Can Addressing Suicidal Behavior and Alcohol Use Together Prevent Suicidal Behavior by Teens?

BACKGROUND

Although suicide in adolescents occurs infrequently, it remains the second leading cause of death for this age group. A significant risk factor for suicide in adolescents is the use of alcohol. Drinking alcohol reduces the ability to inhibit or stop behavior, depresses mood and impairs decision making and can lead those at risk for suicide to engage in suicidal behavior.

Motivational interviewing (MI) interventions are a type of intervention through which clinicians encourage patients to change negative or harmful behaviors by allowing them to discuss the ways these behaviors affect them. Through MI, clinicians work with people to establish a plan for changing harmful behaviors. Previous studies have shown that MI is effective for reducing adolescent alcohol and drug use. Motivational interviewing has also been shown to be an effective intervention for adults hospitalized for suicidal ideation and behavior.

While the interaction between alcohol use and increased risk for suicide in adolescents is clear, interventions for suicidal behavior generally do not focus on alcohol use. Dr. Kimberly O’Brien and her team tested a motivational interviewing intervention called Alcohol and Suicide Intervention for Suicidal Teens (ASIST) to determine if an intervention addressing both alcohol use and suicidal behavior would be helpful to hospitalized adolescents.

QUESTION

Is a brief MI intervention helpful to adolescents hospitalized for suicidal behavior who also use alcohol?

STUDY

Dr. Kimberly O’Brien and her team recruited 50 adolescents who were psychiatrically hospitalized for a suicide attempt. At the beginning of the study, clinicians assessed the participants, asking them questions about their alcohol and drug use over the past 90 days using the Timeline Follow-Back Interview; suicidal ideation experienced over the past month with the Suicidal Ideation Questionnaire; and suicide attempts in the past three months with a single question from the Columbia Suicide Severity Rating Scale. Participants were again asked these questions during a follow-up assessment three months after hospital discharge.

The participants were assigned to one of two groups. One group received the Alcohol and Suicide Intervention for Suicidal Teens (ASIST) along with Treatment as Usual (TAU) as described below. The other group received only TAU.

Patients in the ASIST group participated in two treatment sessions. During the first session, each adolescent met individually with a clinician who asked them about their opinions toward their alcohol use, and how their alcohol use interacts with their suicidal ideation and behavior. Each participant was then asked to establish goals related to these behaviors, create a plan for change, and identify strategies for effecting change. The clinician would discuss these behaviors with the adolescent and then provide them with personalized feedback. This feedback aimed to help the participant understand how alcohol use affects them and interacts with their suicidal behavior.

Adolescents in the ASIST group also participated in a family session with their parent(s). During this session, the adolescent described their goals, change plan, and strategies for change to their parent(s). The adolescent then identified ways for their parents to provide support in achieving these goals. Finally, participants in the ASIST group were asked 20 questions relating to whether they felt the intervention was helpful.

For participants who received TAU, clinicians performed an evaluation to determine which of the adolescent’s mental health problems required the most attention. The participant then received medication, if necessary. TAU included both individual and family sessions aimed at addressing a healthier lifestyle through psychoeducation, or clinician-provided instruction on exercise, sleep and nutrition. Each participant created a safety and coping plan to assist them in resisting suicidal behavior. Alcohol use was only addressed in the TAU group if the clinician determined it to be a significant problem for that participant. The TAU group had an enhanced version of treatment in order to maintain the same level of contact between the patient, their family and the treatment team.  Treatment was much more extensive than what would have been typically provided.

RESULTS

Researchers found that all 50 participants completed either the ASIST intervention or TAU. Of these participants, 82 percent (20 in the ASIST group, and 21 in the TAU group) completed the follow-up assessment three months later. These results showed that the ASIST intervention was feasible, and can be used during hospitalization. Additionally, 92 percent of adolescents who received the ASIST intervention indicated that it helped them to understand the relationship between their alcohol use and suicidal behavior. Participants in both groups reported significantly reduced suicidal ideation alcohol use, marijuana use, and tobacco use, and greater confidence in reducing their alcohol use. Since both groups improved, the study did not demonstrate that the ASIST intervention was better than the enhanced TAU in terms of reducing the severity of suicidal ideation or alcohol use.

TAKEAWAY

– For adolescents, alcohol use can be a significant risk factor for suicide

– Both interventions – Alcohol and Suicide Intervention for Suicidal Teens (ASIST) and an enhanced Treatment as Usual (TAU) helped adolescents who made a suicide attempt and led to reduced suicidal ideation and alcohol use

– Interventions that address both alcohol use and suicidal behavior may be helpful to adolescents

-The brief motivational interviewing intervention Alcohol and Suicide Intervention for Suicidal Teens (ASIST) can be used by clinicians in hospital settings

Dr. Kimberly O’Brien received an AFSP Young Investigator Research Award for this work in April 2019. She was also awarded a grant from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) as a result of her AFSP funded study.

Kimberly O’Brien, PhD, LICSW
Assistant Professor, Harvard Medical School
Grant Title: Brief Alcohol Intervention for Adolescents Who Have Attempted Suicide
2014 Young Investigator Grant

Grant-Related Publications:

McManama O’Brien, K. H., Sellers, C. M., Battalen, A. W., Ryan, C. A., Maneta, E. K., Aguinaldo, L. D., White, E., & Spirito, A. (2018). Feasibility, acceptability, and preliminary effects of a brief alcohol intervention for suicidal adolescents in inpatient psychiatric treatment. Journal Of Substance Abuse Treatment, 94, 105–112. https://doi.org/10.1016/j.jsat.2018.08.013

O’Brien, K., Aguinaldo, L.D., White, E., Sellers, C.M., & Spirito, A. (2018). A brief alcohol intervention during inpatient psychiatric hospitalization for suicidal adolescents. Cognitive and Behavioral Practice, 25(1), 22-31.

Click here to read more about Dr. O'Brien's Young Investigator Grant.