SUICIDAL BEHAVIOR IN ALCOHOLICS HOMELESS

MEN TREATED INASSOCIACIO RAUXABarcelona - Spain

9th ANNUAL INTERNATIONAL STREET MEDICINE SYMPOSIUM

BOSTON, MASSACHUSETTS OCTOBER 24-26 2013

ASSOCIACIÓ RAUXA

NGO founded in 1989 in Barcelona (Spain) with

the aim of alleviating the extreme situation of the

homeless population, offering a more than two

years integral treatment of alcohol dependence

and other drugs

Integral treatment of alcohol dependence for alcoholic homeless

Phases

1. RAUXA VAN: Street outreach resource. Detection and motivation

2. URBAN THERAPEUTIC COMMUNITY: Detox, Reduction of addictive habits & Rehabilitation

3. RAUXA FLATS: Social rehabilitation

4. LABOUR INTEGRATION: Rauxa Cooperative & “La Terrasseta” restaurant

5. DISCHARGE

INTRODUCCION

World Health Organization (WHO) estimates that

about 1 million people commit suicide every

year. And about 5 million are directly affected by

it. Attempted suicides are 10-20 times higher.

In Spain (2010) the rate of completed suicide

increased up to 12,6 for men and 3,9 for women /

100.000 inhabitants of general population.

The report of Drug Abuse Warning Network

(DAWN, 2006) demonstrate that 30 % of suicide

attempts implied a combination of alcohol and

other drugs. The risk of suicide in lifetime of

alcoholics is as high as 18 % (Roy, 1986); and

individuals with alcoholism have 60-120 times

greater suicide risk than non-psychiatrically ill

population.

High rates of completed suicide in alcoholics

(5,6% Freixa and Bach, 1981) as well of

attempted suicide (18% Rodriguez Martos, 1971;

19,4% Freixa and Bach, 1981 in Spain, or up to

24% Weissman, 1980 in USA) have been

reported.

Since one of the worse complication of alcohol

dependence is completed suicide and attempted

suicide we decided to report data on alcoholic

homeless men (N=495) treated at Associacio

Rauxa, with the aim of showing the severity of

this fact especially in this homeless population.

Material and methodology: Sample: alcoholic homeless men treated at

the Associació Rauxa, with or without other drugs dependence (tobacco,

cocaine, cannabis, BZD, heroine…), criteria DSMIV-TR. All of them go

through medical and addictive history, physical exam, blood and urine

analysis, thorax Xray. It is examined the prevalence of completed and

attempted suicide (before admission in Ass. Rauxa) of this sample, as well

as the number of suicide attempts by each man, and its correlation with the

following subgroups of substances consumers (1- only alcohol and alcohol

+ tobacco; 2- alcohol + tobacco + cocaine; 3- alcohol + tobacco + other

drugs). Previous diagnosis to admission in Associacio Rauxa are study in

relation to the presence of mental illness, personality disorders and

depressive disorder and are correlated with suicide attempts and substance

consumers subgroups.

It is evaluated and SD; differences considered significant at X2 p<0,05, in

statiscal analyses to correlate different parameters with suicide attempts.  

SAMPLE N= 495

WITHOUT ATTEMPTS N=319 WITH ATTEMPTS N=176

• Age at the admission in treatment 47,79 44,11

• Status marital - Married 12 3 - Divorced 30 24 - Separated 156 80 - Single 107 68 - Widower 7 1

• Time on the street 758,60 days 771,79 days

• Where are from - Catalunya 127 86 - España 165 66 - Extranjeros 27 24

• Income - With income 121 70 - Without income 198 106

X

X

Parameters and results:

* Alcoholic homeless men 495/495 (100%)

* Age at the admission in treatment in Associacio Rauxa SD46,49 8,76

* Attempted suicides 176 /495 (35,55%) Nº of suicide attempts per person 1 time N=94 (53,41%)

>1-5 times N=64 (36,36%) > 5 times N=18 (10,23%)

 

* Subgroups of drug consumer (N=495) With attempted suicide 176 / 495 - 1 Alcohol only (46) Alcohol + tobacco (240) N= 286 / 495 (58%) 77 / 286 (27%) - 2 Alcohol + tobacco + cocaine N=120 / 495 (24%) 68 / 120 (57%)  - 3 Alcohol + tobacco + other drugs N= 89 / 495 (18%) 31 / 89 (35%)

__________________ ________________

 * Mental Pathology 195/495 (39%) Global With attempted suicide 101/176 (57%)   Mental illness disorders 39 / 495 (7,88%) 18 / 39 (46%) Personality disorders 47 / 495 (9,49%) 29 / 47 (62%) Depressive disorders 109 / 495 (22,02%) 54 / 109 (50%)

* Completed suicide 2/495 (0,40%)

X

N=319 (64%)

N=176 (36%)

ATTEMPTED SUICIDES IN ALCOHOLICS HOMELESS MEN TREATED AT ASSOCIACIO RAUXA

(N=495)

NO ATTEMPTED SUICIDE (N=319) ATTEMPTED SUICIDE (N=176)

N=209 (73%)

N=77 (27%)

ATTEMPTED SUICIDES IN ALCOHOLICS HOMELESS MEN TREATED AT ASSOCIACIO RAUXA

SUBGROUP 1- ONLY OH (46)OH+TOBACCO (240)

(N=286)

NO SUICIDE ATTEMPT (N=209) SUICIDE ATTEMPT (N=77)

N=52 (43%)

N=68 (57%)

ATTEMPTED SUICIDES IN ALCOHOLICS HOMELESS MEN TREATED AT ASSOCIACIO RAUXA

SUBGROUP 2- ALCOHOL+TOBACCO+COCAINE (N=120)

NO SUICIDE ATTEMPT (N=52) SUICIDE ATTEMPT (N=68)

N=58 (65%)

N=31 (35%)

ATTEMPTED SUICIDES IN ALCOHOLICS HOMELESS MEN TREATED AT ASSOCIACIO RAUXA

SUBGROUP 3- ALCOHOL+TOBACCO+OTHER DRUGS

(N=89)

NO SUICIDE ATTEMPT (N=58) SUICIDE ATTEMPT (N=31)

N=319 (64%)

N=176 (36%)

ATTEMPTED SUICIDES IN ALCOHOLICS HOMELESS MEN TREATED AT ASSOCIACIO RAUXA

(N=495)

NO ATTEMPTED SUICIDE (N=319) ATTEMPTED SUICIDE (N=176)

N=52 (43%)N=68 (57%)

SUBGROUP 2- ALCOHOL+TOBACCO+COCAINE

(N=120)

NO SUICIDE ATTEMPT (N=52)SUICIDE ATTEMPT (N=68)

N=209 (73%)

N=77 (27%)

SUBGROUP 1-

ONLY OH (46)OH+TOBACCO (240) (N=286)

NO SUICIDE ATTEMPT (N=209)SUICIDE ATTEMPT (N=77)

N=58 (65%)

N=31 (35%)

SUBGROUP 3-

ALCOHOL+TOBACCO+OTHER DRUGS (N=89)

NO SUICIDE ATTEMPT (N=58)SUICIDE ATTEMPT (N=31)

ATTEMPTED SUICIDES IN ALCOHOLICS HOMELESS MEN TREATED AT ASSOCIACIO RAUXA(N=495)

ONLY OH (46)OH+TOBACCO (240) (N=286)

OH+TOBACCO+COCAINE (N=120) OH+TOBACCO+OTHER DRUGS (N=89)

NO SUICIDE ATTEMPTS (N=319)

209 52 58

SUICIDE ATTEMPS (N=176) 77 68 31

25

75

125

175

225

275

325

209

52 58

77

6831

ATTEMPED SUICIDES IN ALCOHOLICOS HOMELESS MEN TREATED AT ASSOCIACIO RAUXA

(N=495)

                           X2=         32,57253561             X2= 9,772467749               P=            

         <0,00000001               P= <0,001771445

COMMENTS 1

• In this sample of homeless alcoholic men

there is a high number of suicide attempts

up to 36%; as well as a high comorbidity of

other mental disorders, around 39%.

.

COMMENTS 2

• The Subgroup of alcohol + tobacco +

cocaine shows a high rate of suicide

attempts up to 59%, statistically significant;

with a lower comorbidity of other

psychiatric illness.

COMMENTS 3

• Most of psychiatric symptoms of these

patients disappear after an abstinence

period of 6 to 12 months. Some psychiatric

diagnosis may be considered as erroneous,

so many patients are overmedicated and

some develop even dependence to

benzodiazepines (BZD).

. CONCLUSIONS 1

We can confirm that the homeless alcoholics

population has a higher risk of attempted

suicides than general alcoholic population,

specially the subgroup with alcohol, tobacco and

cocaine dependence.

This population presents most of the risk factors

associated to suicide.

CONCLUSIONS 2

We recommend to institutions, authorities,

decision making administrators and health and

social professionals to take these facts into

account, in order to offer adequate and prompt

diagnosis and treatment of alcohol and other

drugs dependence to avoid suffering and human

losses.