CONTENTS

About This Course

Table of Contents

1. The Nature and Scope of Suicide
2. Recognizing the Progressive Development of Suicide
3. Substance Abuse as a Major Contributor to Suicide
4. Suicide Across the Life Span
5. Special Populations and Suicide Risk
6. Prevention and Early Intervention for Suicide and Substance Abuse Problems

Supplements
References
Resources

Holding the Lifeline
A Guide to Suicide Prevention

Key Issues and Concerns

• All substance abuse treatment clients should receive at least a basic screening for suicidality. All substance abuse treatment professionals should know how to conduct at least basic screening and triage.
• The counselor should know his or her own skills and limitations in engaging, screening, assessing, and intervening with suicidal clients. Work out these issues before an emergency.
• Providers are advised to develop clear answers to the following questions:
  1. Do you or your agency have the knowledge, tools, skills, and personnel for crisis stabilization and/or ongoing work with suicidal clients?
  2. How suicidal can clients be and still be retained in your practice or agency?
  3. What about suicidality that emerges later in treatment or in conjunction with relapse?
• The counselor should know what immediate onsite and offsite resources are available to help with someone identified as suicidal.
• Establish standardized protocols and staff training around suicide screening, assessment, intervention, and/or triage? (1) Who asks? (2) What is asked? (3) When is this done? (4) Where does this take place? (5) How are findings documented? (6) What is done with the results?
• Suicide "contracts" are written statements in which the person who is suicidal states that he will not kill himself, but rather call for help, go to an emergency room, etc., if he becomes suicidal. These contracts are not effective as the sole intervention for a client who is suicidal. While such contracts often help to make the client and therapist less anxious about a suicidal condition, studies have never shown these contracts to be effective at preventing suicide. What good contracts really do is help to focus on the key elements that are most likely to keep clients safe, such as agreeing to remove the means a client is most likely to use to commit suicide.

Reprinted from U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. (2005). Treatment Improvement Protocol Series No. 42: Substance abuse treatment for persons with co-occurring disorders (DHHS Publication No. [SMA] 05-3992). Rockville, MD: Author, p. 329.