Crisis Line Support for Suicide Prevention in Alcoholism
Recruiting in Palo Alto (17 mi)
+1 other location
Age: 18+
Sex: Any
Travel: May Be Covered
Time Reimbursement: Varies
Trial Phase: Academic
Recruiting
Sponsor: University of Michigan
Disqualifiers: Non-English speakers, Prisoners, Psychotic symptoms, others
No Placebo Group
Approved in 1 Jurisdiction
Trial Summary
What is the purpose of this trial?
The purpose of this research study is to learn about people who use the National Suicide Prevention (NSP) Lifeline during a suicidal crisis and those who don't. The researchers would also like to learn whether people who have experienced a suicidal crisis could benefit from participating in a therapy session about their thoughts and perceptions of the NSP Lifeline.
Will I have to stop taking my current medications?
The trial information does not specify whether you need to stop taking your current medications.
What data supports the effectiveness of the treatment Crisis Line Facilitation (CLF) for suicide prevention in alcoholism?
Research shows that Crisis Line Facilitation (CLF) can help reduce suicidal behaviors in high-risk Veterans by encouraging the use of crisis lines, although it may not increase the actual use of these lines. This suggests that CLF could be a useful tool in preventing suicide in people with alcoholism by providing support and encouraging help-seeking behavior.12345
Is Crisis Line Facilitation (CLF) safe for humans?
How is the Crisis Line Facilitation treatment unique for suicide prevention in alcoholism?
Crisis Line Facilitation (CLF) is unique because it involves a therapist-led session that educates participants about the National Suicide Prevention Lifeline and includes a practice call to the crisis line, aiming to increase comfort and confidence in using this resource during crises. This approach is different from traditional treatments as it focuses on facilitating help-seeking behavior rather than directly addressing the underlying condition.13467
Eligibility Criteria
This trial is for individuals with a probable alcohol use disorder in the past year, indicated by an AUDIT score of 16 or more. Participants must have attempted suicide within the last year or had suicidal thoughts recently, as shown by certain scores on the Beck scales.Inclusion Criteria
Probable alcohol use disorder within the past year based on an Alcohol Use Disorders Identification Test (AUDIT) score of 16 or greater
You have attempted suicide within the past year or have a history of suicide attempt more than a year ago and have current thoughts of suicide within the past month. This is determined by a test called the Beck Scale for Suicidal Ideation, which measures your thoughts of suicide, or by a test called the Beck Depression Inventory, which measures your level of depression.
Exclusion Criteria
You have severe mental health symptoms or cognitive impairment that could make it difficult for you to understand the study information or assessments.
Prisoners
I do not understand English.
Trial Timeline
Screening
Participants are screened for eligibility to participate in the trial
2-4 weeks
Intervention
Participants receive a single-session intervention addressing perceived barriers and facilitators of crisis line use during suicidal crisis
1 session
1 visit (in-person or virtual)
Enhanced Usual Care
Participants receive a brochure with NSP Lifeline and mental health resources, encouraged to schedule an appointment with a clinical provider
1 session
1 visit (in-person, email, or text)
Follow-up
Participants are monitored for crisis line utilization and suicidal behavior
12 months
Treatment Details
Interventions
- Crisis Line Facilitation (CLF) (Behavioral Intervention)
- Enhanced Usual Care (EUC) (Behavioral Intervention)
Trial OverviewThe study is testing whether therapy sessions discussing perceptions about using the National Suicide Prevention Lifeline can benefit those who've faced a suicidal crisis and have issues with alcohol.
Participant Groups
2Treatment groups
Experimental Treatment
Active Control
Group I: Crisis Line Facilitation (CLF)Experimental Treatment1 Intervention
This single-session intervention addresses the individuals' perceived barriers and facilitators of crisis line use during periods of suicidal crisis.
Group II: Enhanced Usual Care (EUC)Active Control1 Intervention
Participants randomized to the EUC condition will receive a brochure (in-person, via email, or via text message) with the NSP Lifeline and a list of outpatient mental health and substance use resources and encouraged to schedule an appointment with a clinical provider if they would like to discuss any current or past symptoms.
Crisis Line Facilitation (CLF) is already approved in United States for the following indications:
🇺🇸 Approved in United States as National Suicide Prevention Lifeline for:
- Suicidal crisis intervention
- Mental health support
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Detroit Rescue Mission MinistriesDetroit, MI
Meridian Health ServicesWaterford, MI
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Who Is Running the Clinical Trial?
University of MichiganLead Sponsor
National Institute on Alcohol Abuse and Alcoholism (NIAAA)Collaborator
References
Developing and testing Crisis Line Facilitation (CLF) to encourage help-seeking in adults receiving inpatient treatment for a suicidal crisis. [2021]Military Veterans are at overall greater risk of suicide than non-Veterans and have experienced increases in rates of suicide that are on par with or exceed those of the general population. The Department of Veterans Affairs has undertaken several initiatives to reduce suicide among Veterans, including the development and expansion of the Veterans Crisis Line (VCL). The VCL has the potential to reduce suicidal behaviors, but it is likely underutilized by high-risk Veterans. This paper describes the development of Crisis Line Facilitation (CLF) a brief intervention, designed to increase use of the VCL in this high-risk population. In a single session, CLF presents psychoeducational information about the VCL, discusses the participant's perceived barriers and facilitators to future use of the VCL, and culminates in the Veteran calling the VCL with the therapist to provide firsthand experiences that may counter negative impressions of the line. The intervention development process, intervention and control condition, and self-reported change indices are presented. Preliminary results (N = 301) suggest Veterans receiving CLF may experience a significant increase in comfort with, and confidence in, using the VCL during future crises compared to those in the control condition.
The Effectiveness of the Safety Planning Intervention for Adults Experiencing Suicide-Related Distress: A Systematic Review. [2022]The safety planning intervention (SPI) is gaining momentum in suicide prevention practice and research. This systematic review sought to determine the effectiveness of the SPI for adults experiencing suicide-related distress. Systematic searches of international, peer-reviewed literature were conducted in six databases (Cochrane Trials, Embase, Emcare, Medline, PsycINFO and Web of Science), including terms for safety planning, suicide, and suicide-related outcomes. A total of 565 results were included for screening. Result screening (title/abstract and full-text), data extraction and critical appraisal were conducted in duplicate. Twenty-six studies met the inclusion criteria. Studies were primarily quantitative (n = 20), largely with general adult or veteran samples; a small number of studies explored the perspectives of staff and significant others. Half of the studies included the SPI as a standalone intervention, while the other half examined the SPI in combination with other interventions. Most interventions were delivered in-person, with a hard-copy safety plan created, while a smaller number explored internet-based interventions. Primary measures included: suicidality (ideation, behavior, deaths; 10 studies), suicide-related outcomes (depression, hopelessness; 5 studies) and treatment outcomes (hospitalizations, treatment engagement; 7 studies). The evidence supports improvements in each of these domains, with complementary findings from the remaining quantitative and qualitative studies suggesting that the SPI is a feasible and acceptable intervention. While positive, these findings are limited by the heterogeneity of interventions and study designs, making the specific impact of the SPI difficult to both determine and generalize. Conversely, this also points to the flexibility of the SPI.HighlightsThe Safety Planning Intervention (SPI) is a valuable indicated intervention for general adult and veteran populations experiencing suicide-related distress, primarily in face-to-face, clinical settings.Quantitative findings indicate associations between the SPI and improvements in suicidal ideation and behavior, decreases in depression and hopelessness, along with reductions in hospitalizations and improvements in treatment attendance.Qualitative studies suggest the SPI is acceptable and feasible, with areas for development.SPIs have been shown to be adaptable to the clinical area in its modality (digital or paper-based), delivery (face-to-face or online), facilitation (clinician or self-administered) and multiplicity (as stand-alone or combined intervention).
Encouraging the use of the Veterans Crisis Line among high-risk Veterans: A randomized trial of a Crisis Line Facilitation intervention. [2023]The Veterans Crisis Line (VCL) is a core component of VA's suicide prevention strategy. Despite the availability and utility of the VCL, many Veterans do not utilize this resource during times of crisis. A brief, psychoeducational behavioral intervention (termed Crisis Line Facilitation [CLF]) was developed to increase utilization of the VCL and reduce suicidal behaviors in high-risk Veterans. The therapist-led session includes educational information regarding the VCL, as well as a chance to discuss the participant's perceptions of contacting the VCL during periods of crisis. The final component of the session is a practice call placed to the VCL by both the therapist and the participant. The CLF intervention was compared to Enhanced Usual Care (EUC) during a multi-site randomized clinical trial for 307 Veteran participants recently hospitalized for a suicidal crisis who reported no contact with the VCL in the prior 12 months. Initial analyses indicated that participants randomized to the CLF intervention were less likely to report suicidal behaviors, including suicide attempts compared to participants randomized to receive EUC over 12-months of follow-up (χ2 = 18.48/p < 0.0001), however this effect was not sustained when analyses were conducted on an individual level. No significant differences were found between conditions on VCL utilization. Initial evidence suggests a brief CLF intervention has an impact on preventing suicidal behaviors in Veterans treated in inpatient mental health programs; however, it may not change use of the VCL. This brief intervention could be easily adapted into clinical settings to be delivered by standard clinical staff.
National Suicide Prevention Lifeline crisis chat interventions: Evaluation of chatters' perceptions of effectiveness. [2022]As part of the National Suicide Prevention Lifeline's crisis response system, the Lifeline Crisis Chat Network (LCC) answers chats from hundreds of thousands of at-risk individuals yearly. The study's objective was to assess the effectiveness of these online crisis interventions.
The Effectiveness of Crisis Line Services: A Systematic Review. [2020]Background: Crisis lines are a standard component of a public health approach to suicide prevention. Clinical aims include reducing individuals' crisis states, psychological distress, and risk of suicide. Efforts may also include enhancing access and facilitating connections to behavioral health care. This review examines models of crisis line services for demonstrated effectiveness. Methods: Literature searches of Medline, EMBASE, PsycINFO, Web of Science, CINAHL, Cochrane Library, and Google Scholar were conducted from January 1, 1990, to May 7, 2018. Experts were contacted, and references were mined for additional studies. Eligible studies provided health- or utilization-related effectiveness outcome(s). Results were graded according to the Oxford Centre for Evidence-Based Medicine and evaluated for risk of bias using the Effective Public Health Practice Project quality assessment tool for quantitative studies. Results: Thirty-three studies yielded effectiveness outcomes. In most cases findings regarding crisis calls vs. other modalities were presented. Evaluation approaches included user- and helper-reported data, silent monitoring, and analyses of administrative records. About half of studies reported immediate proximal outcomes (during the crisis service), and the remaining reported distal outcomes (up to four years post-contact). Most studies were rated at Oxford level four evidence and 80% were assessed at high risk of bias. Conclusions: High quality evidence demonstrating crisis line effectiveness is lacking. Moreover, most approaches to demonstrating impact only measured proximal outcomes. Research should focus on innovative strategies to assess proximal and distal outcomes, with a specific focus on behavioral health treatment engagement and future self-directed violence.
Evaluation of a suicide prevention training curriculum for substance abuse treatment providers based on Treatment Improvement Protocol Number 50. [2022]Substance use disorders (SUDs) confer risk for suicide yet there are no empirically supported suicide prevention training curricula tailored to SUD treatment providers. We assessed the efficacy of a 2-hour training that featured a suicide prevention training video produced by the Department of Veterans Affairs. The video was based on Treatment Improvement Protocol Number 50 (TIP 50) a practical manual to manage suicide risk produced by the Substance Abuse and Mental Health Services Administration. The training was provided in small groups to 273 SUD treatment providers in 18 states. Results were evaluated using self-report assessments obtained at pre-test, post-test, and 2-month follow-up. Statistically significant changes (p
Caught Between Expectations and the Practice Field. [2022]Background: Volunteer crisis line responders are a valuable resource for suicide prevention crisis lines worldwide. Aim: The aim of this study was to gain a deeper understanding of how volunteers operating a diaconal crisis line in Norway experienced challenges and how these challenges were met. Method: A qualitative, explorative study was conducted. A total of 27 volunteers were interviewed through four focus groups. The material was analyzed using systematic text condensation. Results: The greatest challenge to the volunteers was the perception of a gap between their expectations and the practice field. The experience of many volunteers was that the crisis line primarily served a broad ongoing support function for loneliness or mental illness concerns, rather than a suicide prevention crisis intervention function. Limitations: The focus group design may have made the participants more reluctant to share experiences representing alternative perspectives or personally sensitive information. Conclusion: The findings of this study suggest that a uniform response to callers using crisis lines as a source of ongoing support is warranted and should be implemented in volunteer training programs.