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Using Mindfulness-Based Cognitive Therapy to Prevent Suicide Among High Suicide–Risk Patients Who Also Misuse Opioids: a Preliminary Probe of Feasibility and Effectiveness

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Abstract

Knowledge of how to effectively prevent suicide attempt (SA) in high suicide–risk patients who also misuse opioids is limited. In a subset of data from 36 participants with baseline opioid misuse in a randomized clinical trial testing adjunctive mindfulness-based cognitive therapy to prevent suicide among high suicide–risk veterans (n = 18 per treatment condition), MBCT-S reduced the likelihood of SA and acute psychiatric hospitalization over 12-month follow-up. Those in MBCT-S had a relative risk of 17% and 42% for SA and hospitalization (p = .09, .02), respectively, compared to those receiving enhanced treatment as usual (eTAU) alone. Rates of opioid misuse during follow-up were more than halved with the addition of MBCT-S to eTAU (p = .08). Meanwhile, among trial participants who did not misuse opioids (n = 104), RRs of 64% and 77% for SA and hospitalization (p = .28, .33), respectively, were found with MBCT-S compared to eTAU. An MBCT-S trial with greater power is warranted in this population.

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References

  • Ahmad F.B., Cisewski J.A. (2021). Quarterly provisional estimates for selected indicators of mortality, 2019-Quarter 2, 2021. National Center for Health Statistics. National Vital Statistics System, Vital Statistics Rapid Release Program.

  • Ahmadi, J., Jahromi, M. S., & Ehsaei, Z. (2018). The effectiveness of different singly administered high doses of buprenorphine in reducing suicidal ideation in acutely depressed people with co-morbid opiate dependence: A randomized, double-blind, clinical trial. Trials, 19(1), 462. https://doi.org/10.1186/s13063-018-2843-9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Ali, M. M., & Dubenitz, J. (2021). Suicidal behavior, opioid use disorder, and behavioral health treatment: Prevalence and correlates among adults in the United States 2015–2018. Journal of Substance Abuse Treatment, 130, 108413. https://doi.org/10.1016/j.jsat.2021.108413

    Article  CAS  PubMed  Google Scholar 

  • Argento, E., Braschel, M., Walsh, Z., Socias, M. E., & Shannon, K. (2018). The moderating effect of psychedelics on the prospective relationship between prescription opioid use and suicide risk among marginalized women. Journal of Psychopharmacology, 32(12), 1385–1391. https://doi.org/10.1177/0269881118798610

    Article  PubMed  Google Scholar 

  • Asarnow, J. R., & Chung, B. (2021). Editorial: COVID-19: Lessons learned for suicide prevention. Journal of Child Psychology and Psychiatry and Allied Disciplines, 62(8), 919–921. https://doi.org/10.1111/jcpp.13489

    Article  PubMed  Google Scholar 

  • Ashrafioun, L., Kotwoallama, R. A. Z., Bishop, T. M., & Britton, P. C. (2020). Opioid use disorders, psychiatric comorbidities, and risk for suicide attempts among veterans seeking pain care. Psychological Medicine, 50(12), 2107–2112. https://doi.org/10.1017/S0033291719002307

    Article  PubMed  Google Scholar 

  • Bishop, S. R., Lau, M., Shapiro, S., Carlson, L., Anderson, N. D., Carmody, J., . . . Devins, G. (2004). Mindfulness: A proposed operational definition. Clinical psychology: Science and practice, 11(3), 230-241https://doi.org/10.1093/clipsy.bph077

  • Bohnert, A. S., & Ilgen, M. A. (2019). Understanding links among opioid use, overdose, and suicide. New England Journal of Medicine, 380(1), 71–79.

    Article  PubMed  Google Scholar 

  • Bohnert, K. M., Ilgen, M. A., Louzon, S., McCarthy, J. F., & Katz, I. R. (2017). Substance use disorders and the risk of suicide mortality among men and women in the US Veterans Health Administration. Addiction, 112(7), 1193–1201.

    Article  PubMed  Google Scholar 

  • Caswell, J. M. (2018). Clinical descriptors for two-way tables with independent unweighted or weighted samples: A SAS macro to calculate P, OR, ARR, NNT, RR, and their confidence intervals. Retrieved 07/21/2020, from Academia https://www.academia.edu/37692312/Clinical_Descriptors_for_Two-Way_Tables_with_Independent_Unweighted_or_Weighted_Samples_A_SAS_Macro_to_Calculate_P_OR_ARR_NNT_RR_and_Their_Confidence_Intervals

  • Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2022). National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (producer). Retrieved February 28, 2022, from: www.cdc.gov/ncipc/wisqars.

  • Chesin, M., Interian, A., Kline, A., Benjamin-Phillips, C., Latorre, M., & Stanley, B. (2016). Reviewing mindfulness-based interventions for suicidal behavior. Archives of Suicide Research. https://doi.org/10.1080/13811118.2016.1162244

    Article  PubMed  Google Scholar 

  • Chesin, M., Interian, A., Kline, A., St Hill, L., King, A., Miller, R., Latorre, M., & Stanley, B. (2019). Past-year opioid misuse and suicide attempt are positively associated in high suicide risk veterans who endorse past- year substance use. Addictive Behaviors, 99, 106064.

    Article  PubMed  Google Scholar 

  • Chiesa, A., & Malinowski, P. (2011). Mindfulness-based approaches: Are they all the same? Journal of Clinical Psychology, 67(4), 404–424. https://doi.org/10.1002/jclp.20776

    Article  PubMed  Google Scholar 

  • Coffin, P. O., Santos, G.-M., Matheson, T., Behar, E., Rowe, C., Rubin, T., . . . Vittinghoff, E. (2017). Behavioral intervention to reduce opioid overdose among high-risk persons with opioid use disorder: A pilot randomized controlled trial. PloS One, 12(10), e0183354-e0183354https://doi.org/10.1371/journal.pone.0183354

  • Conner, K. R., Bridge, J. A., Davidson, D. J., Pilcher, C., & Brent, D. A. (2019). Metaanalysis of mood and substance use disorders in proximal risk for suicide deaths. Suicide and Life-Threatening Behavior, 49(1), 278–292.

    Article  PubMed  Google Scholar 

  • Connery, H. S. (2015). Medication-assisted treatment of opioid use disorder: Review of the evidence and future directions. Harvard Review of Psychiatry, 23(2), 63–75. https://doi.org/10.1097/hrp.0000000000000075

    Article  PubMed  Google Scholar 

  • Dean, A. J., Saunders, J. B., Jones, R. T., Young, R. M., Connor, J. P., & Lawford, B. R. (2006). Does naltrexone treatment lead to depression? Findings from a randomized controlled trial in subjects with opioid dependence. Journal of Psychiatry and Neuroscience, 31(1), 38–45.

    PubMed  PubMed Central  Google Scholar 

  • Esang, M., & Ahmed, S. (2018). A closer look at substance use and suicide. American Journal of Psychiatry Residents’ Journal, 13(6), 6–8.

    Article  Google Scholar 

  • Fava, M., Thase, M. E., Trivedi, M. H., Ehrich, E., Martin, W. F., Memisoglu, A., . . . Pathak, S. (2020). Opioid system modulation with buprenorphine/samidorphan combination for major depressive disorder: Two randomized controlled studies. Molecular Psychiatry, 25(7), 1580-1591https://doi.org/10.1038/s41380-018-0284-1

  • Garland, E. L., Hanley, A. W., Kline, A., & Cooperman, N. A. (2019a). Mindfulness-oriented recovery enhancement reduces opioid craving among individuals with opioid use disorder and chronic pain in medication assisted treatment: Ecological momentary assessments from a stage 1 randomized controlled trial. Drug and Alcohol Dependence, 203, 61–65. https://doi.org/10.1016/j.drugalcdep.2019.07.007

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Garland, E. L., Hanley, A. W., Riquino, M. R., Reese, S. E., Baker, A. K., Salas, K., . . . Howard, M. O. (2019b). Mindfulness-oriented recovery enhancement reduces opioid misuse risk via analgesic and positive psychological mechanisms: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 87(10), 927-940https://doi.org/10.1037/ccp0000390

  • Garland, E. L., Manusov, E. G., Froeliger, B., Kelly, A., Williams, J. M., & Howard, M. O. (2014). Mindfulness-oriented recovery enhancement for chronic pain and prescription opioid misuse: Results from an early-stage randomized controlled trial. Journal of Consulting and Clinical Psychology, 82(3), 448–459. https://doi.org/10.1037/a0035798

    Article  PubMed  PubMed Central  Google Scholar 

  • Garland, E. L., Roberts-Lewis, A., Tronnier, C. D., Graves, R., & Kelley, K. (2016). Mindfulness-oriented recovery enhancement versus cbt for co-occurring substance dependence, traumatic stress, and psychiatric disorders: Proximal outcomes from a pragmatic randomized trial. Behaviour Research and Therapy, 77, 7–16. https://doi.org/10.1016/j.brat.2015.11.012

    Article  PubMed  Google Scholar 

  • Geurts, D. E. M., Haegens, N. M., Van Beek, M. H. C. T., Schroevers, M. J., Compen, F. R., & Speckens, A. E. M. (2021). Putting mindfulness-based cognitive therapy to the test in routine clinical practice: A transdiagnostic panacea or a disorder specific intervention? Journal of Psychiatric Research, 142, 144–152. https://doi.org/10.1016/j.jpsychires.2021.07.043

    Article  PubMed  Google Scholar 

  • Hedegaard, H., Curtin, S. C., & Warner, M. (2020). Increase in suicide mortality in the United States, 1999–2018. NCHS Data Brief, no 362. Hyattsville, MD: National Center for Health Statistics.

  • Kraemer, H. C., & Kupfer, D. J. (2006). Size of treatment effects and their importance to clinical research and practice. Biological Psychiatry, 59(11), 990–996.

    Article  PubMed  Google Scholar 

  • Lappan, S. N., Brown, A. W., & Hendricks, P. S. (2020). Dropout rates of in-person psychosocial substance use disorder treatments: A systematic review and meta-analysis. Addiction, 115(2), 201–217.

    Article  PubMed  Google Scholar 

  • Linehan, M. M., Dimeff, L. A., Reynolds, S. K., Comtois, K. A., Welch, S. S., Heagerty, P., & Kivlahan, D. R. (2002). Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug and Alcohol Dependence, 67(1), 13–26. https://doi.org/10.1016/S0376-8716(02)00011-X

    Article  PubMed  Google Scholar 

  • Ling, W., Amass, L., Shoptaw, S., Annon, J. J., Hillhouse, M., Babcock, D., . . . Buprenorphine Study Protocol, G. (2005). A multi-center randomized trial of buprenorphine-naloxone versus clonidine for opioid detoxification: Findings from the National Institute on Drug Abuse Clinical Trials Network. Addiction (Abingdon, England), 100(8), 1090-1100https://doi.org/10.1111/j.1360-0443.2005.01154.x

  • Lizardi, D., & Stanley, B. (2010). Treatment engagement: A neglected aspect in the psychiatric care of suicidal patients. Psychiatric Services, 61, 1183–1191.

    Article  PubMed  Google Scholar 

  • Ma, J., Bao, Y. P., Wang, R. J., Su, M. F., Liu, M. X., Li, J. Q., . . . Lu, L. (2019). Effects of medication-assisted treatment on mortality among opioids users: A systematic review and meta-analysis. Molecular Psychiatry, 24(12), 1868-1883https://doi.org/10.1038/s41380-018-0094-5

  • Mahoney, C. T., Moshier, S. J., Keane, T. M., & Marx, B. P. (2021). Heightened healthcare utilization & risk of mental disorders among Veterans with comorbid opioid use disorder & posttraumatic stress disorder. Addictive Behaviors, 112, 106572. https://doi.org/10.1016/j.addbeh.2020.106572

    Article  PubMed  Google Scholar 

  • Maruti, S., Desjardins, I., Bagge, C. L., & Althoff, R. R. (2019). Commentary: Opioid use disorder and suicide: An important opportunity to address two significant public health epidemics. Preventive Medicine, 128, 105854. https://doi.org/10.1016/j.ypmed.2019.105854

    Article  PubMed  Google Scholar 

  • Matarazzo, B. B., Clemans, T. A., Silverman, M. M., & Brenner, L. A. (2013). The self-directed violence classification system and the Columbia classification algorithm for suicide assessment: A crosswalk. Suicide and Life-Threatening Behavior, 43(3), 235–249. https://doi.org/10.1111/j.1943-278x.2012.00131.x

    Article  PubMed  Google Scholar 

  • Molero, Y., Zetterqvist, J., Binswanger, I. A., Hellner, C., Larsson, H., & Fazel, S. (2018). Medications for alcohol and opioid use disorders and risk of suicidal behavior, accidental overdoses, and crime. American Journal of Psychiatry, 175(10), 970–978. https://doi.org/10.1176/appi.ajp.2018.17101112

    Article  PubMed  Google Scholar 

  • Morley, K., Haber, P., Tucker, P., & Sitharthan, T. (2013). The efficacy of an opportunistic cognitive behavioral intervention package (OCB) on substance use and comorbid suicide risk: A multisite randomized controlled trial. Journal of Consulting and Clinical Psychology, 82https://doi.org/10.1037/a0035310

  • Nestadt, P. S., & Bohnert, A. S. B. (2020). Clinical perspective on opioids in the context of suicide risk. Focus, 18(2), 100–105. https://doi.org/10.1176/appi.focus.20200003

    Article  PubMed  PubMed Central  Google Scholar 

  • Oquendo, M. A., & Volkow, N. D. (2018). Suicide: A silent contributor to opioid-overdose deaths. New England Journal of Medicine, 378(17), 1567–1569. https://doi.org/10.1056/NEJMp1801417

    Article  PubMed  Google Scholar 

  • Padmanathan, P., Hall, K., Moran, P., Jones, H. E., Gunnell, D., Carlisle, V., . . . Hickman, M. (2020). Prevention of suicide and reduction of self-harm among people with substance use disorder: A systematic review and meta-analysis of randomised controlled trials. Comprehensive Psychiatry, 96, 152135https://doi.org/10.1016/j.comppsych.2019.152135

  • Rizk, M. M., Herzog, S., Dugad, S., & Stanley, B. (2021). Suicide risk and addiction: The impact of alcohol and opioid use disorders. Current Addiction Reports, 8(2), 194–207. https://doi.org/10.1007/s40429-021-00361-z

    Article  PubMed  PubMed Central  Google Scholar 

  • Rosenthal, R., Rosnow, R. L., & Rubin, D. B. (1999). Contrasts and effect sizes in behavioral research.

  • Samples, H., Stuart, E. A., & Olfson, M. (2019). Opioid use and misuse and suicidal behaviors in a nationally representative sample of US adults. American Journal of Epidemiology, 188(7), 1245–1253. https://doi.org/10.1093/aje/kwz061

    Article  PubMed  PubMed Central  Google Scholar 

  • Scholl, L., Seth, P., Kariisa, M., Wilson, N., & Baldwin, G. (2019). Drug and opioid-involved overdose deaths — United States 2013–2017. MMWR: Morbidity and Mortality Weekly Report, 67, 1419–1427.

    Google Scholar 

  • Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2013). Mindfulness-based cognitive therapy for depression (2nd ed.). Guilford.

    Google Scholar 

  • Sheehan, D., Janavs, J., Baker, R., Harnett-Sheehan, K., Knapp, E., & Sheehan, M. (2010). MINI International Neuropsychiatric Interview, Version 6.0. Tampa, FL: University of South Florida College of Medicine.

  • Stanley, B., & Brown, G. K. (2008). Safety plan treatment manual to reduce suicide risk: Veteran version. Retrieved from Washington, D.C.:

  • Stanley, B., & Brown, G. K. (2012). Safety planning intervention: A brief intervention to mitigate suicide risk. Cognitive and Behavioral Practice, 19(2), 256–264.

    Article  Google Scholar 

  • Tickell, A., Ball, S., Bernard, P., Kuyken, W., Marx, R., Pack, S., . . . Crane, C. (2020). The effectiveness of mindfulness-based cognitive therapy (MBCT) in real-world healthcare services. Mindfulness, 11(2), 279-290https://doi.org/10.1007/s12671-018-1087-9

  • Williams, J. M. G., Crane, C., Barnhofer, T., Brennan, K., Duggan, D. S., Fennell, M. J. V., . . . Russell, I. T. (2014). Mindfulness-based cognitive therapy for preventing relapse in recurrent depression: A randomized dismantling trial Journal of Consulting and Clinical Psychology, 82(2), 275–286.

  • Wilson, N., Kariisa, M., Seth, P., Smith, H., & Davis, N. (2020). Drug and opioid-involved overdose deaths — United States, 2017–2018. MMWR: Morbidity and Mortality Weekly Report, 69, 290–297. https://doi.org/10.15585/mmwr.mm6911a4

    Article  PubMed  PubMed Central  Google Scholar 

  • Yovell, Y., Bar, G., Mashiah, M., Baruch, Y., Briskman, I., Asherov, J., . . . Panksepp, J. (2016). Ultra-low-dose buprenorphine as a time-limited treatment for severe suicidal ideation: A randomized controlled trial. American Journal of Psychiatry, 173(5), 491-498https://doi.org/10.1176/appi.ajp.2015.15040535

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Funding

This work was supported by a grant from the US Department of Veterans Affairs, Health Services Research and Development Service (IIR 12–134).

This material is the result of work supported with resources and the use of facilities at the VA New Jersey Healthcare System. The contents of this article do not represent the views of the US Department of Veterans Affairs or the US Government.

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Authors and Affiliations

  1. Department of Psychology, William Paterson University, 300 Pompton Road, Wayne, NJ, 07046, USA

    Megan S. Chesin & Megan Sedita

  2. Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy and Aging Research, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA

    Chintan V. Dave

  3. Department of Veterans Affairs, VA New Jersey Health Care System, East Orange, NJ, USA

    Chintan V. Dave, Catherine Myers, Miriam Latorre, Lauren M. St. Hill, Rachael B. Miller, Arlene R. King, Dianna R. Boschulte & Alejandro Interian

  4. Department of Pharmacology, Physiology, and Neuroscience, New Jersey Medical School, The State University of New Jersey, Rutgers, Newark, USA

    Catherine Myers

  5. Department of Psychiatry, Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, New York, NY, USA

    Barbara Stanley & Maureen Monahan

  6. Department of Psychiatry, Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA

    Anna Kline

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Chesin, M.S., Dave, C.V., Myers, C. et al. Using Mindfulness-Based Cognitive Therapy to Prevent Suicide Among High Suicide–Risk Patients Who Also Misuse Opioids: a Preliminary Probe of Feasibility and Effectiveness. Int J Ment Health Addiction 21, 3721–3734 (2023). https://doi.org/10.1007/s11469-022-00817-x

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