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Acute Alcohol Use and Suicide Attempts

Acute Alcohol Use and Suicide Attempts. Courtney L. Bagge , PhD University of Mississippi Medical Center. Rates. Suicidal behavior is common > 36,000 die by suicide 10 th cause of death in US 5 attempts per suicide. Rates. Alcohol use/misuse is common Use Lifetime: 90%

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Acute Alcohol Use and Suicide Attempts

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  1. Acute Alcohol Use and Suicide Attempts Courtney L. Bagge, PhD University of Mississippi Medical Center

  2. Rates • Suicidal behavior is common • > 36,000 die by suicide • 10th cause of death in US • 5 attempts per suicide

  3. Rates • Alcohol use/misuse is common • Use • Lifetime: 90% • Past year: 53% • Misuse (lifetime) • Abuse/problems: 15% • Dependence/alcoholism: 10%

  4. Use & AUD Overlap

  5. Clinical Case • Primary care check-up • 30 yr old female • Drinks 1-2 drinks every 2 mo. • No suicidal thoughts • No history of depression • Mentions relationship prob.

  6. Lecture will Cover • Definitions • Relations • Reasons for drinking • Prevention/Treatment

  7. Definitions • Suicidal thoughts (ideation) • Thoughts of killing oneself • Suicidal behavior • Self-inflicted act (intent to die) • Suicide: Fatal outcome • Attempt: Non-fatal outcome

  8. Alcohol: Standard Drink • ~10 gm pure alcohol • Beer: 12 oz. • Wine: 4 oz. • Spirits: 1.5 oz.

  9. Alcohol: Drinking Patterns • Quantity frequency • Heavy episodic • 5+ drinks/occasion ♂ • 4+ drinks/occasion ♀ • Binge • Intox. > 2 days • Give up usual activities for intox.

  10. Alcohol Use Disorders Dependence 3+ in same 12 mos: Tolerance Withdrawal Use more or longer Desire/inability to ↓ Other activities given up ↑ obtain, use, recover Use despite problems Abuse 1+ in same 12 mos: ↓ role obligations Hazardous use Legal problems Interpersonal problems  dependence

  11. Acute Alcohol Use • Any context • Acute alcohol: 1 drinking instance • When discussing attempts • Acute alcohol: 1 specific instance • Drinking prior to attempt (3-6 hrs) • Drinking any alcohol • Drinking to intoxication

  12. Lecture will Cover • Definitions ✔ • Relations • Reasons for drinking • Prevention/Treatment

  13. Descriptive Statistics • Drinking on day of attempt: 40% • Subgroups differ • Men (53%) > Women (40%) • < age 50 • ↑ AUD • Design limitations • Rates only descriptive • Association not tested

  14. Case-Control Research Not Exposed Not Exposed Exposed (Drink) Exposed (Drink) Attempt No Attempt “CASES” “CONTROLS” • Who is likely to attempt suicide? • Compare 2 groups on alcohol use

  15. Key Findings • Acute use (> 100 g): 60X risk • Chronic use (>100 g/day): 3X risk • Modeled together: • Acute use > effect (6X risk) • Chronic use no longer ↑ risk • Design limitations • No best control group • Many case-control differences

  16. Case-Crossover Research Control Period Day didn’t attempt Case Period Day attempted Drink? Drink? Suicide Attempt • When is someone likely to attempt? • 1 person: Compare use in 2 periods

  17. Key Findings Event Drink Attempt • ↑ risk of suicide attempt while drinking • Regardless of sex, age, marital • Infrequent drinkers (< 1 mo) • Acute drinking ↑ risk than others • Clinical importance • 3rd variable • Time of day • Place • Situation

  18. Lecture will Cover • Definitions ✔ • Relations ✔ • Reasons for drinking • Prevention/Treatment

  19. Reasons for Drinking: Day of Attempt • Non-Suicide Related Reasons • Social, Enhancement, & Coping • Prevalence: 67% • 60% no influence • 40% impaired judgment • How increase risk? • ↑ neg. mood, aggressiveness, impulsivity • All or nothing thinking • Alcohol myopia- attentional shortsight

  20. Reasons for Drinking: Day of Attempt • Suicide Related Reasons • To facilitate attempt (33%) • As suicide method (26%) • How increase risk? • ↑ courage • Anesthetize pain of dying • Alcohol poisoning • Interaction with other substances

  21. Lecture will Cover • Definitions ✔ • Relations ✔ • Reasons for drinking ✔ • Prevention/Treatment

  22. Doc Visit: Unique Opportunity! • Docs likely contacted 1 mo prior • Primary care doctor (45%) • Mental health provider (20%) • Primary care: Many seek help

  23. Doc Visit: Unique Opportunity! • Evaluate both • Screen • Monitor • Prevent • Treatment • Ask all drinkers about suicide • Regardless of chief complaint • Don’t be afraid to ask • Not cause suicide, but ↓ risk

  24. Stepwise Progression: Ask all ? • Ever thought about: • Death/dying? • Life not worth living? • Ending life? • Ever attempted suicide? • Current thoughts? • If ideation + • Ask frequency, duration, intensity • Plan and intent

  25. Docs: Ask all about alcohol patterns • Alcohol Use Identification Test-C Q1) Frequency of any use • 0 (Never) to 4 (4 or more X/week) Q2) # drinks/typical drinking day • 0 (None) to 4 (10 or more) Q3) Frequency of heavy episodic use • 0 (Never) to 4 (almost daily or daily) • Scoring 0-12 (screen ≠ diagnosis) • AUD → Men > 4; Women > 3 • Sensitivity: 80-90%;  specificity: 60-70%

  26. Docs: Ask why patient drinks • Enhancement, social, to cope • If cope: ↑ risk for suicidal thoughts • Help find other coping strategies • How coped in past w/out alcohol? • Talk to someone/Call friend • Leave situation/Walk in park • Distract self/Watch comedy • Docs remember: Don’t ignore • Infrequent drinkers or not AUD

  27. Clinical Case • Primary care check-up • 30 yr old female • No suicidal thoughts • No history of depression • Drinks 1-2 drinks every 2 mo. • No evidence of AUD • Mentions relationship prob. • What else should we ask?

  28. What happened to the patient? • Relationship break up • Attempted suicide • Brought to ER-said • Used alcohol for coping • Suicidal thoughts shortly before act • Drinking connected to attempt?

  29. Behavior Chain Analysis • Prevent future alc/suicide acts • Discuss recent alc/suicide episode • Identify when problem started • Identify how vulnerable to problem • Physical illness • Not taking medications • Eating/sleeping too much • Drug use • Alcohol use

  30. VULNERABILITIES:staying up late, no lunch Identify Links in the Chain for Solutions TARGET VULNERABILITIES:staying up late, no lunch Prompting Event: Relationship break-up Event: Order 1st beer Event: Order 2nd beer Suicide Attempt Event: Order 4th beer Think: never find anyone else Mood: 9 Angry: 7 Do:Drive to a bar Think: I am going to forget about him Mood: 7 Angry: 7 Do:Drink Think: I feel better. Don’t need him! Mood: 5 Angry: 5 Do:Order another beer After Attempt Think: I can’t live w/out him Mood: 9 Angry: 7 Do:Go to bathroom; take 100 Tylenol TARGET

  31. Dialectical Behavior Therapy • Skills to ↓ both behaviors • 4 skill types: To ↑ ability to • Focus on here-and-now • Have + relationships • Regulate emotions • Tolerate – situations/emotions

  32. This Lecture Covered • Definitions ✔ • Relations ✔ • Reasons for drinking ✔ • Prevention/Treatment✔

  33. Key Messages • 40% drink prior to attempt • Acute/Chronic use • ↑ risk while drinking • Reasons • Non-suicide reasons (common) • Assessment: • Assess ALL systematically • Ongoing assessment of both • Explore alcohol-suicide connection

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