Suicide Prevention and Addiction - January 2014


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“Suicide Prevention and Addiction” was presented on Tuesday January 28, 2014; by Raymond Dalton, MA; Dawn Farm Outpatient Services Coordinator. There is an alarmingly high prevalence of suicide among people with addiction and people in early recovery. This program will raise awareness of the signs of suicidal thinking and describe ways to offer support and obtain help for people who may be contemplating suicide. Viewers will learn how to recognize suicidal thinking, reach out and offer support to others contemplating suicide, obtain help when suicidal thoughts are present, and access local and national suicide prevention and intervention resources. This program is part of the Dawn Farm Education Series, a FREE, annual workshop series developed to provide accurate, helpful, hopeful, practical, current information about chemical dependency, recovery, family and related issues. The Education Series is organized by Dawn Farm, a non-profit community of programs providing a continuum of chemical dependency services. For information, please see

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  • Remember attempts may look like overdoses
  • Not out of the woods yet.
  • The difference between those who attempt and complete is not a matter of intention or desire but one of lethality and having means to lethal methods.
  • Important to note that 1/2 of all deaths by suicide are first time attempts on the first one
    A lot of those who are struggling with addiction are prone to unemployment, separation, legal problems, social isolation forced or unforced…
  • Remember most people will exhibit/express signs prior to any attempt
    Posting things, asking you pills, guns etc.
    Giving things up, talking about watching loved ones foreshadowing
  • Ideation look for statements like...
    *****Use the flow chart for this section ******
  • So you have reason to believe indirect or direct warning signs are present now what?
    There is a reason they are talking to you. Show it by reflecting, sit in the pain with them
  • Addiction field is great about asking about sobriety threatening things, cravings, struggles, relapses
  • Suicide Prevention and Addiction - January 2014

    1. 1. The Bridge Between Addiction and Suicide Raymond Dalton, MA Program Coordinator, Dawn Farm Outpatient, Community Corrections and Youth and Family Services programs
    2. 2. This program is part of the Dawn Farm Education Series. It is presented by Raymond Dalton, MA. Ray is currently the coordinator of Dawn Farm’s Outpatient, Community Corrections and Youth and Family Services programs. Prior to this Ray served as the Community Corrections Outreach Program Coordinator for Dawn Farm and also as a therapist with Dawn Farm’s Daybreak Adolescent program. Prior to working for Dawn Farm Ray recruited, trained and supervised volunteer counselors to answer the suicide prevention hotline for the state of Kansas. He received his Master’s degree in Counseling Psychology from the University of St. Mary and his Bachelor’s degree from the University of Kansas.
    3. 3. “I have a spectacular pile of crack in the little ashtray on the nightstand. This is the most I have ever had on my own, and I know I will smoke every last bit of it. I wonder if somewhere in that pile is the crumb that will bring on a heart attack or stroke or seizure. The cardiac event that will deliver all this to an abrupt and welcome halt. My chest pounds, my fingers are singed, I fill my lungs with smoke.” Bill Clegg, “Portrait of an Addict as a Young Man”
    4. 4. “An all night place provided me with a dozen glasses of ale. My nerves were stilled at last. A morning paper told me the market had gone to hell again. Well, so had I… Should I kill myself. No-not now. Then a mental fog settled down. Gin would fix that. So, two bottles and -oblivion.” “Again I swayed dizzily before an open window, or the medicine cabinet where there was poison, cursing myself for a weakling.” “Then came the night when the physical and mental torture were so hellish I feared I would burst through my window, sash and all. Somehow I dragged my mattress to a lower floor, lest I suddenly leap…People feared for my sanity. So did I.” -Bill Wilson, “Bill’s Story”
    5. 5. This part of the presentation refers to the video, “Moyers on Addiction: Close to Home - Portrait of Addiction.” A link to the video is posted on the web site “” and can be accessed at The presenter uses the chapter titled “Battle For My Life.” This section starts at 29:23 minutes and ends 37:28 minutes.
    6. 6. Alcohol and Drug Addiction • • • • Primary Chronic Progressive Fatal
    7. 7. Biopsychosocial consequences of middle and late addiction
    8. 8. • Middle Stage of Addiction (Daily Use, Tolerance, Blackouts, Unpredictable use once use begins, Hard to predict behavior while intoxicated). • • • • • • • • Isolates from non-using friends, non-using family Pre-occupation with use (obsession) Emotional instability Consequences - legal, vocational, family, financial, health May protect use by blaming others Sleep disturbances, weight loss or gain Early withdrawal symptoms Suicidal ideations
    9. 9. • Late Stage of Addiction (Using to “feel normal”, Uses all day, Loss of control when it comes to starting or stopping, Compulsive Use) • • • • • • Emotional Deterioration Chronic Anger, Shame, Guilt or Fear Terrified of being sober Can’t live with the drug, can’t imagine stopping Frequent blackouts, loses time Serious physical health problems - tolerance decreases • Institutions (jail, emergency rooms, psychiatric hospitals) • Frequent suicidal ideations, plans, or attempts
    10. 10. Post Acute Withdrawal Symptoms • Anhedonia • Continued craving • Depression, anxiety, other mental health symptoms no longer masked • Trauma, grief and loss resurface • Cognitive distortions, unclear/unfocused thoughts
    11. 11. PAW symptoms continued…. • Physical health problems (Hepatitis, HIV, heart, lung and liver problems) • Legal consequences • Dealing with shame and guilt; rebuilding relationships • Fatigue, continued sleep disturbances • Relapse
    12. 12. Substance Use and Suicide Statistics: • Suicide is the leading cause of death among people who abuse alcohol and drugs (Wilcox, Conner, & Caine, 2004) • Individuals treated for chemical dependency are 10X more likely to die by suicide compared to the general population. Intravenous drug users are 14X more likely to die by suicide (Wilcox et al., 2004)
    13. 13. • 90% of all persons who completed suicide met criteria for a substance use disorder and/ or another other mental health disorder (Moscicki, 2001). • Acute alcohol intoxication is present in 3040% of suicide attempts/completed suicides (Cherpital, Borges, & Wilcox, 2004). • Overdose suicides often involve multiple substances - including alcohol and other illicit substances (Darke & Ross, 2002).
    14. 14. Fables • Suicide happens without warning • People who die by suicide are physically weak or weak minded • Once a person is suicidal they will struggle with suicide off and on for life • Improvement following a suicide crisis means the risk is over • Suicide runs in the family
    15. 15. • People who are suicidal are “crazy” • More people die by homicide than suicide • Teens kill themselves more than other age groups • People would be better off without me • More suicide deaths happen around holidays • There are two types of people those who talk about it and never will and those who complete suicide.
    16. 16. Golden Gate Bridge and the follow-up study • Estimated 2,000 deaths on SFB bridge • A research study by Seiden (1978), followed up with survivors and those who were stopped prior to jumping • 94% of those who attempted were still alive or died of natural causes. • 1/3 of the those who died, did so within a 6-month period of time • Deaths were highly correlated to response • Suicide tends to be both preventable and temporary
    17. 17. “ I instantly realized that everything in my life that I’d thought was unfixable was totally fixable—except for having just jumped”. Ken Baldwin (he jumped from the Golden Gate Bridge in 1985. He recovered, found his calling, and has been teaching high school now for 20 years).
    18. 18. Suicide Risk Factors • • • • • • • • Prior suicide attempts (most potent factor) Chemical dependency Co-occurring mental health disorder History of childhood abuse or recent trauma Unemployment Recent divorce/seperation Legal problems Social isolation
    19. 19. Risk Factors continued… • • • • • • • • • Proneness to negative affect Aggression and impulsivity Firearm ownership Perfectionist (especially when combined with mood disorder) Low self-esteem, high self-loathing Chronic pain GLBTQ community Family Discord Death of someone close, especially if by suicide
    20. 20. Warning Signs • Direct signs Suicidal communication Seeking access to a method Making preparations
    21. 21. Warning Signs continued… • Indirect warning signs (IS PATH WARM)  Ideation  Substance Abuse or Dependency  Purposelessness  Anxiety  Trapped  Hopelessness  Withdrawal  Anger  Recklessness  Mood Changes
    22. 22. How do I help with someone who is actively suicidal…? • Ask directly This will not make someone want to die Practice Ask if they have done anything yet… • Listen Reflect ambivalence Gather information (don’t forget to listen) Don’t move to planning for safety too quickly, there are no quick fixes (not applicable when person is in imminent danger).
    23. 23. How to help continued…? • • • • • • Ask if they have a plan to kill themselves Do they have access to the method ASK ABOUT FIREARMS! Any previous attempts Listen Identify strengths, values, resources (be careful with this). • Safety Plan & get others involved • Follow up with the person • Finally, take care of yourself
    24. 24. Further actions • Get family, friends, supports or other agencies involved • Arrange a robust referral Substance abuse treatment (or more intense tx) Detoxification Center Psychiatric Other Mental Health Services In home case manager or therapist Mobile Crisis Team
    25. 25. Further Actions (continued) • Follow up with the person about attendance • Continue to ask about suicide (don’t assume) • Increase frequency of care Telephone check-ins More visits, added sessions Look for IS PATH WARM signs or signals over the next several months Provide/create a safety card (example in pamphlet)
    26. 26. “Those who have a 'why' to live, can bear with almost any 'how'.” -Viktor Frankel, Man’s Search for Meaning
    27. 27. Protective Factors • • • • • • • Able to identify reasons for living Being clean from drugs and alcohol Mutual Support attendance Religious attendance or internalized spiritual beliefs Child rearing responsibilities Intact relationships with family, spouse, etc., Trusting relationship with counselor, case worker or sponsor • Employment • Trait optimism (tendency to look at the positive side of life).
    28. 28. “Attending meetings daily, living a day at a time, and reading literature seems to send our mental attitude back toward the positive.” - NA basic text quote p. 82
    29. 29. “Pray for the dead and fight like hell for the living” -Mother Jones
    30. 30. Summary One last Acronym: TALK Tell Ask Listen Keep Safe
    31. 31. Helpful Websites • Substance Abuse and Mental Health Services Administration, • National Institute on Drug Abuse, • American Association of Suicidology, • Huron Valley Intergroup Inc., • National Alliance on Mental Illness of Washtenaw County, (click on local meetings tab for dual-diagnosis meetings and support groups)
    32. 32. For those who have lost a loved one to suicide Survivors of Suicide Support Group Contact: Maryjane Bottonari, (734) 761-2988, Meeting Place: The Women's Center of Southeastern Michigan, 2425 WestStadium Boulevard, Ann Arbor, MI Meeting Days/Meeting Time: 2nd and 4th Tuesday of the month, 7:00-8:30PM
    33. 33. Suicide Hotline National Suicide Prevention Lifeline 1-800-273-TALK Operates 24/7