New Psychoeducational Suicide Prevention Module Found Superior to Usual Care in Patients With Substance Use Disorders

The Preventing Addiction Related Suicide (PARS) module was found to be superior to usual care in improving suicide knowledge, maladaptive attitudes, and help-seeking in adults undergoing community addiction treatment, according to a study recently published in JAMA Network Open.

The PARS module has the potential for a significant impact on the national suicide prevention strategy and for patients with substance use disorder (SUD), according to the study authors.

“SUD treatment may present unique opportunities to prevent suicide, since treatment and recovery staff engage a high-risk population that is both concentrated and accessible,” the authors wrote.

The PARS module, an interactive psychoeducational module, is the first suicide prevention module developed in and for community substance use intensive outpatient programs (IOPs). PARS is a 1-session secondary prevention module administered by trained SUD counselors consisting of didactic preventions about suicide risk factors, warning signs, and actions to take if suicide risk is observed in self or others.

Researchers conducted a stepped-wedge cluster-randomized clinical trial to evaluate the efficacy of PARS on suicide-related outcomes including knowledge, maladaptive attitudes, and help-seeking behavior compared with usual care. The trial was conducted from 2017 to 2020 with follow-up assessments conducted after treatment and at 1, 3, and 6 months.

Participants included adult outpatients in SUD treatment at community IOPs across Western Washington state. Researchers analyzed the data from July 1, 2020, to January 20, 2022.

The study included 906 participants (mean [SD] age, 37.5 [12.0] years; 540 [59.6%] men), of whom 478 participants received usual care and 428 patients received PARS.

In intent-to-treat analysis form baseline to after treatment, there was a greater improvement found in suicide knowledge for participants receiving PARS compared with those receiving usual care (d = 0.15; 95% CI, 0.08 to 0.23; P < .001). Additionally, a greater reduction in maladaptive attitudes was observed for patients receiving PARS (d = 0.18; 95% CI, 0.14 to 0.25; P < .001).

Researchers found improvements were maintained at follow-up for suicide knowledge (1 month: d = 0.16; 95% CI, 0.07 to 0.22; P < .001; 3 months: d = 0.12; 95% CI, 0.05 to 0.19; P = .001; 6 months: d = 0.13; 95% CI, 0.06 to 0.20; P < .001) and reductions in maladaptive attitudes (1 month: d = 0.20; 95% CI, 0.12 to 0.23; P < .001; 3 months: d = 0.10; 95% CI, 0.05 to 0.16; P < .001; 6 months: d = 0.14; 95% CI, 0.09 to 0.19; P < .001), with 788 participants (87.0%) of the sample responding across time points.

Notably, from baseline to 6 months, there was a greater improvement in help-seeking in the PARS group compared with the usual care group (d = 0.16; 95% CI, 0.01 to 0.32; P = .04). The authors note that increasing help-seeking has been recognized as a challenge in the suicide prevention field; however, the effect of PARS on help-seeking was only significant at 6 months.

These findings indicate that PARS is superior to usual care in improving suicide knowledge, maladaptive attitudes, and help-seeking among adults undergoing community addiction treatment for SUD, according to the study authors. The authors suggest that as a 1-session IOP module developed in partnership with community addiction agencies, PARS has the potential for wide impact in the national suicide prevention strategy.

“A goal of PARS from its inception was the development of an effective and feasible intervention that fit into SUD counselors’ usual workflow. Although working with a high suicide-risk population, most SUD counselors are not trained or licensed to give acute suicide treatment; however, PARS, as a secondary prevention intervention (as opposed to acute treatment), fits within SUD counselors’ scope of practice,” the authors wrote. “Furthermore, by repeatedly delivering the PARS module in successive IOP groups, SUD counselors receive continued practice exposure to suicide prevention skills, which may translate into improved clinical care.”

They suggest that the open discussion of experiences around suicide, which is a core component of the PARS module, may additionally help decrease stigma, a key issue in the recognition and intervention of suicidality.

“As substance-related suicide and overdose numbers increase and overlap, effective prevention interventions are needed in SUD treatment settings. With high acceptability and feasibility, PARS has the potential for wide impact,” the authors concluded.

The study has some limitations. Prior to this study, Washington state mandated suicide prevention training for behavioral health workers, including community SUD counselors. This may have affected the counselor’s baseline suicide knowledge and restricted the range of improvement in patient outcomes.

Additionally, results are based on group IOPs, and therefore, may not generalize to other types of SUD treatment.

Reference

Ries R K, Livengood A L, Huh D, et al. Effectiveness of a suicide prevention module for adults in substance use disorder treatment: a stepped-wedge cluster randomized clinical trial. JAMA Netw Open. 2022;5(4):e222945. doi:10.1001/jamanetworkopen.2022.2945