Chemical Dependency And Suicide


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Chemical Dependency And Suicide

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