Georgia State University Study Seeks to Reduce Suicide Risk Among Heavy Drinkers

Research funded by a five-year, $3.4 million National Institutes of Health grant

ATLANTA - Suicide is a leading cause of death in the United States, and the risk is elevated among people who frequently engage in heavy drinking. With the ultimate goal of saving lives, a team of Georgia State University researchers is studying whether techniques from a common form of talk therapy delivered via text message can reduce the risk of suicide among intoxicated heavy drinkers.

Over a period of five years, 240 people in Atlanta will be assigned to a control group or an experimental group that is trained in two skills - expanding awareness and paced breathing. Participants also will be randomized to receive text messages that reinforce the skills twice a day for two weeks or a control message that does not mention the skills. The project is funded by a five-year grant of up to $3.4 million from the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health.

"There are proven programs to reduce suicide and proven programs to reduce alcohol use, but virtually nothing that helps people when they're both suicidal and intoxicated," said the study's co-principal investigator, Professor Amanda Gilmore of Georgia State's School of Public Health. "This study is about filling that gap with practical and effective tools that people can use in those moments."

Creating a Scalable, Evidence-Based Program
The techniques the researchers are testing are drawn from dialectical behavior therapy (DBT), an intensive, year-long treatment that has been shown to reduce suicidal behavior. Full DBT includes weekly individual therapy, weekly group skills classes and 24/7 phone coaching. This model is effective but difficult to scale. Suicide rates have increased by a third over the past 20 years, the researchers note, and nearly three out of every four suicide attempts are preceded by alcohol use.

For the expanding awareness skill, research participants practice noticing five things inside their body and seven things outside their body in a mindful, non-judgmental way. The goal is to counteract the narrowed focus that often occurs with intoxication. For the paced breathing skill, research participants breathe in for a count of five seconds and out for a count of seven seconds, which promotes calm and reduces distress. Gilmore and her colleagues refer to expanding awareness and paced breathing as the "5-7 skills" to make them easier to remember.

"These skills aren't meant to be a replacement for therapy," said co-principal investigator Cynthia Stappenbeck, a professor in the Department of Psychology at Georgia State. "Our goal is to reach people who aren't ready or able to seek treatment and to give them something that can help reduce the risk of self-harm. For people who are already receiving care, these skills can complement therapy."

The new project builds on a pilot study conducted by Gilmore that found that participants were able to use the 5-7 skills even while drinking. If the skills are found to be effective in reducing distress tolerance, which is a widely used proxy for risk of suicide, then findings from the project can be used to optimize the program so that it reaches a broader population.

Gilmore co-leads an NIH-funded doctoral training program known as A-PREVENT that is focused on the intersection of alcohol misuse and violence, and students from the program will contribute to the study's implementation and data collection.

"We want to turn what we learn in this study into practical tools that can be scaled so that fewer people act on suicidal thoughts when they've been drinking," Gilmore said. "Alcohol is involved in the majority of suicide attempts and deaths, so even small gains in helping people through difficult moments could have a profound impact on families and communities."

If you or someone you know is struggling or in crisis, help is available. Call or text 988, or chat at 988 Lifeline.

Research reported in this news release was supported by the National Institute on Alcohol Abuse and Alcoholism of the National Institutes of Health under award number R01 1R01AA033115-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Co-investigators on the project include:

• Ruschelle Leone, Associate Professor at the University of Colorado Anschutz School of Medicine
• Anna Jaffe, Associate Professor at the University of Washington School of Medicine