Friday, December 11, 2009

Will Alcoholism Get Lost in the Shuffle to Prevent Suicide Among Military Personnel?

Over the past couple of months the Army has been ramping up a new effort to address concerns about suicide prevention among personnel. They are going the "building resilience" route to help soldiers. Other military groups are also paying attention to this thrust.

Keep your ear to the ground and pay attention to this effort because it will lead to a movement that will flow to police, civil service, and employees in mainstream workplaces.

This is how new movements begin, and you if you are an HR manager or employee assistance professional, you want to be thinking about the efficacy of this approach to helping employees in this “new economy”, whether or not they are being shot at in battle.

"Employee engagement" is a critical concern for top management. Understand what this phrase means to productivity, and how resiliency training may complement it, and you will make your department or EAP program more valuable.

So, this could be an exciting move. Don’t be on the outside looking in.

Now, just a couple thoughts more and I am done. It’s Friday after all.

A key thrust for this effort appears to be coming from a joint military group in conjunction with University of Pennsylvania psychologists.

Resiliency has been a hot topic for just only a couple years. It first made its way into the mental health literature by the route of managed behavioral health as way to help people cope with life struggles and prevent relapse. (That is where I first really picked upon it full bore.) Magellan Behavioral Health has a strong focus on this topic, by the way.

The concept is a good one to save treatment dollars, but it is not a substitution for what we know empirically and pragmatically that works to sustain ongoing recovery program that includes abstinence.

That said, these new directional shifts in mental health often overlook other aspects of the target problem that are as old as the hills. (Perhaps boredom contributes to these attempts to wheel out something new and sexy.)

Here’s the thought: Will primary alcoholism as a contributing factor be overlooked as the underlying problem and a common denominator in many, many military suicide cases? I am not reading much about this, yet. So, I am nervous. I hope they aren't going to start seeing alcoholism as just a "symptom" of PTSD, Depression, and other stuff.

About 15% of alcoholics commit suicide and about 33 percent of suicides in the 35-something range have a primary diagnosis of alcohol or other substance misuse; over fifty percent of all suicides are related to alcohol or drug dependence. (Miller, NS; Mahler, JC; Gold, MS (1991). "Suicide risk associated with drug and alcohol dependence.". Journal of addictive diseases 10 (3): 49–61.)

After 30 years, it has been my observation that psychologists, as a group, DO NOT whole-heartily march down main street to convince the general public that alcoholism is an acute, chronic disease, with primary biogenic underpinnings. However, they are guiding this military effort! (Hey listen, correct me I am wrong about any of this folks.)

Research says alcoholism suicide risk exists for those with this primary, health care problem, and smoking as a diagnostic indicator is a great signal to spot a potential risk. Can you say "wow"!

If the alcoholism factor is ignored, attempts to reduce violence, suicide, and enhanced resiliency among military personnel (which is a good thing mind you) may have limited long-term impact. Am I off base with this argument?

Missing so far from the discussion are issues associated with alcoholism, smoking as a diagnostic red flag within occupational groups, the known high risk of suicide among these employees who do smoke, (an extremely high percentage of alcoholics smoke, research clearly shows), and similar research particularly with doctors and nurses showing that those who smoke have higher rates of suicide, too.

In fact, nearly 300,000 U.S. Army personnel in the recent past were surveyed and these conclusions were also consistently drawn.

This research has been done in the USA and also in Europe with the same conclusions. The alcoholism, smoking, suicide risk, depression links are all well-established. I believe a lack of resiliency (naturally a part of the human condition) is missing in many folks because of the erosion forced upon its emergence by active addiction.

And, can you believe it, part of the resiliency program even covers spirituality and mastering skills to develop one's spiritual self!

The question: Is a lack of resiliency or the poor manifestation of it, a symptom rather than the problem?

I am hoping that alcohol, drug, and tobacco use do not take a backseat in this effort.

This article discusses research with 300,000 military personnel where smoking and suicide demonstrate a high risk. I believe the alcoholism link is key variable although it was "poo-poo'd" in this study despite all of the personnel committing suicide were heavy drinkers.

To support this discussion, the following links take you to fascinating articles on the high risk of suicide among medical personnel who smoke. This one is from England (where by the way research last month shows 25% of the workforce drinks alcohol at lunch.)

As a side note, did you know that alcohol on the breath in England cannot legally be used as sole indicator of being under the influence at work used to justify a drug test? (That means if you have a high tolerance, you're in like flint!)

This study documents the same problem among hospital nurses.

Smokers are more likely to be alcoholics. In fact, 80 to 90 percent of alcoholics smoke -- a rate three times that of the general population. Moreover, the prevalence of alcoholism in smokers is 10 times higher than among nonsmokers.

And here is a research supported information about how nicotine boosts alcohol’s effects. Wicked, man!

16% of nurses smoke, the highest of all professions, and the suicide rate is highest for nurses who smoke in England.

If you are workplace professional, keep your eye on these developments so you can spot appropriate roles for your contributions to making these efforts successful.