Facilitating use of the National Suicide Prevention Lifeline in Alcohol Patients

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ABSTRACT Individuals with Alcohol Use Disorders (AUDs) are at significantly elevated risk for fatal and non-fatal suicide attempts. This is seen in higher rates of suicide mortality in those diagnosed with an AUD as well as the high rates of prior suicidal behaviors and/or current suicidal ideation among of patients treated for AUDs. This elevated risk persists following AUD treatment. In addition, those with AUDs are prone to impulsive suicide attempts, those attempts that occur with less than 30 minutes planning, and can lead to rapid escalation in risk, particularly when under the influence of alcohol. New and effective strategies are needed to reduce suicide risk among those with AUDs and should be tailored to the unique risks in those with AUDs. The National Suicide Prevention Lifeline (NSP Lifeline) was established by Substance Abuse and Mental Health Services Administration (SAMHSA) to increase consistency in delivery of services. SAMHSA also implemented follow up procedures with treatment referrals for NSP Lifeline callers. Since its inception, the NSP Lifeline has received > 5 million calls. However, no data are currently available on whether use of the NSP Lifeline reduces an individual's likelihood of a suicide attempt or death and it is not feasible to test the efficacy of the Crisis Line in a randomized controlled trial because it is already nationally available. Additionally, the NSP Lifeline may not reach those individuals at most acute risk for suicide. Consequently, we developed and gathered pilot data on a brief intervention designed to increase utilization of crisis lines among high risk patients, called Crisis Line Facilitation (CLF). This single-session intervention involves a discussion of the patient's perceived barriers and facilitators of crisis line use during periods of suicidal crisis. The CLF session ends with the patient calling the NSP Lifeline with the therapist in the room as a way for them to practice the logistics of making the call and to have direct experiences that may counter any negative beliefs about crisis line use. The proposed study will recruit 500 participants who are currently receiving residential AUD treatment and have made a prior suicide attempt. This study will be a randomized controlled trial of the impact of CLF compared to enhanced usual care (EUC) on utilization of the NSP Lifeline as well as suicide attempt(s). All participants will be re-assessed at post-intervention, 4-, 8- and 12-months post baseline. Analyses will also examine the extent to which lifetime changes in the proposed mechanisms of action of CLF explain the effects of CLF on calls to the NSP Lifeline and suicide attempts as we as whether post-baseline NSP Lifeline use mediates the effect or random assignment to CLF on subsequent suicidal behaviors. If successful, the proposed study will provide key data on the potential efficacy of a brief tool to improve the utilization of an existing resource, the NSP Lifeline, to reduce suicidal behaviors in adults receiving treatment for AUDs. Developing a brief and effective approach to encourage use of NSP Lifeline has the potential to have a substantial impact on suicide rates and could be modified and exported to other populations and settings.