Thursday, October 10, 2013

Substance Abuse Prevention is Suicide Prevention

By Action Alliance Executive Secretary David Litts & Colleen Carr

When we prevent or successfully treat substance abuse, we prevent suicides. There is a powerful connection between the missions of the substance abuse prevention and treatment communities and the suicide prevention community – and much to be gained when these groups come together around their common goals.

Drug poisoning deaths have increased 120 percent in recent years – from 17,415 in 2000 to 38,329 in 2010. The majority (58 percent) of the drug deaths involved pharmaceuticals, and 75 percent of those deaths involved prescription pain relievers.[i] In 2010, U.S. emergency departments treated 202,000 suicide attempts in which prescription drugs were used as the means, 33,000 of which were narcotic pain relievers.[ii]
The suicide and substance abuse prevention fields need to align their efforts to promote healthy individuals and healthy communities.

Many of the factors that increase the risk for substance abuse, such as traumatic experiences, also increase the risk for suicidal thoughts and behaviors,[iii],[iv] and substance abuse, like mental health problems, is linked with a several-fold increase in suicide risk.[v],[vi]

There is hope, however: Prevention works, treatment is effective, and recovery is possible. Life skills that support effective problem-solving and emotional regulation, connections with positive friends and family members, and social support can protect individuals from both substance abuse and suicide. Treatment and support are important precursors for recovery from substance abuse as well as recovery from suicidal thoughts.[vii],[viii]

In September 2012, a newly revised National Strategy for Suicide Prevention (NSSP) was released by the National Action Alliance for Suicide Prevention (Action Alliance) in conjunction with the Office of the Surgeon General. The Action Alliance is a public-private partnership, jointly launched in 2010 by the Secretaries of Health and Human Services and Defense, envisioning a Nation free from the tragic experience of suicide. The connection between suicide prevention and the prevention and treatment of substance abuse is either implicit or explicit in each of the 13 goals of the NSSP, as it should be. Recognizing this, the NSSP calls for several actions, including:
  • Train staff in substance abuse treatment settings to ask their clients and patients directly and in a non-judgmental way whether they are having thoughts of suicide or think things would be better if they were dead. Ask on intake and periodically throughout the course of treatment, and ask in a way that opens the door for a truthful response. 
  • Work with individuals, families and other social groups, and communities to reduce access to drugs, especially access to lethal quantities of drugs among individuals at increased risk for suicide. This includes reducing stocks of medications kept in the home, locking up commonly abused medications, and encouraging the proper disposal of unused and unneeded prescription drugs, a key component of the 2013 National Drug Control Strategy.
Let us commit to stronger collaboration between substance abuse and suicide prevention efforts at all levels: community, state, tribal, and national. And let’s take action. The stakes are too high to do otherwise.

[i] Centers for Disease Control and Prevention. National Vital Statistics System. 2010 Multiple Cause of Death File. Hyattsville, MD: US Department of Health and Human Services, Centers for Disease Control and Prevention; 2012.


[iii] Dube, S, Felitti V et all. (2003). Childhood Abuse, Neglect, and Household Dysfunction and the Risk of Illicit Drug Use: The Adverse Childhood Experiences Study. Pediatrics, Vol. 111 No. 3.

[iv] Afifi T, Murray W, et al. (2008) Population Attributable Fractions of Psychiatric Disorders and Suicide Ideation and Attempts Associated With Adverse Childhood Experiences. American Journal of Public Health 2008, Voi 98, No. 5.

[v] Conwell Y, Duberstein PR, Cox C, Herrmann JH, Forbest NT, Caine ED (1996). Relationships of age and axis I diagnoses in victims of completed suicide: A psychological autopsy study. American Journal of Psychiatry, 153(8): 1001-1008.

[vi] Moscicki EK (2001). Epidemiology of completed and attempted suicide: Toward a framework for prevention.Clinical Neuroscience Research, 1, 310-323.

[vii] Brown, G. K., Ten Have, T., Henriques, G. R., Xie, S. X., Hollander, J. E., & Beck, A. T. (2005). Cognitive Therapy for the Prevention of Suicide Attempts: A Randomized Controlled Trial. JAMA: Journal of the American Medical Association, 294(5), 563-570.

[viii] Linehan, M. M., Comtois, K. A., Murray, A. M., Brown, M. Z., Gallop, R. J., Heard, H. L., et al. (2006). Two-Year Randomized Controlled Trial and Follow-up of Dialectical Behavior Therapy vs Therapy by Experts for Suicidal Behaviors and Borderline Personality Disorder. Archives of General Psychiatry, 63(7), 757-766.

This blog entry is cross-posted on the white house website.