Suicide among young people and adults in Ireland: method characteristics, toxicological analysis and substance abuse histories compared

Objective: Information on factors associated with suicide among young individuals in Ireland is limited. The aim of this study was to identify socio-demographic characteristics and circumstances of death associated with age among individuals who died by suicide. Methods: The study examined 121 consecutive suicides (2007–2012) occurring in the southern eastern part of Ireland (Cork city and county). Data were obtained from coroners, family informants, and health care professionals. A comparison was made between 15-24-year-old and 25-34-year-old individuals. Socio-demographic characteristics of the deceased, methods of suicide, history of alcohol and drug abuse, and findings from toxicological analysis of blood and urine samples taken at post mortem were included. Pearson’s χ2 tests and binary logistic regression analysis were performed. Results: Alcohol and/or drugs were detected through toxicological analysis for the majority of the total sample (79.5%), which did not differentiate between 15-24-year-old and 25-34-year-old individuals (74.1% and 86.2% respectively). Compared to 25-34-year-old individuals, 15-24-year-old individuals were more likely to engage in suicide by hanging (88.5%). Younger individuals were less likely to die by intentional drug overdose and carbon monoxide poisoning compared to older individuals. Younger individuals who died between Saturday and Monday were more likely to have had alcohol before dying. Substance abuse histories were similar in the two age groups. Conclusion: Based on this research it is recommended that strategies to reduce substance abuse be applied among 25-34-year-old individuals at risk of suicide. The wide use of hanging in young people should be taken into consideration for future means restriction strategies.

Too young to drink but old enough to drive under the influence : a study of underage offenders as seen in substance abuse treatment in Texas

Driving under the influence (DUI) is a major road safety problem. Historically, alcohol has been assumed to play a larger role in crashes and DUI education programs have reflected this assumption, although recent evidence suggests that younger drivers are becoming more likely to drive drugged than to drive drunk. This is a study of 7096 Texas clients under age 21 who were admitted to state-funded treatment programs between 1997 and 2007 with a past-year DUI arrest, DUI probation, or DUI referral. Data were obtained from the State’s administrative dataset. Multivariate logistic regressions models were used to understand the differences between those minors entering treatment as a DUI as compared to a non-DUI as well as the risks for completing treatment and for being abstinent in the month prior to follow-up. A major finding was that over time, the primary problem for underage DUI drivers changed from alcohol to marijuana. Being abstinent in the month prior to discharge, having a primary problem with alcohol rather than another drug, and having more family involved were the strongest predictors of treatment completion. Living in a household where the client was exposed to alcohol abuse or drug use, having been in residential treatment, and having more drug and alcohol and family problems were the strongest predictors of not being abstinent at follow-up. As a result, there is a need to direct more attention towards meeting the needs of the young DUI population through programs that address drug as well as alcohol consumption problems.

An intervention for substance abuse in schizophrenia

Describes a cognitive-behavioral intervention for alcohol and cannabis abuse with schizophrenic patients. The intervention integrates substance abuse treatment with other aspects of psychosis management, including assessment, use of anti-psychotic medication, and training in coping skills.

Characteristics of Impaired Drivers Who Enter Substance Abuse Treatment

Driving under the influence (DUI) remains a serious concern. Most of the data on characteristics of DUI offenders come from driving records, with little data on the levels of impairment of DUI arrestees. This paper examines data on 103,181DUI offenders admitted to Texas treatment programs between 1988 and 2008. They reported past-year DUI arrests or came to treatment on DUI probation. The changes in the characteristics of DUI offenders over time are examined, along with the factors associated with treatment completion and abstinence 90 days after program discharge. Incorporation of substance abuse treatment with effective DUI education and intervention can improve road safety and reduce the burden of substance-related illness.

Exploring ways to better manage substance abuse issues

- Historically by default we have created an operational environment where the key AOD issue has been testing and not safety, behaviour and culture. - The tail wagging the dog. - We risk loosing the point the point. - Many people traditionally want to hear a paper about, testing, technology or the pros and cons of saliva VS urine testing etc . - This is a good example of how the workplace alcohol and other drugs area has been politicised, commercialised, simplified and myopic.

Does adolescent's exposure to parental intimate partner conflict and violence predict psychological distress and substance use in young adulthood? A longitudinal study

Little is known about the extent to which parental conflict and violence differentially impact on offspring mental health and substance use. Using data from a longitudinal birth cohort study this paper examines: whether offspring exposure to parental intimate partner violence (involving physical violence which may include conflicts and/or disagreements) or parental intimate partner conflict (conflicting interactions and disagreements only) are associated with offspring depression, anxiety and substance use in early adulthood (at age 21); and whether these associations are independent of maternal background, depression and anxiety and substance use. Data (n = 2,126 women and children) were taken from a large-scale Australian birth-cohort study, the Mater University of Queensland Study of Pregnancy (MUSP). IPC and IPV were measured at the 14-year follow-up. Offspring mental health outcomes – depression, anxiety and substance use were assessed at the 21-year follow-up using the Composite International Diagnostic Interview (CIDI). Offspring of women experiencing IPV at the 14-year follow-up were more likely to manifest anxiety, nicotine, alcohol and cannabis disorders by the 21-year follow-up. These associations remained after adjustment for maternal anxiety, depression, and other potential confounders. Unlike males who experience anxiety disorders after exposure to IPV, females experience depressive and alcohol use disorders. IPV predicts offspring increased levels of substance abuse and dependence in young adulthood. Gender differences suggest differential impact.

An integrated alcohol abuse and medical treatment model for patients with hepatitis C.

BACKGROUND: Patients with chronic hepatitis C virus (HCV) infection have high rates of alcohol consumption, which is associated with progression of fibrosis and lower response rates to HCV treatment. AIMS: This prospective cohort study examined the feasibility of a 24-week integrated alcohol and medical treatment to HCV-infected patients. METHODS: Patients were recruited from a hepatology clinic if they had an Alcohol Use Disorders Identification Test score >4 for women and >8 for men, suggesting hazardous alcohol consumption. The integrated model included patients receiving medical care and alcohol treatment within the same clinic. Alcohol treatment consisted of 6 months of group and individual therapy from an addictions specialist and consultation from a study team psychiatrist as needed. RESULTS: Sixty patients were initially enrolled, and 53 patients participated in treatment. The primary endpoint was the Addiction Severity Index (ASI) alcohol composite scores, which significantly decreased by 0.105 (41.7% reduction) between 0 and 3 months (P < 0.01) and by 0.128 (50.6% reduction) between 0 and 6 months (P < 0.01) after adjusting for covariates. Alcohol abstinence was reported by 40% of patients at 3 months and 44% at 6 months. Patients who did not become alcohol abstinent had reductions in their ASI alcohol composite scores from 0.298 at baseline to 0.219 (26.8% reduction) at 6 months (P = 0.08). CONCLUSION: This study demonstrated that an integrated model of alcohol treatment and medical care could be successfully implemented in a hepatology clinic with significant favorable impact on alcohol use and abstinence among patients with chronic HCV.

Adolescent Substance abuse among young people excluded from school in Belfast

The lifestyles of young people excluded from school have received much attention recently, particularly in relation to illicit drug use. Commentators have acknowledged that they constitute a high-risk group to social disaffection and substance abuse. This paper reports on a group of 48 young people living in Belfast aged 13�14 years who are considered to be at a particularly high risk to substance abuse because they are excluded from school. The evidence in this paper suggests that many are already exhibiting potentially high-risk behaviours to problem drug use compared with their contemporaries in mainstream education. This paper examines the evidence within the context of a limited existing literature base on this group of young people. It suggests that a more focused approach is required for the development of appropriate drug-prevention strategies to meet their needs.

Chronic child abuse and domestic violence: Children and families with long-term and complex needs

It is estimated that up to one million children may have been exposed to domestic violence in the UK, with significant consequences for their social and emotional development in childhood and later life. At a time when the central and devolved administrations in the UK have developed strategies to tackle domestic violence, this paper reports the findings from a study conducted on children in the child protection system with long-term and complex needs as a result of experiencing domestic violence. The research identifies the characteristics of the children and their families and tracks their careers through the child protection system. The findings indicate that professionals have an awareness of domestic violence, and that younger children with younger parents are most likely to experience prolonged periods in the child protection system. Domestic violence in this context typically co-exists in families experiencing other difficulties such as substance misuse and socio-economic deprivation. In conclusion, the paper argues that Government policy and professional practice should primarily be concerned with assessing the risk that men present, rather than the risk that children are at. By reframing professional interventions, men are more likely to be challenged to accept responsibility for their behaviour and the consequences for their families.

Substance use and misuse in burn patients: testing the classical hypotheses of the interaction between posttraumatic symptomatology and substance use

Background: We aimed to test whether the three classical hypotheses of the interaction between posttraumatic symptomatology and substance use (high risk of trauma exposure, susceptibility for posttraumatic symptomatology, and self-medication of symptoms), may be useful in the understanding of substance use among burn patients. Methods: We analysed substance use data (nicotine, alcohol, cannabis, amphetamines, cocaine, opiates, and tranquilizers) and psychopathology measures among burn patients admitted to a Burns Unit and enrolled in a longitudinal observational study. Lifetime substance use information (n = 246) was incorporated to analyses aiming to test the high risk hypothesis. Only patients assessed for psychopathology in a six months follow-up (n = 183) were included in prospective analyses testing the susceptibility and self-medication hypotheses. Results: Regarding the high risk hypothesis, results show a higher proportion of heroin and tranquilizer users compared to the general population. Furthermore, in line with the susceptibility hypothesis, higher levels of symptomatology were found in lifetime alcohol, tobacco and drug users during recovery. The self-medication hypothesis could be tested partially due to the hospital stay “cleaning” effect, but severity of symptoms was linked to caffeine, nicotine, alcohol and cannabis use after discharge. Conclusions: We found that the three classical hypotheses could be used to understand the link between traumatic experiences and substance use explaining different patterns of burn patient’s risk for trauma exposure and emergence of symptomatology.

Substance use and depression. Comparative course in adolescents.

OBJECTIVE: To examine the relation between depression and substance use in adolescents and the concomitant courses of both disorders. METHODS: Four individual interviews were administered to 85 adolescent substance users aged 14-19 years (mean 17.1 years, SD 1.4) over a 3.5 year period using the Adolescent Drug Abuse Interview (ADAD) and the Beck Depression Inventory (BDI-13). RESULTS: No predictive effect was observed on one dimension over the other, but each dimension was predictive of its own course. A decrease in substance-use severity paralleled a decrease in depressive state. Similarly, stable substance-use rates, either at a low or a high level, tended to be associated with low or high levels of depression, respectively. However, an increase in substance use was not accompanied by an increase in depressive states. Moreover, depression varied greatly between adolescents, and according to gender and age. CONCLUSIONS: Depressive states and substance use in adolescents can vary considerably overtime, and are closely but rather synchronically related. Since most of the adolescents do not seek help for substance-related problems, substance use should be systematically assessed in adolescents presenting with a depressive state.

Substance use and suicidal conduct: a study of adolescents hospitalized for suicide attempt and ideation.

AIM: To study the prevalence of psychoactive substance use disorder (PSUD) among suicidal adolescents, psychoactive substance intoxication at the moment of the attempt, and the association between PSUD at baseline and either occurrence of suicide or repetition of suicide attempt(s). METHODS: 186 adolescents aged 16 to 21 y hospitalized for suicide attempt or overwhelming suicidal ideation were included (T0); 148 of them were traced again for evaluations after 6 mo (T1) and/or 18 mo (T2). DSM-IV diagnoses were assessed each time using the Mini International Neuropsychiatric Interview. RESULTS: At T0, 39.2% of the subjects were found to have a PSUD. Among them, a significantly higher proportion was intoxicated at the time of the attempt than those without PSUD (44.3% vs 25.4%). Among the 148 adolescents who could be traced at either T1 or T2, two died from suicide and 30 repeated suicide attempts once or more times. A marginally significant association was found between death by suicide/repetition of suicide attempt and alcohol abuse/dependence at baseline (OR=3.3, 95% CI 0.7-15.0; OR=2.6, 95% CI 0.7-9.3). More than one suicide attempt before admission to hospital at T0 (OR=3.2, 95% CI 1.1-10.0) and age over 19 y at T0 (OR=3.2, 95% CI 1.1-9.2) were independently associated with the likelihood of death by suicide or repetition of suicide attempt. CONCLUSION: Among adolescents hospitalized for suicide attempt or overwhelming suicidal ideation, the risk of death or repetition of attempt is high and is associated with previous suicide attempts--especially among older adolescents--and also marginally associated with PSUD; these adolescents should be carefully evaluated for such risks and followed up once discharged from the hospital.

Substance use and suicidal conducts : a study of adolescents hospitalized for suicide attempt and ideation

RESUME Objectifs: Etudier la prévalence des troubles liés à l'utilisation de substances psychoatives parmi des adolescents suicidaires; évaluer l'influence de la prise de substances psychoactives sur le geste suicidaire; analyser l'association entre les troubles liés à l'utilisation de substances psychoactives et le risque de récidive de la conduite suicidaire. Méthode: 186 adolescents, âgés de 16 à 21 ans, hospitalisés pour tentative de suicide ou idées suicidaires envahissantes, ont été inclus. Parmi eux, 148 ont été revus pour évaluation à 6 et/ou 18 mois. Des diagnostics psychiatriques, basés sur les critères du DSM-IV, ont été posés à l'aide d'un questionnaire, le MINI (Mini International Neuropsychiatric Interview). Résultats: A l'inclusion, 39.2% des sujets avaient un trouble lié à l'utilisation de substances psychoactives. Parmi eux, une proportion significativement plus élevée était sous l'influence d'alcool ou drogue au moment de la tentative de suicide (44.3% versus 25.4%). Des 148 adolescents suivis et revus à 6 ou 18 mois, 2 sont décédés par suicide et il y a eu 30 récidives de tentative de suicide durant l'étude. Une association significative a été trouvée entre les récidives de suicide et un diagnostic d'abus/dépendance à l'alcool à l'inclusion (OR=3.3; CI 0.7-15.0; 0R=2.6, CI 0.7-9.3). Des antécédents de plusieurs tentatives de suicide (OR=3.2; CI 1.1-10.0) et un âge supérieur à 19 ans (OR=3.2; CI 1.1-9.2) à l'inclusion étaient associés à la probabilité de mort par suicide ou de récidive de tentative de suicide. Conclusion: Parmi les adolescents hospitalisés pour tentative de suicide ou idées suicidaires envahissantes, le risque de décès ou de récidive est important. Ce risque est associé, entre autres, à des antécédents suicidaires et au diagnostic de trouble lié à l'utilisation de substances psychoactives. Le risque suicidaire ainsi que la consommation de substances psychoactives devrait être évalué chez les adolescents. De plus, les sujets jugés à risque devraient être suivis systématiquement après une hospitalisation pour conduite suicidaire. ABSTRACT Aim: To study the prevalence of psychoactive substance use disorder (PSUD) among suicidal adolescents, psychoactive substance intoxication at the moment of the attempt and the association between PSUD at baseline and either occurrence of suicide or repetition of suicide attempt(s). Methods: 186 adolescents aged 16 to 21 hospitalised for suicide attempt or overwhelming suicidal ideation were included (TO); 148 of them were traced again for evaluations after 6 months and/or 18 months. DSM-IV diagnoses were assessed each time using the Mini International Neuropsychiatric Interview. Results: At TO, 39.2% of the subjects were found to have a PSUD. Among them, a significantly higher proportion was intoxicated at the time of the attempt than those without PSUD (44-.3% vs. 25.4%). Among the 148 adolescents who could be traced at either Ti or T2, two died from suicide and 30 repeated suicide attempt once or more time. A marginally significant association was found between death by suicide/repetition of suicide attempt and alcohol abuse/dependence at baseline (0R=3.3; CI 0.7-15.0; 0R=2.6, CI 0.7-9.3). More than one suicide attempt before admission to hospital at TO (OR=3.2; CI 1.1-10.0) and age over 19 at TO (0R=3.2; CI 1.1-9.2) were independently associated with the likelihood of death by suicide or repetition of suicide attempt. Conclusion: Among adolescents hospitalised for suicide attempt or overwhelming suicidal ideation, the risk of death or repetition of attempt is high and is associated with previous suicide attempts - especially among older adolescents - and also marginally associated with PSUD; these adolescents should be carefully evaluated for such risks and followed up once discharged from the hospital.

Moderating effects of gender on the relationships among substance use and school outcomes /

The following study was a secondary analysis of data drawn from adolescents in South Western Ontario. The purpose of the study was to: examine the relationships among substance use and school outcomes, explore the relationships between gender and school outcomes, examine the moderating potential of gender on the substance useschool outcomes relationship, and to provide researchers and educators further knowledge of adolescent substance use behaviours. Many previous studies have failed to include the three most common substances used by adolescents (i.e., alcohol, tobacco, and marijuana). Furthermore, many studies have included only one school outcome instead of comparing several outcome variables. Moderated hierarchical regression was used to determine if gender moderated the substance use-school outcomes relationships. The dependent variables consisted of alcohol use, binge drinking, tobacco use, and marijuana use. Five measure of school outcomes were used as independent variables, including Grade Point Average, Positive School-role Behaviour, Negative School Behaviour, School Withdrawal, and School Misbehaviour. The results for this study indicated that substance use and gender were both predictors of all school outcome variables. Furthermore, gender was found to moderate 5 of the 25 substance use-school outcome relationships.