Examining transactional relationships between sensor-derived alcohol use data and acute suicide risk in daily life - PROJECT SUMMARY/ABSTRACT Over one million people receive treatment for alcohol use disorder (AUD) annually. Community re-entry following potentially residential AUD treatment is a critically high-risk period for suicide, with residential AUD treatment reflecting a final attempt for help prior to suicide.Most people also return to alcohol use within 30 days of discharge, with acute use of alcohol being a foremost risk factor for suicide. Therefore, determining the causal timing of the proximal relation between acute use of alcohol and suicide risk during community re-entry has high significance for preventing suicide. There is also a need to identify psychological mechanisms underlying the association between acute use of alcohol and suicide risk to inform preventative interventions. The proposed study will assess time-varying, longitudinal changes in acute use of alcohol and suicide risk during community re-entry. This will inform evidence-based digital tools to detect and intervene on suicide risk. Thisstudy significantly advancesresearch by using ecological momentary assessment (EMA) and a transdermal alcohol sensor (BACtrack Skyn) to test temporal and proximal relations between alcohol use and suicide risk, as well as underlying psychological mechanisms, in the 30 days immediately following residential AUD treatment (N=300). Suicide risk fluctuates substantially—even within timescales of hours. Thus, studies of acuteuse of alcohol and suicide riskrequire methods that can track experiences closely over time, rather than relying on retrospective or cross-sectional assessments. Ecological monitoring tools can accurately record suicide risk in daily life, proximally to when it occurs. Transdermal alcohol sensors passively collect clinically relevant and unique information on acute use of alcohol not otherwise available through self-report. Yet, no research has applied these methods to study the relation between acute use of alcohol and suicide risk. Aim 1 examines aspects of sensor-derived alcohol use (i.e., intoxication, volume, and pace) in relation to EMA-derived suicide ideation. Aim 2 tests underlying psychological mechanisms (i.e., psychological distress, impulsivity, and cognitive constriction) in the momentary relations between aspects of sensor-derived alcohol use and EMA-derived suicidal ideation. Aim 3 elucidates whether risk derived from sensor-derived alcohol use in daily life during community re-entry will predict suicidal behavior at 6-month follow up above and beyond subjective measures of alcohol use collected from clinical measures at baseline and with EMA during re-entry. The proposed research fills important gaps regarding time-sensitive proximal predictors and underlying mechanisms of alcohol-related suicide during the high-risk and understudied period of community re-entry. This work is important, timely, and innovative. Developing evidence-based tools to monitor, detect, and intervene on suicide risk during community re-entry has high significance for preventing suicide.
