death rate increases to 16.9 per 100,000.6

  • Suicide rates among American Indian and Alaska Native teens and young adults are twice that of the national average.7

  • 90 percent of those who attempt suicide have a mental illness and/or substance use disorder.7

  • Substance use is thought to be involved in up to 50 percent of all suicides.3

And these rates have remained essentially stable for 50 years.7

Responsibility for assessment

Throughout my career, I have seen the responsibility of suicide assessment fall primarily to mental health workers. Suicidality is most closely associated with hopelessness and depression. Hopelessness is found to be a component of a variety of mood disorders, including major depressive disorder, dysthymic disorder, the depressive phase of bipolar disorder, and adjustment disorder with depressed mood. An individual misusing substances is often found to be experiencing a concomitant negative impact on his/her mental health, which frequently includes depressive symptomology. Drugs and alcohol are often used as a means of “self-medication” by those in psychological distress.

Screening for suicide risk at each and every intake offers one of the best ways in which we can prevent suicide.

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