Abstract
A sample of 183 current cocaine users, 120 primary injecting cocaine users (ICUs), and 63 primary noninjecting cocaine users (NICUs) were administered a structured interview to ascertain attempted suicide histories, methods used, and factors associated with suicide attempts. All respondents were volunteers and current cocaine users recruited through a wide range of sources. The mean age of participants was 30.1 years, and 65% were male. The ICUs were older (32.3 vs. 26.7 years, respectively), more likely to be male (72% vs. 54%, respectively), to be unemployed (84% vs. 23%, respectively) and to have a prison history (53% vs. 1%, respectively) compared to NICUs. Of the sample, 31% had attempted suicide, 18% had done so on more than one occasion, and 8% had made an attempt in the preceding 12 months. Overall, 28% of the sample had been treated by a medical practitioner after an attempt. ICUs (38%) were significantly more likely than NICUs (10%) to have attempted suicide and to have done so on more than one occasion (23% vs. 3%, respectively). The most common method used among both groups was self-poisoning (ICUs 28%, NICUs 8%), primarily by drug overdose. Violent methods had been used by 22% of ICUs and 3% of NICUs. Multivariate analyses revealed that injecting, female gender, and more extensive polydrug use were independent predictors of a suicide attempt. The prevalence of suicide in this study indicates that it represents a major clinical issue among ICUs and to a lesser extent among noninjectors of the drug. Those treating cocaine users for drug dependence need to be aware of the salience of suicide as a problem, among injectors in particular.
Keywords: Cocaine, IDU, Polydrug, Risk, Suicide
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References
- 1.Harris EC, Barraclough B. Excess mortality of mental disorder. Br J Psychiatry. 1998;173:11–53. doi: 10.1192/bjp.173.1.11. [DOI] [PubMed] [Google Scholar]
- 2.Bargagli AM, Sperati A, Davoli F, Forastiere F, Perucci CA. Mortality among problem drug users in Rome: an 18-year follow-up study, 1980–1997. Addiction. 2001;96:1455–1463. doi: 10.1046/j.1360-0443.2001.961014559.x. [DOI] [PubMed] [Google Scholar]
- 3.Hser Y, Hoffman V, Grella C, Anglin MD. A 33-year follow-up of narcotic addicts. Arch Gen Psychiatry. 2001;58:503–508. doi: 10.1001/archpsyc.58.5.503. [DOI] [PubMed] [Google Scholar]
- 4.Quaglio G, Talamini G, Lechi A, et al. Study of heroin-related deaths in north-eastern Italy 1985–98 to establish main causes of death. Addiction. 2001;96:127–1137. doi: 10.1046/j.1360-0443.2001.96811276.x. [DOI] [PubMed] [Google Scholar]
- 5.Darke S, Ross J. Suicide among heroin users: rates, risk factors and methods. Addiction. 2002;97:1383–1394. doi: 10.1046/j.1360-0443.2002.00214.x. [DOI] [PubMed] [Google Scholar]
- 6.Harris EC, Barraclough B. Suicide as an outcome for mental disorders. Br J Psychiatry. 1997;170:205–228. doi: 10.1192/bjp.170.3.205. [DOI] [PubMed] [Google Scholar]
- 7.Darke S, Hall W. Heroin overdose: research and evidence-based intervention. J Urban Health. 2003;80:189–200. doi: 10.1093/jurban/jtg022. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Diekstra RFW, Gulbinat W. The epidemiology of suicidal behaviour: a review of three continents. World Health Stat Q. 1993;46:52–68. [PubMed] [Google Scholar]
- 9.Lynskey M, Degenhardt L, Hall W. Cohort trends in youth suicide in Australia. Aust N ZJ Psychiatry. 2000;34:408–412. doi: 10.1046/j.1440-1614.2000.00740.x. [DOI] [PubMed] [Google Scholar]
- 10.Degenhardt L, Lynskey M, Hall W. Cohort trends in the age of initiation of drug use in Australia. Aust N Z J Psychiatry. 2000;24:421–426. doi: 10.1111/j.1467-842x.2000.tb01605.x. [DOI] [PubMed] [Google Scholar]
- 11.Borges G, Walters EE, Kessler RC. Associations of substance use, abuse, and dependence with subsequent suicidal behaviour. Am J Epidemiol. 2000;151:781–789. doi: 10.1093/oxfordjournals.aje.a010278. [DOI] [PubMed] [Google Scholar]
- 12.Madianos MG, Gefou-Madianou D, Stefanis CN. Symptoms of depression, suicidal behaviours and use of substances in Greece: a nationwide general population survey. Acta Psychiatr Scand. 1994;89:159–166. doi: 10.1111/j.1600-0447.1994.tb08086.x. [DOI] [PubMed] [Google Scholar]
- 13.Pirkis J, Burgess P, Dunt D. Suicidal ideation and suicide attempts among Australian adults. Crisis. 2000;21:16–25. doi: 10.1027//0227-5910.21.1.16. [DOI] [PubMed] [Google Scholar]
- 14.Allison M, Hubbard RL, Ginzburg HM. Indicators of Suicide and Depression Among Drug Abusers. 1979–1981 TOPS Admission Cohorts. Rockville, MD: US Dept of Health and Human Services; 1985. [Google Scholar]
- 15.Darke S, Ross J. The relationship between suicide and overdose among methadone maintenance patients in Sydney, Australia. Addiction. 2001;96:1443–1453. doi: 10.1046/j.1360-0443.2001.961014438.x. [DOI] [PubMed] [Google Scholar]
- 16.Johnsson E, Fridell M. Suicide attempts in a cohort of drug abusers: a 5 year follow-up study. Acta Psychiatr Scand. 1997;96:362–366. doi: 10.1111/j.1600-0447.1997.tb09930.x. [DOI] [PubMed] [Google Scholar]
- 17.Rossow I, Lauritzen G. Balancing on the edge of death: suicide attempts and life-threatening overdoses among drug addicts. Addiction. 1999;94:209–219. doi: 10.1046/j.1360-0443.1999.9422095.x. [DOI] [PubMed] [Google Scholar]
- 18.Roy A. Characteristics of cocaine-dependent patients who attempt suicide. Am J Psychiatry. 2001;158:1215–1219. doi: 10.1176/appi.ajp.158.8.1215. [DOI] [PubMed] [Google Scholar]
- 19.Roy A. Characteristics of opiate dependent patients who attempt suicide. J Clin Psychiatry. 2002;158:403–407. doi: 10.4088/jcp.v63n0505. [DOI] [PubMed] [Google Scholar]
- 20.Vingoe L, Welch S, Farrell M, Strang J. Heroin overdose among a treatment sample of injecting drug misusers: accident or suicidal behaviour? J Substance Use. 1999;4:88–91. [Google Scholar]
- 21.Garlow SJ, Purtselle D, D'Orio B. Cocaine use disorders and suicidal ideation. Drug Alcohol Depend. 2003;70:101–104. doi: 10.1016/S0376-8716(02)00337-X. [DOI] [PubMed] [Google Scholar]
- 22.Darke S, Kaye S, Topp L. Cocaine use in New South Wales, Australia, 1996–2000: 5 year monitoring of trends in price, purity, availability and use from the Illicit Drug Reporting System. Drug Alcohol Depend. 2002;67:81–88. doi: 10.1016/S0376-8716(02)00019-4. [DOI] [PubMed] [Google Scholar]
- 23.Topp L, Day C, Degenhardt L. Changes in patterns of drug injection concurrent with a sustained reduction in the availability of heroin in Australia. Drug Alcohol Depend. 2003;70:275–286. doi: 10.1016/S0376-8716(03)00013-9. [DOI] [PubMed] [Google Scholar]
- 24.Hando J, Flaherty B, Rutter S. An Australian profile on the use of cocaine. Addiction. 1997;92:173–182. doi: 10.1111/j.1360-0443.1997.tb03650.x. [DOI] [PubMed] [Google Scholar]
- 25.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 2000. [Google Scholar]
- 26.Platt JJ. Cocaine Addiction. Theory, Research and Treatment. Cambridge, MA: Harvard University Press; 1997. [Google Scholar]
- 27.Coffin PO, Galea S, Ahern J, Leon AC, Vlahov D, Tardiff K. Opiate, cocaine and alcohol combinations in accidental drug overdose deaths in New York City, 1990–1998. Addiction. 2003;98:739–747. doi: 10.1046/j.1360-0443.2003.00376.x. [DOI] [PubMed] [Google Scholar]
- 28.Gossop M, Darke S, Griffiths P, et al. The Severity of Dependence Scale (SDS) in English and Australian samples of heroin, cocaine and amphetamine users. Addiction. 1995;90:607–614. doi: 10.1111/j.1360-0443.1995.tb02199.x. [DOI] [PubMed] [Google Scholar]
- 29.Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 1994. [Google Scholar]
- 30.Kaye S, Darke S. Determining a diagnostic cut-off on the Severity of Dependence Scale (SDS) for cocaine dependence. Addiction. 2002;97:727–731. doi: 10.1046/j.1360-0443.2002.00121.x. [DOI] [PubMed] [Google Scholar]
- 31.Darke S, Hall W, Heather N, Wodak A, Ward J. Development and validation of a multidimensional instrument for assessing outcome of treatment among opioid users: The Opiate Treatment Index. Br J Addict. 1992;87:593–602. doi: 10.1111/j.1360-0443.1992.tb02719.x. [DOI] [PubMed] [Google Scholar]
- 32.Hassan R. Suicide Explained. The Australian Experience. Melbourne, Australia: Melbourne University Press; 1995. [Google Scholar]
- 33.Denning DG, Conwell Y, King D, Cox C. Method choice, intent and gender in completed suicide. Suicide Life Threat Behav. 2001;30:282–288. [PubMed] [Google Scholar]
- 34.Darke S. Self-report among injecting drug users: a review. Drug Alcohol Depend. 1998;51:253–263. doi: 10.1016/S0376-8716(98)00028-3. [DOI] [PubMed] [Google Scholar]