Cognitive behavioral treatment for suicidal substance users
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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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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

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.


Overview

Overview

  • Describe the process of modifying CBT for suicidal substance users.

  • Discuss content of the intervention.


Interventions to address patients at high risk for suicide

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


Addressing suicide risk during addictions treatment

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


Study design

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


Community programs incorporated

Community Programs Incorporated


Case example background

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


Overall of cbt for suicidal substance users

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.


Structure of sessions

Structure of Sessions

  • Mood/check

  • Tie to previous session

  • Set agenda

  • Review homework

  • Cover primary session topics

  • Discuss homework assignment

  • Summary and feedback


Session content

Session Content


Case example response to treatment

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


Update on study

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)


Changes in post session mood ratings in cbt condition

Changes in post-session mood ratings in CBT condition


Summary

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


Cognitive behavioral treatment for suicidal substance users

Thank You!

[email protected]


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