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Cocaine use disorders and suicidal ideation

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Abstract

The goal of this study was to determine the contribution of substance abuse to the expression of suicidal ideation in a sample of patients referred for evaluation of chemical dependency in a large urban Psychiatric Emergency Service (PES). Records from 777 consecutive patients referred to the chemical dependency service of the PES were analyzed. Of this sample, 43.7% of the patients with only a cocaine use disorder expressed suicidal ideation compared to 38% of those with both cocaine and alcohol use disorders, 24.3% with only an alcohol use disorder and 17% with other drug use disorders (χ2=24.768; df=3; P<0.0001). More than half of the patients (55.26%) with a substance-induced mood or psychotic disorder expressed suicidal ideation (χ2=23.174, df=1, P<0.0001), and the majority (85%) of these patients had a cocaine use disorder (χ2=12.309, df=1, P<0.0005). In this sample of patients served by an urban PES, cocaine use is associated with suicidal ideation, more so than other substances of abuse.

Introduction

There is emerging evidence that one of the adverse sequela of substance abuse is increased suicide risk (Fowler et al., 1986, Marzuk et al., 1992, Rich et al., 1998, Garlow, 2002). In a comprehensive analysis of all completed suicides in Fulton County, Georgia from 1994 to 1998, 9.9% tested positive for cocaine metabolites at the time of autopsy, with 14.4% of all victims under age 50 being positive (Garlow, 2002). In the same sample of completed suicides, 28.8% had ethanol detected at autopsy. We now seek to extend this observation to substance abusing patients, to determine if patients with cocaine, alcohol or other substance use disorders experience suicidal ideation at rates similar to the rates of detection of these substances in suicide victims.

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Setting

Central Intake is a clinical service dedicated to evaluation of chemically dependent patients in the Psychiatric Emergency Service (PES) of a large, urban, public hospital. The PES has over 15 000 patient contacts per year, of which 30% have a substance use disorder (16% alcohol, 14% cocaine) and Central Intake was established in the PES to serve these patients. Central Intake is the gateway into public-sector substance abuse treatment services in Fulton County, GA. (Fulton County encompasses

Results

The demographic characteristics of the patients, by suicidal ideation are included in Table 1. Of the 777 patients referred to Central Intake in the study interval, 331 (42.9%) were self-referred and 441 (57.1%) were clinician referred. Both groups had equal rates of substance abuse: 73.1% of self and 69.6% of clinician referred patients had a cocaine use disorder and 62% of both groups had an alcohol use disorder.

Suicidal ideation was reported by 273 (35.4%) of the patients referred to Central

Discussion

The actions of intoxicating substances may play different roles in the progression from suicidal ideation to completed suicide. In a review of all the suicide victims in Fulton County, GA from 1994 to 1998, 14.4% of all victims under age 50 tested positive for cocaine at autopsy (Garlow, 2002). In comparison, 40.5% of the patients with cocaine use disorders evaluated in the PES expressed suicidal ideation. In contrast, a similar rate of alcohol use was found the sample of completed suicides

Acknowledgements

The authors wish to acknowledge and thank the dedicated staff of the Psychiatric Emergency Service at Grady Memorial Hospital. SJG is supported by grants K23 RR15531-01, RO1 MH60745-01, NARSAD Young Investigator award and AFSP pilot project award.

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