A cognitive-behavioral intervention showed promise for reducing suicidal ideation among substance users in a pilot, controlled study with 46 patients.
“Preliminary evidence supports the short-term efficacy of CBT [cognitive-behavioral therapy] for suicidal substance users, but more comprehensive data are needed,” Mark A. Ilgen, Ph.D., said at the annual conference of the American Association of Suicidology.
Dr. Mark Ilgen
The study’s main finding was that among 22 patients assessed 1 month after the end of a 4-week CBT intervention, 3 participants (14%) said they had recent suicidal ideation, compared with 10 of 24 (42%) people from the control arm of the study, a statistically significant difference, said Dr. Ilgen, a psychologist at the University of Michigan in Ann Arbor.
Suicidal ideation and attempts among substance users receive little attention in “standard” addiction-treatment programs. But attention in this area is needed because “substance use disorders are strong risk factors for suicide attempts,” he said. Results from prior studies of people receiving substance use treatment showed that 45% reported making at least one suicide attempt, and a third reported suicidal ideation within the prior 2 weeks.
The current study by Dr. Ilgen and his associates began with 56 people enrolled in a residential addiction-treatment program in Waterford, Mich.; many of the residents lived at the center in lieu of going to jail, he noted. The participants in Dr. Ilgen’s study all had a history of at least one suicide attempt and current suicidal ideation. The researchers randomized 29 people into the CBT intervention and 27 into a control education-support program. The intervention consisted of eight sessions, done twice a week for 4 weeks.
The average age of the participants was 32, and they closely split between women and men. About four-fifths were white, 71% had used more than one substance, and 70% had a history of at least two suicide attempts.
Dr. Ilgen modeled the CBT intervention on CBT programs used for depression and substance use that have a focus on avoiding and managing suicidal crises. The program began with a suicide-risk assessment; subsequent sessions included the development of a narrative of past suicide attempts; advice on safety plans, coping skills, and problem solving; identifying reasons for living; and guidance on social support and relapse prevention. Patients in the CBT program attended an average of six of the eight scheduled sessions, while those in the control group attended an average of seven sessions.
Forty-six of the 56 enrolled participants returned for a follow-up assessment 1 month after the end of treatment, and 36 returned for a second assessment 3 months following treatment. At the first follow-up, participants in the CBT program had a significantly reduced prevalence of suicidal ideation, compared with the controls. The CBT participants also had statistically significant reductions in several other measurements of suicidality at 1-month follow-up. A wish to die sentiment was expressed by 8 of the 22 assessed (38%) in the CBT group, vs. 14 of the 24 (58%) controls. The average number of depressive symptoms was 14 in the CBT group and 18.8 in the controls. And the average level of suicide self-efficacy was 133 in the CBT patients, significantly higher than the average of 106 among the controls.
In contrast, the researchers found no statistically significant differences between the two treatment groups at the 3-month follow-up, possibly in part explained by the reduced number of study participants who returned for the second assessment, Dr. Ilgen said.
He said he had no relevant financial disclosures.