Crisis Line Support for Suicide Prevention in Alcoholism

No longer recruiting at 1 trial location

Overseen By Amanda Price, MS

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Michigan

Disqualifiers: Non-English speakers, Prisoners, Psychotic symptoms, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 1 Jurisdiction This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 2

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial explores how individuals with alcohol use issues manage suicidal crises and whether a single therapy session about the National Suicide Prevention Lifeline might help. The study compares two approaches: one group discusses barriers and supports for using crisis lines (Crisis Line Facilitation), while the other receives regular care information (Enhanced Usual Care). It targets individuals who have struggled with alcohol misuse and have recently experienced suicidal thoughts or attempts. Participants must understand and communicate in English. As an unphased trial, this study provides a unique opportunity to contribute to understanding and improving crisis intervention strategies.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that Crisis Line Facilitation and Enhanced Usual Care are safe?

Research has shown that crisis lines, such as the National Suicide Prevention Lifeline, are generally safe. Studies indicate that callers often feel less suicidal and distressed afterward, suggesting a positive experience.

The Crisis Line Facilitation (CLF) program aims to encourage more people to use these lines during difficult times, making it easier to reach out in crisis. This program involves just one session and does not use medication or complicated treatments, resulting in a lower risk of side effects.

In summary, safety data for crisis lines is positive. There are no reports of negative effects, making them a safe option for those in need. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about Crisis Line Facilitation (CLF) because it offers a fresh approach to suicide prevention for individuals struggling with alcoholism. Unlike standard treatments that often focus on ongoing therapy sessions or medication, CLF is a single-session intervention aimed at overcoming personal barriers to using crisis lines during suicidal crises. This method empowers individuals to access immediate support when they need it most, potentially reducing suicidal behavior by encouraging proactive help-seeking.

What evidence suggests that this trial's treatments could be effective for suicide prevention in alcoholism?

Research has shown that Crisis Line Facilitation (CLF), an intervention in this trial, can help reduce suicidal thoughts and distress. One study found that the urgency to act on suicidal thoughts decreased in 16% of calls to crisis lines. Observations also indicate that people often feel less upset after calling a suicide hotline. CLF aims to make these lifelines more accessible by addressing any obstacles individuals might face. While not everyone seeks further mental health care afterward, CLF can still provide immediate relief during a crisis. ^{1 4 5 6 7}

Who Is on the Research Team?

Mark Ilgen, Ph.D.

Principal Investigator

University of Michigan

Are You a Good Fit for This Trial?

This trial is for individuals with a probable alcohol use disorder in the past year, indicated by an AUDIT score of 16 or more. Participants must have attempted suicide within the last year or had suicidal thoughts recently, as shown by certain scores on the Beck scales.

Inclusion Criteria

Probable alcohol use disorder within the past year based on an Alcohol Use Disorders Identification Test (AUDIT) score of 16 or greater

You have attempted suicide within the past year or have a history of suicide attempt more than a year ago and have current thoughts of suicide within the past month. This is determined by a test called the Beck Scale for Suicidal Ideation, which measures your thoughts of suicide, or by a test called the Beck Depression Inventory, which measures your level of depression.

Exclusion Criteria

You have severe mental health symptoms or cognitive impairment that could make it difficult for you to understand the study information or assessments.

Prisoners

I do not understand English.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive a single-session intervention addressing perceived barriers and facilitators of crisis line use during suicidal crisis

1 session

1 visit (in-person or virtual)

Enhanced Usual Care

Participants receive a brochure with NSP Lifeline and mental health resources, encouraged to schedule an appointment with a clinical provider

1 session

1 visit (in-person, email, or text)

Follow-up

Participants are monitored for crisis line utilization and suicidal behavior

12 months

What Are the Treatments Tested in This Trial?

Interventions

• Crisis Line Facilitation (CLF)
• Enhanced Usual Care (EUC)

Trial Overview The study is testing whether therapy sessions discussing perceptions about using the National Suicide Prevention Lifeline can benefit those who've faced a suicidal crisis and have issues with alcohol.

How Is the Trial Designed?

Group I: Crisis Line Facilitation (CLF) Experimental Treatment 1 Intervention

This single-session intervention addresses the individuals' perceived barriers and facilitators of crisis line use during periods of suicidal crisis.

Group II: Enhanced Usual Care (EUC) Active Control 1 Intervention

Participants randomized to the EUC condition will receive a brochure (in-person, via email, or via text message) with the NSP Lifeline and a list of outpatient mental health and substance use resources and encouraged to schedule an appointment with a clinical provider if they would like to discuss any current or past symptoms.

Crisis Line Facilitation (CLF) is already approved in United States for the following indications:

Approved in United States as National Suicide Prevention Lifeline for:

• Suicidal crisis intervention
• Mental health support

Who Is Running the Clinical Trial?

University of Michigan

Lead Sponsor

Trials

1,891

Recruited

6,458,000+

National Institute on Alcohol Abuse and Alcoholism (NIAAA)

Collaborator

Trials

865

Recruited

1,091,000+

Published Research Related to This Trial

The Safety Planning Intervention (SPI) is effective in reducing suicidal ideation and behavior, as well as improving depression and treatment engagement among adults experiencing suicide-related distress, based on a systematic review of 26 studies.

The SPI is adaptable and can be delivered in various formats (in-person or online) and as a standalone or combined intervention, making it a flexible tool in suicide prevention practices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effectiveness of the Safety Planning Intervention for Adults Experiencing Suicide-Related Distress: A Systematic Review. Ferguson, M., Rhodes, K., Loughhead, M., et al.[2022]

Crisis Line Facilitation (CLF) is a brief intervention aimed at increasing the use of the Veterans Crisis Line (VCL) among high-risk Veterans, addressing barriers to its use and providing psychoeducational support.

Preliminary results from a study with 301 participants indicate that Veterans who received CLF reported significantly greater comfort and confidence in using the VCL during crises compared to those who did not receive the intervention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Developing and testing Crisis Line Facilitation (CLF) to encourage help-seeking in adults receiving inpatient treatment for a suicidal crisis. Ilgen, MA., Stewart, HJ., Lhermitte, SL., et al.[2021]

The Crisis Line Facilitation (CLF) intervention, which includes education about the Veterans Crisis Line (VCL) and practice calls, showed a significant reduction in suicidal behaviors among high-risk Veterans compared to Enhanced Usual Care over a 12-month follow-up period.

Despite the positive impact on suicidal behaviors, the CLF intervention did not significantly increase the utilization of the VCL among participants, indicating that while it may help prevent crises, it does not necessarily encourage Veterans to reach out for help through the VCL.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Encouraging the use of the Veterans Crisis Line among high-risk Veterans: A randomized trial of a Crisis Line Facilitation intervention. Ilgen, MA., Price, AM., Coughlin, LN., et al.[2023]

A 2-hour suicide prevention training for 273 substance use disorder (SUD) treatment providers significantly improved their self-efficacy, knowledge, and practice behaviors related to suicide prevention, with results showing statistical significance (p < .001).

The training, which utilized a video based on a recognized protocol from the Substance Abuse and Mental Health Services Administration, demonstrated high potential for widespread adoption due to its brief duration and ease of implementation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Evaluation of a suicide prevention training curriculum for substance abuse treatment providers based on Treatment Improvement Protocol Number 50. Conner, KR., Wood, J., Pisani, AR., et al.[2022]

Volunteers at a Norwegian crisis line reported a significant challenge in reconciling their expectations of providing suicide prevention with the reality that many calls were for ongoing support related to loneliness and mental health issues.

The study suggests that training programs for crisis line volunteers should include strategies for addressing the ongoing support needs of callers, ensuring a more uniform response to various concerns.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Caught Between Expectations and the Practice Field. Vattø, IE., Lien, L., DeMarinis, V., et al.[2022]

The Lifeline Crisis Chat Network significantly reduced distress among users, with two-thirds of suicidal chatters finding the chat helpful and nearly half reporting decreased suicidal thoughts after the intervention.

This study provides strong evidence for the effectiveness of online crisis interventions, which is especially important as the Lifeline prepares to expand its services with the new 988 nationwide number for mental health crises.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

National Suicide Prevention Lifeline crisis chat interventions: Evaluation of chatters' perceptions of effectiveness. Gould, MS., Chowdhury, S., Lake, AM., et al.[2022]

A review of 33 studies on crisis line services found that while these services aim to reduce psychological distress and suicide risk, high-quality evidence demonstrating their effectiveness is lacking, with most studies rated at high risk of bias.

Most studies focused only on immediate outcomes during the crisis, highlighting the need for future research to assess both short-term and long-term impacts on behavioral health treatment engagement and self-directed violence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Effectiveness of Crisis Line Services: A Systematic Review. Hoffberg, AS., Stearns-Yoder, KA., Brenner, LA.[2020]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6978712/

The Effectiveness of Crisis Line Services: A Systematic Review Additionally, suicidal urgency decreased in 16% of calls, but increased in 7.8% of calls (33). For this study, suicidal urgency was defined ...

2. clinicaltrials.gov clinicaltrials.gov/study/NCT04488055

Facilitating Use of the National Suicide Prevention Lifeline ... Experimental : Crisis Line Facilitation (CLF). This single-session intervention addresses the individuals' perceived barriers and facilitators of crisis line ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7931251/

Developing and testing Crisis Line Facilitation (CLF) to ... Some observational data provides support for crisis lines indicating that suicidal ideation and/or distress decreased, on average, after calling a suicide ...

4. psychiatryonline.org psychiatryonline.org/doi/10.1176/appi.ps.20220294

Crisis Lines: Current Status and Recommendations for ... Findings (20, 22) indicate that a minority of callers complete follow-up with a mental health care provider, with approximately 33%–42% ...

5. sciencedirect.com sciencedirect.com/science/article/abs/pii/S1077722920300523

Developing and Testing Crisis Line Facilitation to ... This paper describes the development of Crisis Line Facilitation (CLF) a brief intervention, designed to increase use of the VCL in this high-risk population.

6. samhsa.gov samhsa.gov/mental-health/988/performance-metrics

988 Lifeline Performance Metrics The data below represents the 988 Lifeline performance of the overall national network, which includes data from all 988 Lifeline network centers.

7. samhsa.gov samhsa.gov/data/

SAMHSA Data SAMHSA collects data through multiple sources and surveys and provides access to public-use data files and documentation to support a better understanding of ...