1. SUICIDAL BEHAVIOR IN ALCOHOLICS HOMELESS MEN TREATED IN ASSOCIACIO RAUXA Barcelona - Spain 9th ANNUAL INTERNATIONAL STREET MEDICINE SYMPOSIUM BOSTON, MASSACHUSETTS OCTOBER 24-26 2013

2. ASSOCIACIÓ RAUXA 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

3. Integral treatment of alcohol dependence for alcoholic homeless Phases 1.RAUXA VAN 1.RAUXA VAN: Street outreach resource. Detection and motivation 2.URBAN THERAPEUTIC COMMUNITY 2.URBAN THERAPEUTIC COMMUNITY: Detox, Reduction of addictive habits & Rehabilitation 3.RAUXA FLATS 3.RAUXA FLATS: Social rehabilitation 4.LABOUR INTEGRATION 4.LABOUR INTEGRATION: Rauxa Cooperative & La Terrasseta restaurant 5.DISCHARGE

4. 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.

5. 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.

6. 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.

7. 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.

8. 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.

9. SAMPLE N= 495 WITHOUT ATTEMPTS N=319 WITH ATTEMPTS N=176 Age at the admission in treatment 47,7944,11 Status marital - Married 12 3 - Divorced 3024 - Separated 15680 - Single 10768 - Widower 7 1 Time on the street 758,60 days 771,79 days Where are from - Catalunya 12786 - España 16566 - Extranjeros 27 24 Income - With income 121 70 - Without income 198 106

10. Parameters and results: * Alcoholic homeless men 495/495 (100%) * Age at the admission in treatment in Associacio Rauxa SD 46,498,76 * Attempted suicides176 /495 (35,55%) Nº of suicide attempts per person1 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%)

16. X2=32,57253561 X2=9,772467749 P=<0,00000001 P=<0,001771445

17. 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%.

18. . 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.

19. 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).

20. . 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.

21. 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.