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Cognitive Behavioral Treatment for Suicidal Substance Users

Cognitive Behavioral Treatment for Suicidal Substance Users . Mark Ilgen, Ph.D. VA Serious Mental Illness Treatment Research and Evaluation Center Assistant Professor of Psychiatry, University of Michigan. Acknowledgements.

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Cognitive Behavioral Treatment for Suicidal Substance Users

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  1. Cognitive Behavioral Treatment for Suicidal Substance Users Mark Ilgen, Ph.D. VA Serious Mental Illness Treatment Research and Evaluation Center Assistant Professor of Psychiatry, University of Michigan

  2. Acknowledgements • This work was supported by the National Institute on Drug Abuse (R21DA026925). • Thanks to patients and treatment providers at Community Programs Incorporated. • I have no conflicts of interest to declare.

  3. Overview • Describe the process of modifying CBT for suicidal substance users. • Discuss content of the intervention.

  4. Interventions to Address Patients at High risk for Suicide • Intervention research on suicide is difficult • Most well-controlled experimental trials focus on suicidal thoughts or non-fatal attempts as the outcome • Linehan et al. (2006) - women randomized to DBT had lower rates of suicide attempt over a 2-year follow-up than those randomized to community therapists (N = 101) • Brown et al. (2005) – individuals randomized to CBT had significantly fewer attempts from baseline to 18-months than those randomized to usual care (N = 120) • Both Linehan and Brown have versions of their treatment for individuals with substance use disorders – mostly developed on patients in methadone maintenance treatment • Existing treatments tend to be relatively long term; could be difficult to implement in standard addictions treatment settings

  5. Addressing Suicide Risk During Addictions Treatment. • Advantages of working in a residential treatment setting: • Period of sobriety and relative safety • Logistics of delivery treatment are easier • Patients may be motivated to re-evaluate their situation when in treatment

  6. Study Design • First phase of study was to modify intervention. • Pilot RCT of men and women recruited from a large residential addictions treatment program in Waterford, MI • To be eligible, participants must report: • At least one prior suicide attempt • Current suicidal ideation (BSS > 5 during the past week) • 50 Participants randomly assigned to 8 sessions of: • CBT • Educational supportive therapy

  7. Community Programs Incorporated

  8. Case Example Background • 35 year old Caucasian man • Treatment in lieu of jail time for cocaine possession • Substances of misuse (since age 13): • Cocaine, Alcohol, Marijuana • Divorced; unemployed • Ex-girlfriend died by suicide • One prior suicide attempt; overdose found by mother

  9. Overall of CBT for Suicidal Substance Users • Similar structure to CBT for depression and CBT for substance use. • Primary difference, most of the content focuses on avoiding/managing a suicidal crisis. • Based on: • Wenzel, A., Brown, G., and Beck, A. Cognitive Therapy for Suicidal Patients: Scientific and Clinical Approaches. American Psychological Association, 2008.

  10. Structure of Sessions • Mood/check • Tie to previous session • Set agenda • Review homework • Cover primary session topics • Discuss homework assignment • Summary and feedback

  11. Session Content

  12. Case Example Response to treatment • Described prior attempt as a “huge mistake” that won’t happen again; however, during treatment reported that he often thought about how to “get it right” the next time • Appreciated chance to talk about suicidal thoughts and guilt over ex-girlfriend’s death • Hope kit – challenge to find things that did not glorify drug use • Benefitted from the imaginal exposure

  13. Update on Study • Recruited 25 participants • All have been accepting of our risk management protocol • Most participants reported that they had never discussed prior attempts previously in treatment • Most participants express some embarrassment about prior attempt and state that it “won’t happen again” • Homework compliance has been excellent • Sessions sometimes feel rushed • Participants are generally positive about session content (including coping cards and hope kits)

  14. Changes in post-session mood ratings in CBT condition

  15. Summary • CBT techniques can be applied to treating suicidal substance users • Many patients are reluctant to discuss prior suicidal episodes but, over time, appear to appreciate this opportunity • This topic seems to receive little attention during “standard” addictions treatment • Although faced with challenging circumstances, all participants expressed hope about the future and investment in staying safe following treatment

  16. Thank You! marki@umich.edu

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