The Suicide Probability Scale: A Means to Assess Substance Abusing Clients' Suicide Risk

Article excerpt

Although substance abusing clients may not be the primary treatment population that most counselors serve, it is nearly inevitable that at one time or another, the vast majority of counselors will encounter clients presenting with substance use issues. Given the significant suicide risk with persons meeting substance abuse and substance dependence criteria, it is imperative that counselors be aware of both the frequency of suicide among these treatment populations and the means to assess such risk. The authors describe the frequency of suicide and findings purporting that substance abusing and substance dependent clients are at increased suicide risk. The Suicide Probability Scale (SPS) is then described along with a description of how the authors utilized the instrument with substance abusing and substance dependent clients presenting with suicidal ideation.

Contrary to the beliefs of some counselors, substance abusing clients do not have to be physically or psychologically dependent to substances to be a significant risk for suicide; substance abusing clients can also be in danger. Nevertheless, those who are substance dependent do present extreme suicide risk. Thus, the intent of this article is to provide counselors who may at one time or another encounter substance abusing or substance dependent clients a succinct literature review of the correlation between suicidal behaviors and substance use and a description and general overview of a suicide assessment instrument we have found helpful when counseling both youth and adults who are abusing substances and report at least some degree of suicidal ideation or thought. Two accompanying clinical vignette examples are used to further demonstrate how we utilize the Suicide Probability Scale (SPS) with our clients.

Approximately 32,000 Americans committed suicide in 2005 (Centers for Disease Control and Prevention, 2007a). That equates to nearly 89 people within the US committing suicide each day or one suicide every 17 minutes. Overall suicide is the 11th leading cause of deaths in the US (Centers for Disease Control and Prevention, 2007a). Among Americans ages 25-34, suicide is the second leading cause of death (Centers for Disease Control and Prevention, 2007b), whereas for ages 10 to 24, it is the third leading cause of death (Centers for Disease Control and Prevention, 2007b). Nearly 12% of all deaths among this latter group of youth result from suicide.

Given these alarming numbers, suicide assessment is especially important to counselors treating youth and adults who are substance abusing or substance dependent (Juhnke, 2002; Rogers, 1992). When compared with the general US population, it has long been noted that potential for suicidal behavior is significantly greater for substance abusing persons as well as persons presenting with diagnosable mental disorders (Maris, 1991; Nekanda-Trepka, Bishop, & Blackburn, 1983; Rich, Young, & Fowler, 1986; Stillion, McDowell, & May, 1989). Given that substance abuse and dependence in particular are diagnosable mental disorders, clients meeting these diagnostic criteria deserve special attention related to suicide (Foster, 2001; Rogers, 1992).

Substance Use and Suicide Risk

Counselors should be aware that alcohol dependent persons may be 60 to 120 times more likely to risk suicide than a non-psychiatrically diagnosed population (Hufford, 2001). Several reasons have been proposed to explain this greater risk among Alcohol Dependent persons: (a) their experiences of more frequent negative life events (e.g., marital discord, family dysfunction, and employment problems), (b) the high comorbidity rates of alcohol dependence and depression, (c) their high rates of helplessness and hopelessness, (d) common personality characteristics of impulsivity and sociopathy, and (d) family histories of suicide (Hufford, 2001; Roy, 1993; Roy, 2000). Therefore, until determined otherwise via clinical interviews and diagnostic assessments, alcohol dependent clients should be considered at significant suicide risk due to their long-term and immediate psychological and social dysfunctions. …