John Robins
John Robins is based at the National Addiction Centre at King’s College London, where he was awarded departmental funding to complete his PhD. Previously, John spent seven years as a practitioner in community drug and alcohol treatment services in Tottenham, London, working in criminal justice drug treatment, aftercare and outreach teams. He was awarded a student bursary from the SSA to complete an MSc at the National Addiction Centre focussing on the role of substance use in psychiatric crisis. He is currently researching the profile of alcohol use disorder in suicidal crisis and its impact on risk and care.
Risk factors for suicidal behaviour among community alcohol treatment service users
Background / aims: Given that alcohol dependence is associated with an increased risk of suicide, Community Drug and Alcohol Team (CDAT) services may play a role in preventing suicide. This study aims to identify clinical, demographic, and social risk factors for suicidal behaviour among a cohort of service users accessing CDAT treatment for their alcohol use.
Methods: We analysed 14 years of electronic health record data from 7,145 adults accessing CDAT alcohol treatment in London. We used proportional hazards regression to estimate the association of each risk factor with psychiatric crisis care contact or death by suicide, and all-cause mortality, within one year of starting treatment.
Results: After adjustment, the largest increases in risk of crisis care contact or death by suicide were associated with a history of suicide attempts (HR=1.83, 95%CI=1.43-2.33), current suicidal plans or carer concern (HR=1.65, 95%CI=1.18-2.31) and mental health problems (HR=1.81, 95%CI=1.41-2.32); decreases in risk were associated with abstinence from alcohol (HR=0.51, 95%CI=0.31-0.83), Black ethnicity (HR=0.61, 95%CI=0.45-0.83); and children living with the service user (HR=0.74, 95%CI=0.56-0.99). Social isolation was the only risk factor associated with increased risk of crisis care contact or death by suicide (HR=1.24, 95%CI=1.02-1.51) and death by any cause (HR=1.85, 95%CI=1.24-2.76).
Conclusions: Although drug and alcohol treatment services do not provide intensive psychiatric care, engagement with such services may help prevent suicide in people with alcohol dependence. This study identifies a profile of risk factors for suicidal behaviour among alcohol treatment service users, which may aid risk formulation and safety planning in CDAT services.