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升高 尝试.这可以从被诊断患有AUD的人的自杀死亡率较高以及 接受AUD治疗的患者中既往自杀行为和/或当前自杀意念的发生率。这 AUD治疗后风险持续升高。此外，那些有AUD的人容易冲动自杀 尝试，这些尝试发生在不到30分钟的计划，并可能导致风险迅速升级， 特别是在酒精的影响下。需要新的有效策略来降低自杀风险 应根据澳元持有者的独特风险量身定制。国家自杀 预防生命线（NSP生命线）是由物质滥用和精神健康服务建立的 行政管理（SAMHSA），以提高提供服务的一致性。SAMHSA还执行了以下操作 为NSP生命线呼叫者提供治疗转介。自成立以来，NSP生命线已 收到超过500万个电话。然而，目前没有数据表明使用国家战略计划生命线是否减少了 个人自杀企图或死亡的可能性，并且无法测试危机线的有效性 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 接触那些自杀风险最高的人。因此，我们开发并收集了以下方面的试点数据： 一个简短的干预措施，旨在提高高风险患者对危机热线的利用率，称为危机热线 促进（CLF）。这种单次干预涉及讨论患者感知的障碍， 在自杀危机期间使用危机线的促进者。CLF会话以患者呼叫 NSP生命线与治疗师在房间里，作为他们练习打电话的逻辑和 有直接的经验，可能会抵消任何负面的信念，对危机线的使用。拟定的研究将 招募500名目前正在接受住院AUD治疗并有自杀史的参与者 企图。本研究将是一项随机对照试验，比较CLF与加强常规护理的影响 (EUC)使用NSP生命线以及自杀企图。所有参与者将在 干预后、基线后4个月、8个月和12个月。分析还将检查生命周期 CLF作用机制的变化解释了CLF对NSP生命线呼叫的影响 和自杀企图，因为我们认为基线后NSP生命线的使用是否介导了效果或随机 分配到CLF对随后的自杀行为。如果成功，拟议的研究将提供关键数据， 国家战略计划生命线是一个简单的工具，可以提高现有资源的利用率， 减少接受AUD治疗的成年人的自杀行为。制定一个简短有效的方法， 鼓励使用NSP生命线有可能对自杀率产生重大影响， 修改并导出到其他群体和设置。

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.