Facilitating use of the National Suicide Prevention Lifeline in Alcohol Patients

摘要 酒精使用障碍(AUD)患者的致命性和非致命性自杀风险显著增加 尝试。这在那些被诊断为AUD的人中更高的自杀死亡率中可见一斑 在接受AUDS治疗的患者中，既往自杀行为和/或当前自杀意念的比率。这 在AUD治疗后，风险升高仍然存在。此外，患有AUDS的人容易冲动自杀 尝试，那些在计划时间少于30分钟的情况下发生的尝试，并且可能导致风险的快速升级， 尤其是在酒精的影响下。需要新的有效策略来降低自杀风险 在AUDS患者中，应针对AUDS患者的独特风险量身定做。《国家自杀》 预防生命线(NSP生命线)是由药物滥用和精神健康服务机构建立的 行政部门(SAMHSA)，以提高提供服务的一致性。SAMHSA还实现了以下功能 为NSP生命线呼叫者提供治疗转介的UP程序。自成立以来，NSP生命线已经 接到了500万个电话。然而，目前没有关于NSP生命线的使用是否减少的数据 一个人自杀未遂或死亡的可能性，测试危机热线的效果是不可行的 在随机对照试验中，因为它已经在全国范围内可用。此外，NSP生命线可能不会 接触到那些自杀风险最大的人。因此，我们开发并收集了关于以下方面的试点数据 一种短暂的干预措施，旨在增加高危患者对危机热线的利用，称为危机热线 促进(CLF)。这种单次干预包括讨论患者感知到的障碍和 在有自杀倾向的危机期间使用危机热线的协助者。CLF会话结束时，患者调用 NSP与治疗师在房间内的生命线，作为他们练习打电话和 有直接的经验，可能会反驳任何关于使用危机线的负面看法。拟议的研究将 招募500名目前正在接受住院AUD治疗并有过自杀经历的参与者 尝试。这项研究将是一项随机对照试验，将CLF的影响与加强的常规护理进行比较 (欧洲联盟委员会)关于使用新SP生命线以及自杀未遂(S)。所有参与者将在以下时间重新评估 干预后、基线后4、8和12个月。分析还将检查生命周期的程度 CLF拟议作用机制的变化解释了CLF对NSP生命线调用的影响 和自杀未遂一样，我们作为基线后是否使用NSP生命线的中介效应或随机 在随后的自杀行为上分配给CLF。如果成功，拟议的研究将提供关键数据 关于提高现有资源利用率的一个简短工具--新能源生命线--的潜在效力 减少接受AUDS治疗的成年人的自杀行为。开发一种简短有效的方法来 鼓励使用NSP生命线有可能对自杀率产生重大影响，并可能 修改并导出到其他人口和设置。

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.