Substance use in adulthood following adolescent self-harm: a population-based cohort study
Jul 24, Mental disorders have a close relationship with self-injurious DSM-IV describes a variety of “substance use disorders” and this Education. Hurting? Get free help for self-harm now. Text CONNECT to Self-harm is a coping mechanism just the way that substance abuse is. Trouble with interpersonal relationships; Lacking self-worth or hope for the future . These techniques teach clients how to approach triggers, such as emotional upset.
The latter events can be further categorized into self-mutilation, parasuicide attempts, and other behavior with no deliberate self-harm. Along this spectrum of suicide events lie indeterminate behaviors broadly categorized into self-injurious behavior with suicidal intent unknown and with not enough information. To our knowledge, there is no study that has estimated the prevalence or identified risk and protective factors for self-harm behavior among patients with alcohol or drug abuse problems in the Kingdom of Saudi Arabia.
Therefore, this research aimed to assess the magnitude of suicide ideation, attempts, and parasuicidal behavior, and to explore possible risk and protective factors among patients diagnosed with alcohol or drug abuse. We hypothesized that the prevalence rate of self-harm behavior would be relatively low in Saudi culture, and attributable to a protective sociocultural belief system.
DSM-IV criteria are structured and research-oriented, but cross-sectional interviews conducted by qualified psychiatrists having indepth knowledge of the DSM-IV were unstructured. Other inclusion criteria were: Comorbid diagnosis of medical disorders was based on patient self-reporting. Patients with brain injury and those with psychoses caused by medical and neurological conditions were excluded from this study.
Following a detailed interview of all eligible patients together with a review of their medical files, sociode-mographic and clinical variables were abstracted on a semistructured sheet. Primary and comorbid diagnoses were based on medical file reviews and interviews conducted by assistant researchers. The respondents were arbitrarily categorized into four income groups, based on total annual income in Saudi Riyals SR whereby 1 USD is equivalent to 3. This scale has good reliability and validity, and assesses actual attempts, nonsuicidal self-injurious behavior, interrupted attempts, aborted attempts, preparatory acts or behaviors, absence of suicidal behavior, frequency of suicidal ideations over the last one week, and risk factors for and protective factors against suicide behavior.
From an ethical perspective, the complete research proposal including informed consent was submitted to the General Administration for Medical Research, Ministry of Health.
This department has both scientific and ethical committees for evaluating submitted research protocols. Finally, permission was obtained for conducting this research in the Ministry of Health setting. All participants were requested to sign the informed consent.
Data analysis The data collected were entered into a computer and cleaned before conducting the analysis.
In addition to calculating the frequency distribution and statistics of the variables, odds ratios were estimated by comparing certain socioclinical and risk factors. Self-harming and other equivalent behaviors can give some students temporary relief from these anxieties and fears. Signs and Symptoms On the basis of what we know from clinical experience and research as well as from the adolescents themselves, most adolescents who self-harm tend to cut or burn themselves on their arms, legs, abdomens, or the bottoms of their feet, all places they can cover up.
Many self-harming adolescents wear pants and long-sleeved shirts even when the weather is warm to cover up their scars, fresh cuts, or burn marks. We have to worry most about those who cut or burn themselves around their eyes and on their necks. These students—as well as those who deliberately display the scars, cuts, or burn marks on their arms and legs—are often waving a red flag, indicating they're in emotional trouble.
In many cases, a friend or peer will become alarmed and seek out a teacher or other school staff member to share his or her concerns. Many self-harming adolescents have difficulty managing their depressed, anxious, and angry feelings. In some cases, they cannot articulate their feelings, possibly because of repeated invalidation in their interactions with their parents.
Suicidal and self-injurious behavior among patients with alcohol and drug abuse
Self-harming, bulimia, and substance abuse are adolescents' solutions. On a cautionary note, tattoos, body piercings, or dark Goth-looking makeup and clothing may not indicate self-harming. There is a difference between self-decorating to be cool—as a symbol of peer group tribal connection—and engaging in these behaviors to rid oneself of emotional demons. What Schools Can Do School personnel need to be familiar with the territory of adolescent self-harm. They need to understand the common causes, signs, and symptoms; the difference between self-harming behavior and suicidal behavior; constructive and empowering ways to respond; and effective treatments.
Schools can provide two major interventions on the junior and senior high school levels that can help reduce the likelihood of self-harming epidemics. Create a Support Group Once you have red-flagged self-harming students, you can refer them to an on-site intervention group that capitalizes on their strengths to teach them how to become more resilient, effectively cope with stress, and take on leadership responsibilities in their schools and communities.
I have developed one such model that improves students' coping skills—the Stress-Busters' Leadership Group.
Self-injury (Cutting, Self-Harm or Self-Mutilation)
Ideally, a male-female cotherapy team of school social workers, psychologists, or counselors is best for gender balance. However, one counseling professional can also effectively run the sessions. Students who have completed the program often stay involved in prevention work in their schools and communities.
Graduates serve as ideal gatekeepers for identifying self-harming students and for getting them to see a counselor or participate in a new group. Finally, groups like these can reverse self-harming and other self-destructive behavior epidemics in schools by accentuating at-risk students' strengths and honing their leadership abilities. Educate Responding Adults Adult inspirational others serve a major protective function for at-risk children and adolescents Anthony, ; Selekman, These can be teachers, coaches, extended family members, family friends, neighbors, clergy, and community leaders.
Adult inspirational others are often compassionate, possess strong social skills, and are good at identifying and accentuating the strengths in children and adolescents. They consistently make themselves available to young people for connection, support, and advice.
In every school, some staff members have served this role for at-risk students without even knowing it. Eight practical guidelines can help adults effectively respond to self-harming students. Because teachers and school nurses are often the first responders, it is crucial that they be respectful listeners to self-harming students; validate the students; build trust; and serve as a bridge to get the students to a school psychologist, social worker, or counselor for further help.
If the self-harming student has a strong relationship with the teacher, it may be useful for the teacher to sit in on counseling sessions. Teachers and school nurses should ask the student these questions: How can I help you? How has the cutting helped you? How does cutting fit into your life right now? I'm happy to be there for you, but I also need to connect you with one of our social workers because of our school policy. Would you like to see a male or a female social worker when the option is available?
If I can arrange it, would you like me to sit in on your first meeting with your social worker?Psychiatric Interviews for Teaching: Self-Harm
At all costs, school personnel need to avoid responding to self-harming students with disgust, anxiety, or fear. They must not lecture the students about the dangers of this behavior, play detective and ask to see their cuts or burn marks, or interrogate and further invalidate them.
The Mental Effects of Substance Abuse and Self-Harm | Laguna Treatment Hospital
Instead, they should strive to understand the meaning of this behavior for the student, how the behavior has been helpful, and how they can now be helpful to the student. It is important to remember that each self-harming student's story is unique. Self-harming students need to know that teachers and other school personnel care about them and are available for emotional connection, support, and advice when needed.
Once a referral is made to the school counseling staff member, the counselor needs to determine in conjunction with his or her supervisor and the student whether the school can successfully counsel the student on-site or whether parent involvement is required.
For students who have just begun experimenting with self-harming or who have engaged in this behavior only intermittently, a trusting relationship with a school counselor may generate alternative coping strategies.
I recommend that the student also participates in an on-site intervention group, such as the Stress-Busters' Leadership Group. If the student has been self-harming regularly and is engaging in other self-destructive behaviors like bulimia, substance abuse, and risky sexual activity, the school needs to contact the parents immediately for referral to a private practitioner or community-based program for family therapy that specializes in treating these adolescent behavioral difficulties.
Concurrent participation in an on-site intervention group is also recommended. These students should be taken immediately to the nearest hospital emergency room for evaluation. Although only a small percentage of self-harming students become suicidal, if these students have not responded well to both on-site and outside counseling, struggle to cope with multiple life stressors, and clearly voice suicidal thoughts, they need to be immediately taken to the nearest hospital emergency room.
Identified school personnel who have been serving as inspirational adults for other disconnected at-risk students can provide added support to self-harming students who are trying to reduce or stop engaging in this behavior. These adults can closely collaborate with the involved counseling staff members for guidance and back-up if necessary. Graduates of intervention groups who are interested in schoolwide prevention work help identify at-risk students who are self-harming, get them to counseling staff, and spark their interest in participating in a new group for added support.
The school can ask these graduates to cofacilitate new intervention groups and get involved in the school peer counseling program. More Than Just a Problem As provocative and perplexing as this behavior may seem, we must not lose sight of how bright, creative, and talented many self-harming students are. With compassion, guidance, and support, we can empower self-harming students by being respectful listeners and accentuating their natural gifts.
A Look Inside a Stress-Busters' Leadership Group Session In the initial session in the Stress-Busters' Leadership Group—called What Are My Strengths and Protective Shields—the group leaders get to know the participants by having them discuss their key strengths, talents, hobbies, and interests as well as any important positive changes that have recently occurred. After discussing group rules and confidentiality, leaders ask members what they would like to get out of group participation and what they would like to change in themselves.
The leaders negotiate with each group member some doable and measurable goals and ask each participant to track his or her progress. In a 15—20 minute presentation on resiliency, leaders describe the major protective factors that have helped at-risk children and adolescents overcome adversity.
Group members discuss which of these protective factors they are already using and how such factors helped them manage specific stressful events.
Group members learn about positive psychology research, which focuses on strengths and virtues Peterson,and take the Values in Action Inventory of Strengths for Youth available online at www.
Group members will discuss the results in the next group session. Participants then engage in an exercise called visualizing movies of success. Group members close their eyes and picture a blank movie screen. Using all their senses, they project on the screen a movie about something they accomplished that pleased them and made them feel proud.
This can include doing a good deed, handling a difficult family situation well, performing well with their band, doing something that surprised them about their abilities, and so on. Participants then share their movies with the group. As a conclusion, participants acknowledge the various strengths of group members. Students also create victory boxes out of old shoe boxes, which they decorate in any way they wish.
Each day, they write down on slips of paper personal victories or accomplishments, along with the thinking and actions that helped them pull off each victory. They share with the group at least one of their most meaningful personal victories that occurred during the week.