LIFE News Issue 5, June 2009
Welcome to LIFE News – June 2009. In this edition LIFE focuses on drugs and alcohol and suicide prevention, taking a look at the latest research and projects including the PALM initiative from the Ted Noffs Foundation, the National Centre for Education and Training on Addiction and many more. LIFE News contributors also report on drug and alcohol programs from organisations such as Orygen and the Australian Drug Foundation. LIFE warmly encourages feedback on LIFE News - please contact us with your comments and suggestions.
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Above: Professor Margaret Hamilton
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By Professor Margaret Hamilton with Australian National Council on Drugs Secretariat
Professor Hamilton describes suicide prevention in the alcohol and other drugs (AOD) sector, identifying several areas of concern including gaps in education and weaknesses in collaboration between health services. She also identifies a need for media guidelines for AOD reporting and addresses AOD use in relation to risk-taking behaviour, social rituals, coping strategies and more.
Alcohol and other drugs (AODs) are widely associated with suicide in Australia and internationally, especially among young adults. Studies of post-mortem investigations by coroners consistently find AODs at measureable levels in 30-50% of suicides. Such an association is likely to result for three main reasons. First, AOD use may exacerbate or cause mental health problems such as depression or psychosis which then increases the risk of suicide. This is most likely to occur among individuals with prolonged AOD problems. Second, AOD intoxication, especially alcohol intoxication, is known to cause disinhibition and impulsivity. This may provide ‘courage’ to the individual to overcome the fear of continuing a suicide act or even instigate an act which leads to death (Goldsmith, Pellmar, Kleinman, & Bunney, 2002). Third, while relatively uncommon, overdose may be the method used to end an individual’s life. Alcohol and other drug use is also a common response to the grief and bereavement of losing a friend or family member to suicide.
Given the complexity of the association between AOD use and suicide a number of issues confound the AOD sector’s ability to deal with the risk of suicide.
Co-occurring substance use and mental health problems is a major drug and alcohol issue. According to the National Survey of Mental Health and Wellbeing, more than half of Australians seeking help for mental health problems also have substance use problems (Teesson, M., Hall, M., Lynskey, M., & Degenhardt, L. 2000.). Both substance misuse and mental health are known risk factors for suicide and their co-occurrence further increases the risk. Complicating the approaches to address this co-morbidity issue is the lack of integration between AOD and mental health services.
Many services in the AOD sector are ill equipped to assist patients with mental health problems. Conversely, most mental health services, including psychologists, are not sufficiently trained or educated in AOD issues. Both sectors need to be adequately equipped to assist patients with both substance use and mental health issues as co-occurring substance use and mental health problems will continue to contribute to the high prevalence of suicide among individuals with AOD problems.
Other issues contribute to the high prevalence of suicide among AOD clients. The lifetime risk for suicide is greater for individuals with alcohol dependence than for individuals with schizophrenia and about 15% of individuals with alcohol dependence will die by suicide (Saddock & Saddock, 2002). Much of this risk might be accounted for by the mental confusion which often accompanies AOD problems.
Risk-taking behaviour is also often associated with both suicide and substance use. Addressing risky behaviour among individuals who use alcohol and other drugs forms a large component of harm minimisation strategies. Risky behaviour is often a cause and consequence of substance misuse. Further, intoxication, especially by alcohol, is known to reduce people’s inhibitions and commonly plays a role in road fatalities, deaths by misadventure, and unintentional death. Because AOD issues disproportionately impact upon young adults, and this group is often characterised by impulsivity, AOD use can place this group at particular risk. This is particularly problematic for individuals with AOD dependence, because the dependent state leads directly to increased use of the very substances that are contributing to risk taking and confusion. Addressing this issue is difficult because of the positive cultural acceptance of alcohol, especially in Australian society.
Substance use is often associated with important social rituals such as celebration, socialising, relaxation, and grieving. This is in part because these substances are psychoactive drugs meaning that they influence our mood, thinking and behaviour. That is why most people take them. These effects are recognised and used to promote them through advertising. Drugs are part of our culture and conventions. Most people who use alcohol and other psychoactive drugs will not become dependent. Some people however use them as an adaptive coping strategy to alleviate the pain of specific life events or ongoing stress and prolonged use overtime and create extra difficulties.
Individuals with AOD issues often have low self-esteem, a negative self-concept, have difficulty making friends and some are subject to discrimination on a regular basis. This can result in an individual not seeking treatment for their problems and continuing or increasing their substance misuse which may increase the risk of suicide. Such a circumstance is often exacerbated by feelings of hopelessness associated with relapse and failed treatment attempts. This may be a major issue for people after all available avenues for treatment have been exhausted or in areas where inadequate treatment services exist.
Media reporting of AOD issues provides a challenge for preventing suicide among people with AOD problems. While there are clear, agreed and recognised guidelines for the reporting of suicide and mental illness (see mindframe) no such standards exist for the reporting of alcohol and other drug related matters. The Australian National Council on Drugs has been working on this area with the Australian Press Council (see here). Because many substances are illegal, the result is that individuals with AOD problems are often portrayed in the media as dangerous criminals, which promotes a culture of stigma and isolation. A more balanced approach to reporting AOD issues, particularly in the tabloid press and TV, would be of great benefit.
There is more that can and should be done by the AOD sector to prevent suicide. There are many committed workers actively involved with individuals and sometimes families in this effort. Other important work under way includes the Australian Centre for Addiction Research’s current NH & MRC funded project aimed at reducing the risk of suicide among alcohol and other drug misusers.
- Professor Margaret Hamilton is an Executive member of the Australian National Council on Drugs.
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The National Drug Strategy 2004-2009 is a policy framework that provides a coordinated and integrated approach to prevent and reduce the harms caused by drugs in the Australian community. It is a publication from the Ministerial Council on Drugs Strategy, which is the peak policy and decision making body on licit and illicit drugs.
Pictured above: Wesley and Amanda Noffs
By LIFE Communications
The Program for Adolescent Life Management (PALM) initiative is a residential program for young people with serious drug and alcohol abuse problems. Founded in 1995, PALM became the first evidence-based drug treatment program for adolescents in Australia. It is funded by the Commonwealth Department of Health and Ageing, NSW Health, NSW Juvenile Justice, NSW Department of Community Services and ACT Health.
Based in four locations - Sydney, Dubbo, Coffs Harbour and Canberra - PALM is an initiative of the Ted Noffs Foundation, an NGO established In 1969 by Reverend Ted Noffs who, amongst other humanitarian engagements, formed Kings Cross’ famous Wayside Chapel in 1964 and Sydney's first 24 hour crisis centre in 1968.
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The most commonly used drug identified by PALM residents is cannabis, followed by alcohol. A smaller percentage of participants have issues relating to ecstasy and a smaller portion still identify as their drug of choice. Nicotine dependency is common.
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The PALM program consists of a three month live-in program and a 12 month follow-up program for young people aged between 14-18 years.
'A serious drug and or alcohol problem means that the young person's life has been significantly affected by their substance use,' says Wesley Noffs, Ted Noffs Foundation CEO. 'The young person may stop going to school or work. Their relationships may deteriorate. They may have more difficultly managing their feelings and reactions. They may develop a mental or physical health condition. They may involve themselves in risky behaviour or criminal behaviour and they may end up homeless. Not every young person in our service experiences all of these outcomes but they usually have experienced one or more from this list.'
PALM participants are culturally and ethnically diverse, and according to Noffs many of them come from low income backgrounds with limited family support. PALM is a voluntary program: the participants are required to ring and make the initial referral themselves and attend face-to-face assessment with a counsellor, who then consults with the Foundation's clinical team about the young person's suitability.
'Having a drug dependency in itself can create some resistance in a young person to seek treatment,' says Noffs. 'Even a partial motivation to attend the program is all that a young person needs to start the process of rehabilitation.'
The program can accommodate up to 16 residents at a time. Every day participants attend 'house meeting' groups to address a range of topics including drug and alcohol related issues, community issues, communication skills and personal goals. A 'vocational/educational' program focuses on developing a plan for what residents wish to do upon completion of the PALM program, and they are assisted in gaining the necessary skills such as interview techniques, resume writing, job researching and literacy and numeracy. A wide range of sports, hobbies and creative pursuits are incorporated into daily routines and a 'living skills' program encourages young people to cook, clean, maintain a healthy diet, maintain their personal hygiene and meet daily responsibilities including making appointments and getting up on time.
'The program is very structured so this can be difficult for the young person to adjust to initially. However, within a couple of weeks the young people start to appreciate the calmness and predictability of the program,' Noffs says.
'Their reactions greatly depend on which substance they were using prior to admission and how much and how often they were using for. Generally they do experience some challenging feelings and physical responses and this can affect their ability to concentrate in groups and activities.'
The 12 month follow-up program consists of a series of individual in-house counselling sessions usually held at least every fortnight as well as phone calls from other members of staff. Ex-residents often return to facilitate groups.
'For many young people PALM is the place where they become aware of their strengths and develop goals for the future,' Noffs says.
'Recently one of our staff ran into a young person who had completed the program three years ago. She told the staff member she was doing really well and that PALM had saved her life. She is now working for an advertising company as a designer and is drug free.'
By Orygen Youth Health
New first aid guidelines for problem cannabis use have recently been released to help the community identify and assist users who are developing a problem with their cannabis use or are in a cannabis-related crisis.
The guidelines, the first to be produced in the world, have been researched and produced by Orygen Youth Health for the National Cannabis Prevention and Information Centre (NCPIC) based at the University of NSW, and are a response to the growing body of evidence that links cannabis use to a range of physical and mental health problems.
They are designed to inform members of the community how to recognise when someone’s cannabis use has become a problem, how to provide initial support and information and how to guide the user to seek professional help.
According to Dr Dan Lubman, Associate Professor of Addictions at Orygen Youth Health and the University of Melbourne, ‘Friends and family can provide an important source of support and assistance to those suffering with problematic cannabis use, however they often do not know what to say or do to best help the person get professional help. These guidelines are important in this regard, as the sooner someone receives help for their cannabis use or mental health problems the better the outcome.’
Director of NCPIC, Professor Jan Copeland, says ‘This is an important initiative in raising community awareness of cannabis-related problems with practical advice on how to appropriately respond.’
According to Associate Professor Lubman, what makes these guidelines particularly effective is that they have been developed by an international panel of experts, including clinicians, consumers and carers from Australia, Canada, New Zealand, the USA and the UK, who reached consensus about what to do when someone is developing a cannabis use problem.
‘Although there is a broad range of information about cannabis use available to the public, the messages are often inconsistent, or even inaccurate, with little evidence for their effectiveness,’ Lubman says.
‘Being aware of when and how to encourage a cannabis user to seek appropriate help is an important community skill, especially as many of those with problems do not seek help. Indeed, not seeking help further increases the harms associated with problem cannabis use, such as developing more serious mental health problems.
These guidelines may be used by community members worried that someone they know is developing a problem. They are a general set of recommendations which might help the public recognise if there is a problem, teach them how to deal with that problem and give them advice on how to seek professional help. They are designed for people who have had no formal training in drug and alcohol or mental health care.
Even though knowing about Mental Health First Aid (insert hyperlink: http://www.mhfa.com.au/) may determine how quickly the person with the problem recovers, many people often don’t know how to respond to mental health or drug related crises. By knowing about Mental Health First Aid, community members may be able to help someone get help for their cannabis use or a related crisis.
The first aid cannabis use guidelines were developed in response to the following dilemmas.
- Drug use and mental health problems are common.
- They are stigmatized, which stops people getting help.
- Many people are not well informed about drug use problems, so most people do not seek help early.
- In crisis situations, professional help is often not immediately on hand.
- Many people may not realize they need help or that effective help is available.
- Members of the public often do not know how to respond to drug related crises (e.g. they look the other way).
- The helper’s actions may determine how quickly the person with the problem recovers.
- The First Aid Cannabis guidelines can be downloaded from the MHFA website.
- For more information call the Cannabis Information and Helpline on 1800 30 40 50 or visit the NCPIC website.
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Drug Action Week (June 21 – June 27) aims to raise awareness about alcohol and other drug (AOD) issues and highlight the achievements of people who work in the AOD sector. Last year over 600 activities were held across the nation, providing information, opportunity for community debate and cooperation between sectors. For more information, including resources, promotional tools and a calendar of events, visit the comprehensive Drug Action Week website.
By LIFE Communications
The National Centre for Education and Training on Addiction (NCETA) is one of three national research centres that were established in the 1980s by the National Drug Strategy and the Australian Research Council. Situated at Flinders University in Adelaide, where it is a department within the School of Medicine, NCETA’s core work concerns the promotion of Workforce Development (WFD) principles, research, evaluation of effective practices and implementing initiatives to act as knowledge brokers. The centre aspires to 'work as a catalyst for change in the alcohol and other drugs field.'
NCETA employs 20 permanent staff who work on a range of projects, which run from six months to three or four years and examine cutting edge issues. The areas of interest and topics explored by NCETA are determined by a variety of factors including available data, patterns of use and media attention.
In 2009 alcohol is a hot topic. NCETA are undertaking a number of alcohol-related projects including studying cultural driving factors in drinking amongst 14 to 24-year-olds and the role of schools in alcohol education.
‘At the moment we are doing a lot of work around young people and alcohol,’ says Professor Ann Roche, director of NCETA. ‘This includes some qualitative and some quantitative research and trying to identity what some of the major drivers are in terms of Australian drinking culture that help to facilitate risky drinking.’
‘Recently there has definitely been a lot more interest and people are a lot more receptive to considering the role alcohol might have in a fairly wide range of adverse outcomes.’
In February the National Health and Medical Research Council (NHMRC) published the Government’s new alcohol guidelines. Roche was part of the group that determined these guidelines, developing them over roughly a two year period. In response she wrote a document entitled ‘Making Sense of Australia’s Alcohol Guidelines: An NCETA Workforce Development Tool,’ which explains in a straightforward manner how the new guidelines differ from the old ones.
‘It’s had a very positive response,’ Roche says. ‘People have found it very helpful to try and get a handle on how the new guidelines vary from the old ones, because they are quite substantially different.’
Roche believes alcohol use will remain the focus in 2009. Previous topical issues include heroin, opiate and methamphetamine addictions.
‘The data tells us that into the late 1990s there was an exponential growth in the level of opiate related overdose deaths that caused great concern,’ she says. ‘The amount of street heroin dried up and the level of opiate plummeted in 2000 and in 2001 it had dropped down to a level it had been at about 10 years earlier. In the last two to three years prior to alcohol there was a strong political push around methamphetamine and so some of our work focused on that.’
Roche predicts that illegal prescription drugs will be an increasing issue into the future.
According to Roche, some of the greatest ongoing challenges encountered by NCETA involve overcoming the high levels of stigmatisation invariably associated with perceptions of drug addiction.
‘Alcohol and drugs or anything frequently perceived as socially deviant behaviour is often highly stigmatised, so there’s a high level of stigma attached not necessarily to alcohol use per se but certainly addiction,’ she says.
‘That is often quite a challenging concern as there are a lot of myths and misinformation. People, including everyone from politicians to the person on the street, often hold very strong views about these issues whether they are accurate or not.’
NCETA are currently in the process of developing their strategic plan. Future aims include consolidating at a nationally coordinated level and forming a national workplace development strategy for the drug and alcohol field.
By the Australian Drug Foundation
The Australian Drug Foundation is about to celebrate 50 years of service to the Australian community. As the foundation commemorate its past, it remains acutely aware of the need to look to the future to work with the community and other organisations to influence cultural forces affecting the lives of our young people.
The foundation gathers the latest research from around the world to help the Australian health and welfare sector tackle the impact of alcohol and other drugs. People under 30 years of age are a particular focus. The foundation also provides easy-to-understand information via a range of websites for the general public.
In 2007 nearly a quarter of 15–24-year-olds had used an illicit drug in the previous 12 months. Of those, 78 per cent had used cannabis, 39 percent ecstasy and 17 per cent had used methamphetamines.
In 2008, 11 to 24-year-olds ranked drugs and suicide as two of their top four issues of concern, consistent with the trend for the three years prior.
When young people are concerned about drug use and suicide, who do they turn to for help? If they don’t - or can’t - talk to their friends and family, they jump online to look for information and support on the Internet.
‘As I've turned 18 and just started going out clubbing, I’ve started taking one to two ecstasy pills a week. What kind of effects could that have on me?’
‘I don't know how to stop smoking weed. It just seems like part of my life now and when I tried to stop I felt depressed and I cried every day.’
‘I need to help my friend. I think that she's suicidal and I don't know what I should be doing.’
Somazone is a health website set up by the Australian Drug Foundation to provide young people with an online, safe and accessible community of support. Every week, young people across Australia ask questions on Somazone like those above. When they ask, they know that their anonymity is protected and they can get a free, non-judgmental and reliable answer - something that’s often rare on the Internet. Answers are provided by professionally trained volunteer health workers, such as GPs, counsellors, social workers, nurses and educators.
Whether or not they’re male or female, live in a city or regional area or have a supportive family and community, young people across Australia can access free and professional advice on Somazone. They don’t have to fill out paperwork, get a referral or have a Medicare card. Nor do they have to go from service to service - one for mental health assessment, another for drug withdrawal, another for relationship counselling. Though they are encouraged to seek further help from specialist services where appropriate, young people can have all their health-related questions answered on Somazone.
Somazone was created by a team of young people and has continued to operate over the last nine years as a youth-driven site. The Australian Drug Foundation - an independent, not-for-profit organisation - is committed to expanding Somazone as well as finding new ways to reach our youth. With a growing workforce of dynamic young talent, the foundation is entering an exciting time of development with the explicit intention of improving young lives - by tackling Australia’s alcohol and drug culture.
By LIFE Communications
The Mail-based Cannabis Treatment Intervention is an initiative of the National Cannabis Prevention and Information Centre (NCPIC) and is currently in the development stages along with an internet-based program.
NCPIC was established in 2007 in response to community concerns about cannabis use. The intervention is the first trial of mail-based treatment (i.e. postal-based correspondence) for cannabis and began in April. It is available to anyone in Australia or New Zealand who wishes to quit or reduce his or her use of cannabis. The idea came from NCPIC director Professor Jan Copeland in collaboration with the Department of Health and Ageing and is particularly oriented towards people who live outside metropolitan areas.
‘Some older literature has shown that mail is an effective means of treatment for things like alcohol and depression,’ says project manager Dr. Desiree Boughtwood. ‘Rural health services are pretty limited in some remote areas so it’s about getting specialist health care out to people who otherwise can’t access it for whatever reason. It is about providing an intervention that people can use in their homes. They can do it at home at any time that’s convenient to them.’
The program consists of six modules that participants fill in and return, which include activities (such as ‘how to quit cannabis’), situations that may arise from drug use and decision making. The intervention is expected to take roughly two months to complete.
Boughtwood gives feedback to participants at three different points in the process to provide encouragement, support and suggest other strategies participants may not have tried. A reduction in cannabis use is the main determinant of the effectiveness of the program. Boughtwood says the program is to some extent individualised but acknowledges that it cannot be as tailored as other forms of treatment, such as one-on-one counselling.
‘We are stretching into the unknown,’ she says. ‘But we are hopeful that it will work well so that people in rural areas can get a good service. Rural health care is a problem worldwide across many different fields, not just drug and alcohol.’
- For more information about the Mail-based Cannabis Treatment Intervention contact Desiree Boughtwood on 0293850449 or email her.
- The NCPIC currently offers a phone-based intervention program. For more information visit their website or call 1800 30 40 50.
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By the Turning Point Alcohol and Drug Centre
Co-occurring mental health and alcohol and other drug (AOD) problems pose a complex range of clinical and management issues for the health sector and create a significant challenge for AOD treatment services in Australia. Research indicates that people with ‘comorbid’ conditions are more likely to suffer from lower levels of psychosocial functioning than other people. Homelessness, family disruption, poorer social supports, financial and legal issues, as well as the risk of harming themselves and others are just some of the problems experienced by people with these comorbid conditions.
Most client presentations to AOD services are for high prevalence disorders, such as anxiety and depression. These problems generally don’t qualify for public mental health services and service providers are often required to address these symptoms within AOD treatment. To support work in this area, the Australian Government Department of Health and Ageing funded Turning Point Alcohol and Drug Centre to develop a validated screening tool (and accompanying clinical treatment guidelines) called PsyCheck. Constructed from the Self Reporting Questionnaire (SRQ) that assesses current symptoms, a general mental health screen which includes a history of treatment, and a suicide/self harm risk assessment, the PsyCheck tool is designed as a “first pass” indicator of potential mental health problems in AOD clients.
Routine screening of mental health among AOD treatment clients is essential to increase detection and intervention for comorbidity. Questionnaires (self report and/or clinician-administered) do not take the place of a comprehensive clinical or diagnostic assessment, however, the data collected can provide valuable information for the clinician. The Psycheck screen is known as an ‘opportunistic’ screening because the clinician takes the opportunity to screen for mental health problems when a client presents for another issue, that is, misuse of drugs and alcohol. Opportunistic screening is most effective when the screening is universal and all clients are screened, even when a mental health problem is not obvious or seems unlikely. This way, greater rates of detection of previously hidden symptoms can be observed.
People with co-occurring problems are more likely to be at risk of harm to themselves and others as alcohol and other drug use can impair judgement and increase the likelihood that people will act impulsively. In light of the fact that clinicians must always be aware of the potential for clients to harm themselves or others, assessment and management of suicidal ideation and self-harm are included in the PsyCheck screening tool.
The screening tool is linked to an intervention manual, known as the PsyCheck Clinical Treatment Guidelines. Once a clinician is familiar with the screening process, it is easy to determine if their client needs a more comprehensive mental health assessment. An evidence-based intervention will then give both the clinician and client the opportunity to really get to know and understand what underlies the client’s thoughts, feelings and behaviours. The intervention can be tailored to the holistic needs of the client, including their mental health symptoms.
The intervention utilises four core cognitive techniques:
- educating the client about the cognitive model and common unhelpful thinking patterns;
- educating the client about how to identify their unhelpful patterns of thinking;
- modifying these negative or distorted thoughts by a process called cognitive restructuring; and
- developing strategies to prevent relapse and maintain healthier patterns of thinking.
Clinical activities and worksheets, linked to the PsyCheck intervention, have been designed to support and reinforce learning in clinician/client sessions.
- Clinicians working in the alcohol and drug sector who would like to find out more about treating clients with comorbidity are encouraged to visit the PsyCheck website, where Psycheck can be downloaded for free.
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By Brian Flanagan
Manager Strategic Communications and Policy
Alcohol and other Drugs Council of Australia
Periods of excessive drinking are almost considered a rite of passage among many Australians. But the dangers of alcohol are often underestimated, and young people may not have considered the short and long-term harm which comes from binge drinking.
Drinking alcohol is the most common type of drug use in Australia. Alcohol is so widely used that many people don’t think of it as a drug, and may not realise that it can be very harmful.
Research has shown that that there is a strong link between mental health disorders and regular or dependant drug use, known as comorbidity. Comorbidity is of particular concern among young people. Alcohol and other drugs treatment services report that approximately 50-70% of young people with an alcohol or substance use issue also have a mental health problem. Those aged 18-24 have the highest prevalence of mental health disorders of any group and are also the most common users of drugs.
Drinking in excess of recommended levels can have harmful effects on the drinker’s health. These risks include short-term risks such as injury, violence, and accidental death and long-term risks such as cancer, cirrhosis of the liver, brain damage, memory loss and sexual dysfunction.
There are many social and personal problems that can be related to drinking at risky or high-risk levels, including family or relationship problems, problems at work or school and legal and financial problems. Because alcohol is a depressant, it can exaggerate moods and impair judgement – making it a dangerous drug to indulge in.
The National Health and Medical Research Council (NHMRC) issued revised Alcohol Guidelines on in March this year, which recommend that young people under 15 should not drink at all and those aged 15-17 should delay drinking as long as possible.
By LIFE Communications
This brief review presents the most recent substance use statistics for Australia, as well as providing a snapshot of some recent research findings from Australian and international research pertaining to substance use and suicide risk.
In Australia, the most recent estimates (2004-05) of alcohol consumption indicate that 13.4% of the population consumes enough to be classified in the risky/high risk categories (ABS, 2006). In 2004 38% of Australians surveyed admitted to using an illicit drug during their lifetime, and 15% admitted to using in the past 12 months. Further, in June 2008, there were 41,347 people registered for pharmacotherapy treatment of opoid dependence, two-thirds were male (AIHW, 2009).
The reason for highlighting opoid use is that people who have a history of opiate addiction appear more likely to have made at least one suicide attempt. For instance, one study (Trémeau, et al., 2008) found that 48% of clients attending a detoxification program in France had a history of attempting suicide. Additional risk was present for those who were assessed as more impulsive, had initially tried opiate substances at age 19 years (as opposed to 21) or had a family history of suicide. Increased risk was present for those who had a combination of these risk factors.
A review of the toxicology reports from suicide cases in New South Wales for the period 1997-2006 (Darke, Duflou, Torok, 2009) suggests that the majority of the deceased were not chronic substance users. This review found that 67.2% of those people who had completed suicide by means other than overdose had some form of substance in their system at the time of death. However, only 16.9% of all cases analysed were known to have a history of substance dependence (primarily intravenously delivered substances and alcohol). The most common substance was alcohol (40.6% of all cases). The proportion of substances present in the toxicology reports were up to 41 times higher than what might be expected to be found in the general Australian population.
Conversely, another study (in the United States; Mukamal, Kawachi, Miller, Rimm, 2007) found that there was an increased suicide risk for those who drank regularly, particularly for those who consume more than two standard drinks each day.
A study (Dunn, Goodrow, Givens, Austin, 2008) of American rural school-aged adolescents with an average age of 12-years-old found that those who had initiated the use of a variety of substances (both licit and illicit) were more likely to have contemplated suicide, planned suicide or attempted suicide. When considering the findings of the study, the authors called on stakeholders to develop policy and programs that aimed to prevent suicide as well as tackling the factors that contribute to drug use behaviour.
There is also a correlation between substance use and mental illness that can increase suicide risk. According to Surja and colleagues (2008) the comorbidity of mental illness and substance use usually goes unacknowledged when treatment is considered (Surja, Talari, Nair, Mettu, Lippman, 2008), with the former receiving the attention in treatment formulations. Practitioners who work with clients who are substance dependent are urged to complete a suicide risk assessment (Sher, 2006; Surja et al., 2008).
It should be noted that this review is limited in scope and does not aim to be complete, but instead sought to highlight some of the recent research findings in the area of substance use and suicide risk. The conclusion arising from those studies outlined here is the importance for people who work with clients who are using substances (licit and illicit) to be aware of recent research in relation to suicide risk.
References
Australian Bureau of Statistics (2006). Alcohol Consumption in Australia: A Snapshot, 2004-05. ABS: Canberra.
Australian Institute of Criminology (2006). Crime Facts Info: Trends in illicit drug use in Australia. AIC: Canberra, Australia.
Australian Institute of Health and Welfare (2009). National opoid pharmacotherapy statistics annual data collection: 2008 report. AIWH: Canberra, Australia.
Darke S, Duflou J, Torok M (2009). Toxicology and circumstances of completed suicide by means other than overdose. Journal of Forensic Science 54:2, 490-494.
Dunn MS, Goodrow B, Givens C, Austin S (2008). Substance use behaviour and suicide indicators among rural middle school students. Journal of School Health 78:1, 26-31.
Mukamal KJ, Kawachi I, Miller M, Rimm EB (2007). Drinking frequency and quantity and risk of suicide among men. Journal of Social Psychiatry and Psychiatric Epidemiology 42, 153-160.
Sher L (2006). Commentary: Alcohol consumption and suicide. QJM 99, 57-61.
Surja AAS, Talari S, Nair PK, Mettu P, Lippmann SB (2008). Teaching suicide risk assessment and treatment for depressed alcohol abusers. Primary Psychiatry 15:3, 49-51.
Trémeau F, Darreye A, Staner L, Corréa H, Weibel H, Khidichian F, Macher J-P (2008). Suicidaility in opoid-dependent subjects. American Journal of Addictions 17:3, 187-194.
LIFE Indigenous webpage
Suicide among Australia’s Indigenous population is significantly higher than the general Australian population, with some recent estimates suggesting the suicide rate for Indigenous people in some communities is as much as 40% higher in some years than that of the Australian population as a whole. The new LIFE indigenous webpage contains statistics, issues to consider, policy resources and more about suicide prevention in Australia’s Indigenous population.