Integrated CBT Reduces Suicide in Addicted Adolescents

Adolescents who struggle with alcohol or drug use disorders (AOD) are at increased risk for suicide. “In a review of the adolescent suicide literature, rates of any AOD were found to range from 27% to 50% among adolescents who died by suicide and were associated with 6- to 8.5-fold increase in risk of suicide,” said Christianne Esposito-Smythers of the Department of Psychology at George Mason University. “Rates of AOD among adolescents who attempted suicide ranged from 12% to 50%, and an AOD was associated with a three- to four-fold increase in the likelihood of suicide attempts.”

Despite the evidence of comorbidity, these two issues are usually treated separately. “Many substance abuse providers subscribe to a medical or disease model of addiction, whereas mental health providers often integrate biological and psychological perspectives in their conceptualization of substance-related problems,” said Esposito-Smythers. “Such differences can leave individuals with conflicting treatment messages that, in turn, can negatively affect treatment adherence.” Esposito-Smythers believes that an integrated CBT approach (I-CBT) that targets suicidality and AOD would be a more effective method of treatment for adolescents.

For her study, Esposito-Smythers enrolled 40 teens from an inpatient psychiatric hospital to either the I-CBT or enhanced treatment as usual (E-TAU) and found that the integrated model was significantly more effective. “Relative to E-TAU, I-CBT was associated with greater reductions in heavy drinking days, days of marijuana use, and marijuana-related problems over the course of treatment,” she said. “Further, youths who received I-CBT reported less global impairment as well as fewer suicide attempts, psychiatric hospitalizations, emergency department visits, and arrests than did those in the E-TAU condition.” She added, “By addressing both suicidality and AODs in one protocol, the therapist is able to simultaneously monitor both conditions, obtain an understanding of their functional relationship for each client, and intervene accordingly.” She said, “Moreover, the use of a consistent cognitive– behavioral conceptualization and orientation for both conditions yields a simpler treatment plan, allows for a consistent treatment message for clients, and provides clients with more practice with the same basic set of cognitive–behavioral skills to facilitate skill mastery and generalization.”

Esposito-Smythers, Christianne, Anthony Spirito, Christopher W. Kahler, Jeffrey Hunt, and Peter Monti. “Treatment of Co-occurring Substance Abuse and Suicidality among Adolescents: A Randomized Trial.” Journal of Consulting and Clinical Psychology79.6 (2011): 728-39. Print.

© Copyright 2011 by By Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • cHIP


    December 20th, 2011 at 5:34 PM

    How do we make sure to get this kind of treatment to the right kids? And in time to keep them from doing something as destructive as harming themselves?

  • Kerigan Bryant

    Kerigan Bryant

    December 21st, 2011 at 2:50 PM

    It makes me so sad to know that there are so many kids who given the chance would choose to end their lives. What has given them such sadness that they have a desire to end it all? I have had some bad days before but never anything that would have driven me to this.

  • Liz


    December 23rd, 2011 at 1:05 PM

    I’m not saying drugs and alcohol are not dangerous but this method of seeing the picture seems wrong to me..what if these kids chose drugs and alcohol due to a prior problem and that is the actual reason for suicide?

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