Crisis Intervention in Substance Abuse Treatment

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Manage episode 273010373 series 2460299
By AllCEUs Counseling CEUs and Dr. Dawn-Elise Snipes. Discovered by Player FM and our community — copyright is owned by the publisher, not Player FM, and audio is streamed directly from their servers. Hit the Subscribe button to track updates in Player FM, or paste the feed URL into other podcast apps.

Crisis Intervention in Substance Abuse Treatment
Based in part on SAMHSA TIP 50 Addressing Suicidal Thoughts and Behaviors in Substance Abuse Treatment
Dr. Dawn-Elise Snipes PhD, LPC-MHSP
AllCEUs Counselor Continuing Education

CEUs Available at: allceus.com/member/cart/index/product/id/37/c/

Objectives
• Explore crisis/ disaster counseling
• Articulate helpful tips for dealing with client suicidality.
• List 6 Positive Attitudes and Behaviors towards clients dealing with suicidal thoughts.
• Identify warning signs for suicidality using the acronym IS PATH WARM.
• Know statistics related to suicide in order to better identify potentially suicidal clients.
• Become familiar with the GATE Procedures for substance abuse counselors.
• Suicidality issues at different levels of care

Statistics Related To Suicide
– Suicide danger zones: Between age 10 and 24 years and after age 70
– More than 90% of persons who die from suicide satisfy the criteria for one or more psychiatric disorders (including adjustment disorder)
– Anxiety disorders are associated with a six- to 10-fold increase in suicide risk
– Alcohol abuse or dependence is present in 25%–50% of those who died by suicide
– When trauma and substance abuse are combined, the risk for suicide jumps to 42%
– Impending interpersonal losses and comorbid psychiatric disorders, have been specifically linked to suicide in alcoholic individuals.
Characteristics of Crisis
– Complicated
– Generally does not have one simple cause
– Beliefs may be operating when an emotion or reaction seems out of proportion to what you’re thinking in the heat of the moment
– Precipitating events may impact many different areas of life
– No Panaceas or Quick Fixes
– May provide temporary, immediate relief
– Ensure they do not make problem worse
– Necessity of Choice
– Making a choice requires action
– Choosing not to act is a still a choice
Types of Crisis & Risk Factors
– Physical (Illness, addiction)/Developmental (Life stages)
– Affective (anxiety, depression, bipolar)
– Cognitive (Alzheimer’s, Dementia, Psychotic (schizophrenia, Parkinson’s)
– Environmental/Financial
– Job Loss
– Homelessness
– Cabin Fever
– Changes in levels of care
– Relational (breakups, death, abuse history, isolation)
– Spiritual (loss of meaning)
Addiction and Suicidality
• People with substance use disorders who are in treatment are at especially high risk of suicidal behavior for many reasons, including:
• Entering treatment when their substance abuse is out of control and a number of co-occurring life crises may be occurring (e.g., marital, legal, job)
• They enter treatment at peaks in depressive symptoms
• Mental health problems often co-occur among people who have been treated for substance use disorders.
• Crises that are known to increase suicide risk sometimes occur during treatment (e.g., relapse and treatment transitions).

Mitigating Factors
– Physical
– Sleep
– Nutrition
– Sunlight/Circadian Rhythms
– Affective: Emotional regulation and psychological flexibility
– Cognitive: Hope, commitment, control/empowerment, challenge (Hardiness, Kobasa 1977)
– Environmental: Safety and Positive Triggers
– Relational: Social support, effective interpersonal skills (boundaries, communication)
6 Positive Attitudes and Behaviors
– Provide an array of biopsychosocial services
– Screen and communicate status and interventions
– All expressions of suicidality indicate significant distress and increased vulnerability
– Be aware of indirect signs including those warning signs unique to the client (agitation, giving away things, no future plans)
– Explore past suicide attempts and ideation to identify exacerbating and mitigating factors
– Make sure all clients have the number of a suicide hotline and/or a procedure for addressing suicidal or self-injurious thoughts.
Warning Signs: IS PATH WARM
– Ideation
– Substance Abuse

– Purposelessness
– Anger
– Trapped
– Hopeless/Helpless

– Withdrawing
– Anxiety
– Recklessness
– Mood Change
GATE Procedures
– Gather information
– Early identification of warning signs, and asking follow-up questions
– Focus on the nature, frequency, intensity, duration and triggers of suicidal thoughts and context in which they are occurring.
– If the patient does not report a plan, ask whether there are certain conditions under which the patient would consider suicide
– Access supervision
– Take responsible action
– Extend the action
– Vulnerable clients may relapse into suicidal thoughts or behaviors. Continue to observe and check in

Inpatient settings
– There are not specific risk factors unique to the inpatient setting
– Fewer than half of the patients who die by suicide in the hospital were admitted with suicidal ideation
– Extreme agitation or anxiety or a rapidly fluctuating course is common before suicide.
– Many people report a state of extreme calm immediately preceding the attempt
– Each suicidal crisis must be treated as new with each admission and assessed accordingly.
Outpatient settings
– Initial evaluation should be comprehensive and include a suicide assessment including strengths, vulnerabilities, stressors and development of a safety plan
– Be aware that suicidality may wax and wane in the course of treatment.
– Sudden changes in clinical status, which may include worsening or unexpected improvements in reported symptoms, require that suicidality be reconsidered
– Risk may also be increased by
– The lack of a reliable therapeutic alliance
– The patient's unwillingness to engage in psychotherapy or adhere to medication treatment
– Inadequate family or social supports
Long-term care facilities
– Indirect self-destructive acts are found among both men and women are a common manifestation of suicide in institutional settings
– Physical illness, functional impairment, and pain are associated with increased risk for suicide
– Hopelessness and personality styles that impede adaptation to a dependent role also play a role
Jail and correctional facilities
– Suicide is one of the leading causes of death in correctional settings.
– Persons who die by suicide in jails tend to be young, white, single, intoxicated substance abusers
– Suicide in correctional facilities generally occurs by hanging
– Isolation may increase suicide
– Suicidal behaviors increase
– Immediately on entry into the facility
– After new legal complications with the inmate's case (e.g., denial of parole)
– After inmates receive bad news about loved ones
– After sexual assault or other trauma
Helpful Tips
– People who are suicidal are often ambivalent
– Crisis is an opportunity and a risk
– Suicide risk assessment and regular screening is vital
– Prevention must be ongoing
– Suicide contracts are NOT recommended
– Many clients will be at risk of suicide even after getting clean

Summary
– Suicidality is not uncommon
– It is important to regularly screen all clients for suicidality (e.g. check in sheets, monitoring logs)
– Suicidality is an opportunity for change
– A variety of different issues can contribute to suicidality.
– Early recovery is a period of extreme vulnerability for many people and treatment plans should always contain a suicide prevention plan (does not substitute for active monitoring)

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