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 GoodTherapy.org.
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