Many youth who present for substance abuse treatment report co-occurring suicidality. Therefore, it is important to learn about the characteristics of this population and effective treatment strategies. The purpose of this paper is to provide an overview of some of the key issues that arise when treating youth with substance abuse and co-occurring suicidality and to offer recommendations on how to approach these areas. Specifically, we discuss the potential utility of an integrated approach to treatment, and provide an overview of the characteristics of this treatment population, motivational and treatment engagement issues, the clinical management of suicidality in the context of treatment, and the effect of psychiatric comorbidity on treatment needs. We then discuss school, family, and peer issues that may arise as well as special considerations for the use of urine drug screens with this population. We conclude with recommendations for future treatment development research in this very important area.
Keywordssuicide; substance abuse; treatment; comorbidity; adolescence Substance abuse and suicidality commonly co-occur among adolescent psychiatric populations. In youth receiving substance abuse treatment, 18% to 36% report a history of suicidal behavior (1-4). In recent reviews of the literature, the presence of a substance use disorder was noted to be associated with a 3-to 4-fold increase in suicide attempts (5). Moreover, adolescents diagnosed with a substance use disorder were 5 to 13 times more likely to die by suicide than adolescents without this diagnosis (4,6). Given the association between substance use disorders and suicidality, it is important to consider our approach to treatment and clinical research with this very difficult high risk adolescent population.In this paper, we offer information on many of the clinical issues that arise in treating suicidal substance abusing adolescents. This information is based on our experience working with this population in the context of clinical trials for suicidal substance abusing teens. Specifically, our treatment development studies compare an integrated outpatient cognitive behavioral treatment for both substance use disorder and suicidality to enhanced standard care. We will review some of the key issues that should be considered when assessing and treating this population and offer recommendations for how to approach these issues. We will conclude