September is both National Recovery Month and Suicide Prevention Awareness Month, creating a critical opportunity for all of us to address the intersection of these two public health challenges. For behavioral health professionals, this means making it a priority to screen and safety plan for suicide and substance use risk with every patient we encounter.
Understanding the urgency & connection
In 2023, more than 100,000 people in the United States died from drug overdoses and 49,000 died by suicide. Substance use disorders are strongly linked with suicidal thoughts, attempts and death, with alcohol and opioid use disorders carrying the highest risk.
Drug use patterns have also shifted. Deaths involving stimulants have increased, frequently with opioid co-involvement. This means individuals who do not intend to use opioids may still be exposed to an opioid such as fentanyl because it can be mixed into counterfeit pills or stimulant supplies unknowingly.
An integrated screening & intervention model
Screening for both suicide and substance use risks is recommended during every patient encounter. You can utilize a brief suicide screen alongside a substance use screen in the same visit. Consider using screening tools such as:
- Ask Suicide-Screening Questions (ASQ) to screen for suicidal ideation.
- Alcohol Use Disorders Identification Test (AUDIT-C) to screen for alcohol use.
- Drug Abuse Screening Test (DAST-10) to screen for other substance use.
Ask directly about substance use disorder symptoms, including the use of non-prescribed pills, counterfeit benzodiazepines and stimulants. You should clarify recent use, withdrawal symptoms and the patient’s desire to change. Given co-involvement trends, stimulant use without stated opioid use still warrants overdose risk counseling.
If you are concerned about suicidal behavior, ask about the individual’s access to medications or firearms and if they are actively engaged with mental health treatment. Always validate patients who disclose concerns and offer your support.
Reduce risk for overdose
Offer naloxone to patients who are at risk for an opioid overdose. Encourage them to keep it within reach throughout the day and to let friends and family know where it is. You can learn more about discussing naloxone with patients from the CDC.
Matching level of care to patient need
When outpatient therapy is not enough, you can connect patients to a higher level of care, such as an intensive outpatient program (IOP), partial hospitalization program (PHP) or inpatient hospitalization for very acute needs. You can explore hospital-based levels of treatment to find the right fit. Be sure to consider therapy and medication management when indicated and discuss recovery housing or sober living options for patients who need more structure.
Local trends in DuPage County
In DuPage County, you can tie the guidance you provide to patient’s to local suicide prevention and substance use recovery progress. Over the past five years, DuPage County averaged about 94 suicide deaths annually. On substance use, after a 10% rise in overdose deaths in 2022, the county saw a 24% decrease in 2023 — the first positive movement since 2012. This success is credited to collaborative efforts in the community including the HOPE Taskforce (Heroin/Opioid Prevention and Education).
This downward trend creates an opportunity to highlight local initiatives to de-stigmatize sober living and recovery homes. Frame your messaging to emphasize community acceptance and the importance of safe, supportive recovery housing. Tying into this emerging initiative grounds your guidance in a local context and signals proactive leadership.
Key factors in clinical assessments
- Alcohol & sedatives. Alcohol is a contributing factor in many suicides, with a substantial share having a blood alcohol concentration (BAC) at or above 0.08 g/dL. Ask about the timing and quantity of use to guide safety planning and risk reductions efforts with patients.
- Stimulants. Deaths involving cocaine and methamphetamine often also involve opioids. Screen for stimulant use even if a patient denies opioid use and educate them about the risks of counterfeit pills and unintentional opioid exposure.
Resources for your team & patients
- Recovery Month. Learn more and access clinical-ready messaging from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Centers for Disease Control (CDC).
- Suicide Prevention Awareness Month. Use current education materials for staff huddles and patient-facing content from SAMHSA and the American Foundation for Suicide Prevention (AFSP).
- Podcasts. Podcasts are free, on-demand and can extend support between sessions. Consider recommending one based on a patient’s need, such as The Addiction Psychologist, which features evidence-based discussions with researchers, clinicians, and policymakers in the field of addiction psychology, or Recovery Elevator, which focuses on peer support and shares powerful stories from everyday people navigating their recovery journey.
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