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Impulsive suicide attempts predict post-treatment relapse in alcohol-dependent patients.

Wojnar M, Ilgen MA, Jakubczyk A, Wnorowska A, Klimkiewicz A, Brower KJ. Impulsive suicide attempts predict post-treatment relapse in alcohol-dependent patients. Drug and Alcohol Dependence. 2008 Oct 1; 97(3):268-75.

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BACKGROUND: The present study was designed to examine the influence of suicidality on relapse in alcohol-dependent patients. Specifically, a lifetime suicide attempt at baseline was used to predict relapse in the year after treatment. Also, the unique contribution of impulsive suicide attempts was examined. METHODS: A total of 154 patients with alcohol dependence, consecutively admitted to four addiction treatment facilities in Warsaw, Poland participated in the study. Of the 154 eligible patients, 118 (76.6%) completed a standardized follow-up assessment at 12 months. RESULTS: Previous suicide attempts were common in adults treated for alcohol dependence with 43% patients in the present sample reporting an attempt at some point during their lifetime. Additionally, more than 62% of those with a lifetime suicide attempt reported making an impulsive attempt. Lifetime suicide attempts were not associated with post-treatment relapse (chi-square = 2.37, d.f. = 1, p = 0.124). However, impulsive suicide attempts strongly predicted relapse (OR = 2.81, 95% CI = 1.13-6.95, p = 0.026) and time to relapse (OR = 2.10, 95% CI = 1.18-3.74, p = 0.012) even after adjusting for other measures of baseline psychopathology, depression, impulsivity, hopelessness and alcohol use severity. CONCLUSIONS: This study is the first to document the relationship between pre-treatment impulsive suicide attempts and higher likelihood of post-treatment relapse in alcohol-dependent patents. Clinicians should routinely conduct an assessment for previous suicide attempts in patients with alcohol use disorders, and when impulsive suicidality is reported, they should recognize the increased risk for relapse and formulate their patients'' treatment plans accordingly with the goals of reducing both alcoholic relapse and suicide rates.

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