Development of an Intervention to Reduce Overdose Risk in Dual Diagnosis Patients

Suicide is a leading cause of death for individuals leaving psychiatric hospital settings, and co-morbid substance use dramatically increases risk for post-discharge suicidal thoughts and behaviors. Because of their mental health comorbidities and other treatment barriers, these dual-diagnosis patients with co-occurring psychiatric and substance use disorders are more likely to experience both intentional and unintentional overdose, especially during the period following a transition from higher-level hospital care to lower-intensity outpatient treatment. Given the myriad of barriers and problems encountered by patients during these care transitions, current intervention and prevention strategies are less effective for this group. In fact, there is limited evidence to support the effectiveness of suicide interventions specifically for individuals with drug or alcohol use disorders, highlighting a high-risk group in need of adaptations and supplements to current evidence-based treatments. Suicide prevention interventions need to address overdose across the spectrum of intentionality and with additional considerations related to the influences of substance use and intoxication. The proposed study aims to address important gaps in current research by adapting and integrating evidence-based strategies to determine the feasibility and acceptability of a novel, overdose-specific safety planning intervention for dual diagnosis individuals in order to inform a future large-scale randomized controlled trial. All participants will provide informed consent and complete both self-report and interview measures to confirm eligibility. In Phase 1, qualitative interviews will be conducted with dual diagnosis patients with recent suicidality and history of overdose experience (n = 16-18) to understand their unique needs and special considerations for this population. In Phase 2, a novel overdose prevention intervention, called Steps for Overdose Safety (S.O.S), will be piloted using an iterative process and successive cohort design (3 cohorts, n = 8 each). Eligible participants will receive S.O.S, an adjunctive, multifaceted, 3-session intervention (1 primary session while hospitalized, 2 remote sessions post-discharge) over the course of 4 weeks. Goals for the project include: (1) explore overlapping risk factors for suicide and overdose to inform an overdose-specific prevention plan; (2) iteratively develop and test content and structure of the intervention, and (3) determine feasibility and acceptability of the approach through feedback from participants and a Community Advisory Board of clinicians, administrators, and patients. A structured mentorship plan will ensure project success through oversight from senior investigators regarding implementation of clinical trial methodology, intervention development for the intersection of suicidality and overdose, and the integration of mixed-methods research. Mentorship and consultation will be guided by an exceptional mentorship team with highly relevant expertise, as well as rich training environments in the Brown University Medical School, Butler Hospital, and Michigan State University. This project has important clinical and public health implications with the potential to significantly reduce rates of overdose. The study will launch the PI’s career as an independent clinical scientist to allow for follow-up studies and additional contributions to the field of suicide research.