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Substance-Related Disorders

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Alcoholism and Alcohol abuse

Substance abuse and dependence:

Research articles:

Boenisch, S. S., Bramesfeld, A. A., Mergl, R. R., Havers, I. I., Althaus, D. D., Lehfeld, H. H., & ... Hegerl, U. U. (2010). The role of alcohol use disorder and alcohol consumption in suicide attempts–A secondary analysis of 1921 suicide attempts. European Psychiatry, 25(7), 414-420. doi:10.1016/j.eurpsy.2009.11.007

Abstract: Background: It is not known how characteristics of suicide attempts vary with different forms of alcohol involvement. The aim of this study is to clarify the role of alcohol use disorder and acute alcohol consumption in suicide attempts. Methods: Data on 1921 suicide attempts was gathered in a major German city over a 5-year period. Suicide attempts were categorised according to a diagnosis of alcohol use disorder and acute alcohol consumption at the time of the attempt. Group comparisons and multinomial logistic regression were used for statistical analysis. Results: In 331 suicide attempts (17%) an alcohol use disorder was diagnosed. Six hundred and twenty-two suicide attempts (32%) were committed with acute alcohol consumption. Suicide attempts by individuals with alcohol use disorder were more often committed by men, older individuals and as a recurrent attempt, independently of alcohol consumption at the time of the attempt. When alcohol was consumed in suicide attempts by individuals with alcohol use disorder, low-risk methods were used most often. Conclusions: Individuals with a diagnosis of alcohol use disorder are a high-risk group for multiple suicide attempts and should be a target group for suicide prevention. Screening for suicidality should be a regular part of the clinical assessment in individuals with alcohol use disorder. [Copyright &y& Elsevier]

de la Vega Sánchez, D. D., Urrutia, P., Arnau, J., Soler, M., Bonafont, A., Páez, P., & Moreno, A. (2011). P01-21 - Substance abuse is associated with a higher risk of suicide. European Psychiatry, 26, 21. doi:10.1016/S0924-9338(11)71732-1

Introduction: Suicide is a major and preventable public health problem. Risk factors may vary with age, gender, or ethnic group, being substance abuse one of the most frequent. Objectives: To investigate the relation of substance related disorder and suicide attempt. Methods: Review of the suicidal attempts of patients with personal history of substance related disorder attended during the year 2010. Results: We identified 85 cases. Alcohol (64″3%) and cocaine (47″7%) were the two most identified substances. Cannabis (17″2%) and heroin (23″06%) were less consumed. Benzodiacepines abuse was very frequent among the patients attended (38″2%). Previous attempts were found in 43″8% of the patients. Drug overdose was the most commonly method used (98″4%), especially with benzodiacepines and antidepressants, but non psychiatric drugs were also frequent. Substance overdosage or intoxication was the second most frequent method used (23%), and poisoning the third (9%). Most of times these methods were presented with concomitant drug overdose. Defenestration threats were very rare (2″34%), and always associated with hospitalization request by the patient. We did find significant differences when studying triggers (family, partnership, economical or others) compared with non substance abusers suicidal attempts. Conclusions: [-] Chronic substance misuse and acute substance abuse is associated with a higher risk of suicide, what may be explained by the disinhibiting effects of psychoactive substances. [-] As benzodiazepine misuse is associated with suicide, special care must be taken when prescribing to at risk patients such as substance abusers [Copyright & Elsevier]

Dietz, T. L. (2011). Substance misuse, suicidal ideation, and suicide attempts among a national sample of homeless. Journal of Social Service Research, 37(1), 1-18. doi:10.1080/01488376.2011.524511

This study's purpose was to identify the relationship between the annual incidence of drug and alcohol misuse among a national probability sample of 2,974 homeless individuals and self-reports of suicidal ideation and attempts while considering the predictors of both drug and alcohol misuse and suicidal ideation and attempts. By using a national dataset, the National Survey of Homeless Assistance Providers and Clients (NSHAPC), and testing a series of logistic models, this study allows for the development of empirically-driven prevention and treatment programs designed to appropriately and effectively target suicidal ideation and attempts among homeless substance misusers. [ABSTRACT FROM AUTHOR]

Landheim, A. S., Bakken, K. K., & Vaglum, P. P. (2006). What characterizes substance abusers who commit suicide attempts? Factors related to axis I disorders and patterns of substance use disorders. European Addiction Research, 12(2), 102-108. doi:10.1159/000090430

Objective: The frequency of suicide attempts and clinical characteristics of attempters among poly-substance abusers and alcoholics were examined. Methods: A consecutive sample (n = 260) of in- and outpatients from two Norwegian counties were assessed by Composite International Diagnostic Interview (Axis I disorders), Millon’s Clinical Multiaxial Inventory (Axis II disorders) and the Norwegian National Client Assessment Form. When analysing the association between suicide attempters and the range of predictor variables, logistic regression analysis was conducted. Results: Almost half (47%) of the sample reported lifetime suicide attempts; significantly more frequently in poly-substance abusers (58%) than alcoholics (38%). A substance use disorder with duration of ≥15 years and an early onset (<18 years of age) were independently associated with being a suicide attempter after controlling for Axis I disorders. In addition, eating disorders, agoraphobia and major depression were strongly and independently associated with being a suicide attempter. Conclusion: Attempts at preventing suicidal behaviour should not ignore the suicide risk among poly-substance abusers. In addition, prevention of suicidal behaviour demands a treatment programme focusing concomitantly on both addictive behaviour and comorbid psychiatric disorders. Copyright © 2006 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Light, J. M., Grube, J. W., Madden, P. A., & Gover, J. (2003). Adolescent alcohol use and suicidal ideation: A nonrecursive model. Addictive Behaviors, 28(4), 705. doi:10.1016/S0306-4603(01)00270-2

Prior research has found that adolescent alcohol use is correlated with suicide ideation and behaviors. The causal nature of this relationship, however, has not been established. It could result from a significant causal effect in either direction, both directions, or joint influence from some third factor. These possibilities were addressed using data from a two-wave (24-month) panel survey of junior and senior high school students aged 12 or older at Wave 1. A total of 615 students (301 males, 314 females) completed both waves. Alcohol Problems were related to suicide ideation and behavior cross-sectionally within Waves 1 and 2. Separate Full-Information Maximum Likelihood (FIML) models were estimated for males and females using the same set of identifying restrictions. Results suggested that suicidality leads to increased alcohol-related problems for females, while alcohol-related problems are predictive of suicidality among males. Sensitivity and spuriousness tests did not appreciably alter this conclusion. [Copyright &y& Elsevier]

Martins, A. P., Silva, A. A., Pinho, M. M., & Samico, G. G. (2011). P03-459 - Drug addiction and suicide - Retrospective study. European Psychiatry, 26, 1629. doi:10.1016/S0924-9338(11)73333-8

Impulsiveness has an important role in suicide behaviour and substance abuse. In this context, it''s important to assess suicide risk among drug users and to determine which factors play a protective role and which factors increase the risk. In this study the authors propose to determine the prevalence of actual or past suicidal ideation in a sample of substance users; to determine the prevalence of previous suicidal behaviours in the same sample; and to study the relation with clinical and sociodemographic variables. The sample included 119 patients with drug addiction behaviours receiving treatment in an inpatient detoxication unit (Unidade de Desabituação do Norte do IDT - Instituto da Droga e das Toxicodependências), admitted between May 2010 and July 2010. Data was obtained from the patient clinical chart, including the admission protocol form. SPSS was used for statistical analysis. The results founded were: 18,5% (n=22) had previous suicidal ideation at least once in their lifetime. 2,5% (n=3) had suicidal ideation at admission. 10,9% (n=13) had previous suicidal attempts. According to literature, in general population, lifetime prevalence of suicidal ideation is 10–18% and history of suicidal attempt is 3–5%. In the studied sample, suicidal ideation during lifetime is slightly raised (18,5%) and history of suicidal behaviours is strongly higher (10.9%). These data suggest a raised suicidal risk in drug abuse population, probably reflecting a higher impulsiveness in this population. [Copyright &y& Elsevier]

Pompili, M., Serafini, G., Innamorati, M., Dominici, G., Ferracuti, S., Kotzalidis, G., & ... Lester, D. (2010). Suicidal behavior and alcohol abuse. International Journal Of Environmental Research And Public Health, 7(4), 1392-1431. Retrieved from EBSCOhost.

Suicide is an escalating public health problem, and alcohol use has consistently been implicated in the precipitation of suicidal behavior. Alcohol abuse may lead to suicidality through disinhibition, impulsiveness and impaired judgment, but it may also be used as a means to ease the distress associated with committing an act of suicide. We reviewed evidence of the relationship between alcohol use and suicide through a search of MedLine and PsychInfo electronic databases. Multiple genetically-related intermediate phenotypes might influence the relationship between alcohol and suicide. Psychiatric disorders, including psychosis, mood disorders and anxiety disorders, as well as susceptibility to stress, might increase the risk of suicidal behavior, but may also have reciprocal influences with alcohol drinking patterns. Increased suicide risk may be heralded by social withdrawal, breakdown of social bonds, and social marginalization, which are common outcomes of untreated alcohol abuse and dependence. People with alcohol dependence or depression should be screened for other psychiatric symptoms and for suicidality. Programs for suicide prevention must take into account drinking habits and should reinforce healthy behavioral patterns.

Sakai, J. T., Hall, S. K., Mikulich-Gilbertson, S. K., & Crowley, T. J. (2004). Inhalant use, abuse, and dependence among adolescent patients: Commonly comorbid problems. Journal of the American Academy of Child & Adolescent Psychiatry, 43(9), 1080-1088. doi:10.1097/01.chi.0000132813.44664.64

Objective: Little is known about adolescents with DSM-IV-defined inhalant abuse and dependence. The aim of this study was to compare comorbidity among (1) adolescents with inhalant use disorders, (2) adolescents who reported using inhalants without inhalant use disorder, and (3) other adolescent patients drawn from an adolescent drug and alcohol treatment program. Method: The authors examined 847 admissions of patients who had completed structured diagnostic assessments. The three groups were compared for non inhalant substance use disorders post traumatic stress disorder, conduct disorder, major depression, previous suicide attempts, and physical/sexual abuse and neglect. Results: Adolescents with inhalant abuse or dependence (group 1; n = 28) were significantly more likely to meet lifetime criteria for abuse or dependence on alcohol, hallucinogens, nicotine, cocaine, and amphetamines, to have had major depression, and to have attempted suicide compared with other adolescent patients who reported never using inhalants (group 3); adolescents with inhalant use disorders also reported significantly more abuse and neglect. Adolescents with inhalant abuse or dependence (group 1) did not differ significantly on any measure compared with adolescents who reported using inhalants without an inhalant use disorder (group 2). Conclusions: Adolescent patients with a history of inhalant use, abuse, or dependence entering treatment should be carefully screened for noninhalant substance use disorders, major depression suicidality and abuse and neglect. [ABSTRACT FROM AUTHOR]

Vijayakumar, L., Kumar, M., & Vijayakumar, V. (2011). Substance use and suicide. Current Opinion in Psychiatry, 24(3), 197-202. Retrieved from EBSCOhost.

PURPOSE OF REVIEW: To address gaps identified in earlier reviews, namely, the comparative influence of substance use on attempted suicide and completed suicide; the proximal role of substance use as a trigger of suicidal behaviour; the association between substances and suicidal behaviour; suicide and substance use disorders in youth; and the influence of combinations of risk factors, including psychiatric morbidity, on suicide. RECENT FINDINGS: The presence of an alcohol use disorder is confirmed as a distal risk factor for completed suicide, as well as attempted suicide. Alcohol use at the time of the suicide attempt is associated with low-risk methods. The use of other substances as a trigger of suicidal behaviour is highlighted in recent studies, but the circumstances leading to the suicidal act and the direct influence of substances in suicidal behaviour need to be explored further. Inhalant use and cocaine use are particularly associated with suicidal behaviour. Young people with multiple risk behaviours, such as substance use and risky sexual behaviours, are at high risk for suicidal behaviour. Psychiatric comorbidity with substance use escalates the risk for suicidal behaviour. Environmental interventions, such as reduction in the number of bars, may be helpful in reducing alcohol-related morbidity, including suicides. SUMMARY: Prevention strategies for reducing suicidal behaviour among substance users need to be prioritized at the individual and the national level through effective design, policy and implementation.

Wilsnack, S., Wilsnack, R., Kristjanson, A., Vogeltanz-Holm, N., & Windle, M. (2004). Alcohol use and suicidal behavior in women: Longitudinal patterns in a U.S. national sample. Alcoholism: Clinical & Experimental Research, 28(5), 38S-47s. Retrieved from EBSCOhost.

BACKGROUND: Much of the research on suicidality has focused on adolescents and completed suicides, with less attention to types of suicidal behavior (ideation and attempts) that are more common among women. Research has associated women's suicidality with hazardous drinking, adverse childhood experiences, relationship problems, depression, and earlier suicidal behavior. The longitudinal analyses here examine long-term antecedents of suicidal ideation among women in the U.S. general population. METHODS: We used 1981 and 1991 survey data to predict post-1991 suicidal ideation in a 1996 national sample of 709 women aged 26 to 54 (538 current drinkers). Predictors included 1991 measures of hazardous drinking, depressive episodes, illicit drug use, general health, children at home, interaction with partner, and previous suicidal ideation. Predictors from childhood included recalled parental drinking, parental love or rejection, early drinking and sexual intercourse, and sexual abuse. Demographic predictors included age, education, and ethnicity. A three-stage structural equation model that included these variables was evaluated with Mplus for women who were drinkers in 1991 and/or 1996. RESULTS: Almost all women who attempted suicide also reported suicidal ideation. Among women drinkers, suicidal ideation before 1991 was more common in the following groups: Latinas, women who believed that their parents had rejected them, and women who reported childhood sexual abuse. Hazardous drinking and poorer health in 1991, childhood histories of sexual abuse and early drinking, and previous suicidal ideation predicted suicidal ideation after 1991. Domestic stressors in 1991 (inability to share feelings with a partner and having four or more young children at home) also predicted subsequent suicidal ideation, but depressive episodes did not. Suicidal ideation was less likely among women drinkers who reported past illicit drug use. CONCLUSIONS: Suicidal ideation among women drinkers was largely predictable from previous suicidal ideation, hazardous drinking, adverse childhood experiences, and domestic stressors. Higher rates of pre-1991 suicidal ideation among Latinas indicate a need for further study of ethnic influences on suicidality. Reduced suicidal ideation among women with past illicit drug use suggests that conclusions about such use from shorter-term studies may be oversimplified. Understanding women's suicidal ideation, as a precursor to suicidal actions, requires more detailed research on pathways by which hazardous drinking as well as combined distress from childhood experiences and adult domestic environments may increase women's despair and thoughts of suicide.

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