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Chemical Dependency And Suicide
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Chemical Dependency And Suicide

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    Chemical Dependency And Suicide Chemical Dependency And Suicide Presentation Transcript

    • Chemical Dependency and Suicide
      Karen Rawlins and Lauren Barkley
    • Veterans with Addiction
      Kausch, 2001
    • Veteran’s – Suicide Rates
      248 completed suicides in one year:
      3x the rate of non-dependent vets.
      63% of outpatient vets were alcohol dependent.
      1/3 of those with alcohol dependence were also “other” drug dependent.
      770 reported suicide attempts in same year.
      Kausch, 2001
    • Veteran’s – Suicide Risk Factors
      The longer they were alcohol dependent, the greater the risk.
      Most were male in the third decade of life, which is approximately 10 years younger than non-veteran suicides.
      Mood and Personality Disorders increased risk.
      Kausch, 2001
    • Opioid Dependence & Suicidality
      Maloney, 2007
    • Opioid Dependence and Suicide Rates
      66% lifetime prevalence of suicide ideation.
      31% had attempted suicide
      19% had attempted suicide more than once.
      63% indicated a severe intent to die.
      Both cases and controls were more likely than the general population to suffer from substance abuse issues and psychological disorders.
      Maloney, 2007
    • Opioid Dependence and Suicide Risk Factors
      Childhood Maltreatment – including physical, emotional, sexual & neglect
      Axis II Disorders, esp. Borderline Personality Disorder
      DSM-IV Diagnosis of PTSD
      Depressive Episode
      Other drug dependency (sedatives, stimulants)
      Unemployment
      Maloney, 2007
    • What can we do as nurses?
    • Non-physicianAssessment and Service Planning
      Bartels, 2005
    • Evaluating Provider Assessments
      Survey conducted of
      NON-physician
      community mental health providers:
      13 agencies,
      44 clinicians, &
      100 consumers.
      Bartels, 2005
      33% failed to screen for substance use.
      Over 40% failed to screen for suicide risk and dangerous behaviors.
      Over 75% failed to screen for caregiver burden & risk of neglect or abuse.
    • Integrated Assessment, Planning and Evaluation
      Multi-disciplinary team of clinicians, consumers, administrators, and clinical outcomes researchers developed an integrated system of clinical assessment, service planning, and outcome measurement.
      Compare to nursing process: Assessment, Diagnosis, Planning, Intervention and Evaluation (ADPIE)
      Bartels, 2005
    • The Non-physician Intervention
      Included 4 elements:
      Selecting key domains of functioning and symptoms
      Identification of valid, brief assessment and outcome measures
      Development of decision-support materials for selecting appropriate treatments
      Pilot-testing in community settings.
      Bartels, 2005
    • Symptom-specific Domains
      Axis I – Behavioral Issues
      Axis IV – Social/Environmental
      Axis V – Global Functioning
      Bartels, 2005
      Depression, suicide, mania, anxiety, suspiciousness, hallucinations, substance abuse, hostile and dangerous behaviors, and memory.
      Daily living skills, personal care skills, social skills, leisure activities, work and education, health status, and treatment, self-management.
      Social supports, caregiver burden, residential risk, safety, neglect and abuse, and residential status.
    • Outcomes and Evaluation
      Increased comprehensiveness of assessments and specificity of treatment planning.
      Major gains made in routine clinical assessment practices as described through clinician interviews, and reflected in medical record reviews.
      Improvements also found in the specificity of service plans.
      Bartels, 2005
    • Nurses can make a difference
      Major gap between knowledge and routine clinical practice.
      Promote use of standardized methods that guide the clinician (nurse) through the process of assessment, outcome measurement, and treatment planning.
      Demonstrated effectiveness.
      Bartels, 2005
    • Suicide,Chemical Dependency and Mental Health IssuesGo Hand in Hand
      We can be the ones who ask…
    • References
      Bartels, S.J., Miles, K. M., VanCitters, A.D., Forester, B.P. & Cohen, M.J. (2005). Practices for older adults: A controlled comparison study. Mental Health Services Research, 7 ,213-223.
      Kausch, O., McCormick , R.A., (2001). Suicide prevalence in chemical dependency programs: preliminary data from a national sample, and an examination of risk factors. Journal of Substance Abuse Treatment,2,97–102.
      Maloney, E., Degenhardt, L., Darke, S., Mattick, R.P., & Nelson, E., (2007). Suicidal behaviour and associated risk factors among opioid-dependent individuals: A case–control study. Society for the Study of Addiction, 102, 1933–1941.