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Chemical Dependency And Suicide
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Chemical Dependency And Suicide Presentation Transcript

  • 1. Chemical Dependency and Suicide
    Karen Rawlins and Lauren Barkley
  • 2. Veterans with Addiction
    Kausch, 2001
  • 3. 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
  • 4. 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
  • 5. Opioid Dependence & Suicidality
    Maloney, 2007
  • 6. 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
  • 7. 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
  • 8. What can we do as nurses?
  • 9. Non-physicianAssessment and Service Planning
    Bartels, 2005
  • 10. 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.
  • 11. 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
  • 12. 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
  • 13. 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.
  • 14. 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
  • 15. 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
  • 16. Suicide,Chemical Dependency and Mental Health IssuesGo Hand in Hand
    We can be the ones who ask…
  • 17. 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.