title: The efficacy of an opportunistic cognitive behavioral intervention package (OCB) on substance use and comorbid suicide risk: a multisite randomized controlled trial.
abstract: OBJECTIVE
  People with substance use disorders who present with suicidal behavior are at high risk of subsequent suicide. There are few effective treatments specifically tailored for this population that diminish this risk. We aimed to assess the impact of an opportunistic cognitive behavioral intervention package (OCB) among adult outpatients with a substance use and comorbid suicide risk.
  
  
  METHODS
  A randomized controlled trial was conducted across 2 sites in which 185 patients presenting with suicide risk and concurrent substance use received either OCB (8 sessions plus group therapy) or treatment as usual (TAU) over a 6-month period. Primary outcomes were suicidal behavior (suicide attempts, suicidal intent and presence of suicide ideation) and level of drug and alcohol consumption. Secondary outcomes were changes in psychological measures of suicide ideation, depression, anxiety, and self-efficacy.
  
  
  RESULTS
  There were no completed suicides, and only 2 participants reported suicide attempts at follow-up. Suicide ideation, alcohol consumption, and cannabis use fell over time but no significant Treatment × Time differences were found. There were also no differences between OCB and TAU over time on psychological measures of depression, anxiety, or self-efficacy. Suicide ideation at 6-month follow-up was predicted by cannabis use and higher scores on the Brief Psychiatric Rating Scale at baseline.
  
  
  CONCLUSIONS
  The opportunistic cognitive behavioral intervention package did not appear to be beneficial in reducing suicide ideation, drug and alcohol consumption, or depression relative to treatment as usual.
authors.affiliation: National Health and Medical Research Council (NHMRC) Centre for Research Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine, University of Sydney.
authors.forename: Kirsten C
authors.initials: KC
authors.lastname: Morley
authors.affiliation: Department of Health Sciences, University of Sydney.
authors.forename: Gomathi
authors.initials: G
authors.lastname: Sitharthan
authors.affiliation: NHMRC Centre for Research Excellence in Mental Health and Substance Use, Discipline of Addiction Medicine, University of Sydney.
authors.forename: Paul S
authors.initials: PS
authors.lastname: Haber
authors.affiliation: Concord Centre for Mental Health, Concord Hospital.
authors.forename: Peter
authors.initials: P
authors.lastname: Tucker
authors.affiliation: Department of Psychiatry, Sydney Medical School, University of Sydney.
authors.forename: Thiagarajan
authors.initials: T
authors.lastname: Sitharthan
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D020377:Self Efficacy; D019966:Substance-Related Disorders / Q000523:psychology / Q000628:therapy*; D059020:Suicidal Ideation; D013405:Suicide / Q000523:psychology; D013406:Suicide, Attempted / Q000517:prevention & control* / Q000523:psychology; D016896:Treatment Outcome; D000092864:Suicide Prevention