Project Abstract/Summary Studies consistently show suicide and suicidal behaviors are highly related to substance use disorders (SUDs). Recent reviews find that the risk of suicide is 10-17 times higher for people using multiple drugs, injecting drugs, and for alcohol use disorders. Utilizing clearly established Stage I guidelines for developing and adapting behavioral interventions, as well as information included in a SAMHSA Treatment Improvement Protocol (TIP50) on suicide and addiction, the current Investigators developed the Preventing Addiction Related Suicide (PARS) program by integrating the content of empirically-supported secondary suicide prevention programs. PARS is a psychoeducational program taught as a single 3 hour module integrated into a standard group therapy-oriented Intensive Outpatient Program (IOP), the most common form of community drug abuse treatment.9 PARS was conceptualized and developed with a team of community treatment leaders who advised on its scope, duration, and approach. Community partners reviewed early drafts and all pilot testing was conducted in community treatment settings. Pilot testing of PARS demonstrated significant post- intervention increases in client knowledge of suicide and decreases in maladaptive attitudes toward suicide; both were maintained at 1-month follow-up. The likelihood of positive help seeking to prevent suicide for themselves as well as for a friend and for family all doubled for the month after the program compared to the month before. Given these promising Stage I results in Stage III settings, we propose a fully-powered Stage III effectiveness trial of PARS compared to Treatment-As-Usual (TAU) using a randomized stepped wedge design with 900 clients in 15 community addiction treatment sites in Washington State to replicate the pilot findings and evaluate how the mechanisms of improving accurate information and attitudes about suicide promote help-seeking. This proposal is innovative in its topic and development in community settings as well as its use of a stepped wedge design. Community treatment agencies, by integrating PARS into their IOP group treatment, are in a unique position to act as key players in the national suicide prevention strategy by providing accurate suicide prevention information, improving attitudes toward suicide, and increasing help- seeking skills to one of the most high-risk suicidal populations in the country.

Public Health Relevance Preventing Addiction Related Suicide (PARS) is a psychoeducational suicide prevention program designed to be used within Intensive Outpatient Programs, the most widely available modality of community addiction treatment. The proposed study aims to evaluate the effectiveness and utility of PARS utilizing a novel, randomized stepped wedge design. If proven effective, PARS will allow community addiction treatment agencies to be key players in the national suicide prevention strategy by helping one of the most high-risk suicidal populations in the country.