A Randomized Controlled Trial of an Integrated Alcohol and Suicide Intervention for Suicidal Teens (iASIST)

Background and Purpose: Suicide deaths have increased significantly over the last decade, disproportionately affecting adolescents. Alcohol use is a risk factor for suicide and alcohol use and suicidal thoughts and behavior (STB) are functionally interrelated with a demonstrated bidirectional relationship among adolescents. Despite the relationship between alcohol use and STBs, they are typically treated separately. The risk for suicide is elevated following discharge from inpatient psychiatric care, highlighting the need for interventions that address both alcohol use and STB in an integrated fashion during and immediately following hospitalization. The purpose of this study was to test the feasibility, acceptability, and preliminary effectiveness of an integrated Alcohol and Suicide Intervention for Suicidal Teens (iASIST). A secondary aim was to explore intervention effects at 3-month follow-up on alcohol, drug, and suicide-related outcomes relative to an Attention-matched Comparison condition focused on sleep, diet, and exercise.

Methods: We conducted a two-group pilot randomized controlled trial of iASIST relative to an attention-matched comparison condition. Participants (N=40) were recruited from an inpatient psychiatric unit of a general pediatric hospital in northeastern United States (62% female; M_age = 15.82, SD = 1.06) psychiatrically hospitalized following STB. iASIST involves three components: 1) an individual intervention with the adolescent that explores alcohol use as a risk factor for continued STB and creates a complementary change plan, 2) a subsequent family intervention in which the interventionist facilitates a discussion between the adolescent and parent about the change plan to strengthen the adolescent’s self-efficacy and commitment to the change plan, and the parent’s ability to support their child to reduce or stop drinking, and 3) a post-discharge mHealth booster to adolescents focused on strengthening their commitment to the change plan, and to parents focused on their commitment, confidence, and ability to support their adolescent in reducing or stopping drinking.

Results: iASIST was determined to be acceptable. More than 90% of participants reported that the in-person intervention components were somewhat or very useful. Satisfaction with in-person content averaged 3.30 or greater (out of 4) for youth and 3.42 or greater for parents. Fidelity to the iASIST model was very favorable, with nearly all components delivered 100% of the time; least consistent were conversations about summarizing goals (77%) and addressing participant concerns (64%). Mixed models indicated that, for days of alcohol use, binge drinking, vaping cannabis, and vaping nicotine, both groups had significant decreases in substance use over the 3-month follow-up period. Post-intervention group differences were not found. In terms of cannabis use, however, iASIST participants significantly improved over time. Finally, iASIST participants showed a significant decrease in suicide plans from baseline (88%) to follow-up (38%).

Conclusion and Implications: Study findings suggest a larger RCT is warranted to test the effectiveness of the iASIST intervention. iASIST shows promise in its ability to target the problems of alcohol use and STB in an integrated fashion with a high-risk adolescent population receiving acute psychiatric care. Social workers are well positioned to deliver these integrated interventions.