Modeling abstinent and non-abstinent remission in all family members with life-time AUD allows for the possibility that abstinent and non-abstinent remitted individuals may have characteristics, such as social responsiveness, that contribute to their ability to remit but that are different from those linked to their development of AUDs. The goals of this study were to estimate the strength of the association of probands’ persistent AUD, non-abstinent remission and abstinent remission with relatives’ AUD/remission status, and to test whether this association differed in related and unrelated proband relative pairs.This study explicitly modeled abstinent and non-abstinent remission in probands who were recruited from AUD treatment programs and in their first-degree family members with life-time AUDs to test for familial associations of remission in high-risk families and to define a phenotype which can be used to explore associations of remission with potentially heritable characteristics. Results showed that individuals who were related to an abstinent proband were more than three times as likely to be abstinent themselves, compared to individuals related to a proband with persistent AUD; this association was not significant in unrelated pairs. The significant association of probands’ with relatives’ abstinent remission in related but not in unrelated proband-relative pairs suggests there are familial influences on abstinent remission which may be due to genetic or familial environmental factors. The familial association of abstinent remission in this sample selected for high-risk for AUDs has not been observed previously. The association of abstinence in one family member with abstinence in another stands in contrast to a host of null findings regarding familial influences on remission from other studies in population-based,hydro tray high-risk and clinical samples using a variety of definitions of remission.
The current analyses used an explicit abstinent and non-abstinent remission phenotype, distinct from AUDs and consistent with the idea that the distribution of risks for development of, and for remission from, AUDs may not lie on the same continuum. Our results suggest that there may be genetic or familial environmental influences on abstinent remission and demonstrate that departing from the more common risk factor-to-remission comparisons within families may indeed prove useful. When remission is the target phenotype, remission in all family members should be measured explicitly, rather than measuring it as an outcome only in target subjects but not in their relatives. This will facilitate the examination of potentially heritable characteristics underpinning abstinent outcomes, such as social responsiveness, that may increase the likelihood of remission, as well as the investigation of family environments associated with remission from AUDs. Much more work will need to be conducted to identify heritable traits that may be related to abstinent remission and to probe for mediators and moderators of their effect. In addition to potentially heritable effects on abstinent remission, another explanation for the current findings might rest with a social contagion model, or the spread of behavior within a family due to social proximity. Analysis of large social networks from a population-based study indicated that both heavy drinking and abstinence clustered in networks, and also that the heavy drinking or abstinence of relatives and friends at one time-point were associated with changes in the subject’s alcohol consumption, to heavier drinking or abstinence, at a subsequent time-point. The same may be true within families affected by severe AUDs, where abstinence in one person may influence another family member with an AUD to try to quit drinking. This possibility is consistent with evidence that abstinence is the most stable form of remission among individuals with severe AUDs . If older family members with life-time AUD are abstinent as younger family members are developing alcohol problems, it is possible that younger members, if they recognize severe problems in themselves, may look to older members for direction or example, or that older members may recognize problems in younger members and intervene. In fact, analysis of twin data showed that the variance associated with treatment-seeking for alcohol problems was accounted for primarily by familial influences, with 41% of the variance due to genetics, 40% due to shared environment, and just 19% to unique environment.
In the current study, all probands had by definition been treated, which precluded examination of familial associations for treatment-seeking; however, abstinent relatives had the highest rates of treatment seeking in the sample, suggesting an association of relatives’ with probands’ treatment-seeking. More than 40% of probands and relatives were remitted in this high-risk sample, with abstinence the most common type of remission in probands and abstinent and non abstinent remission equally common in relatives. An earlier study in the COGA sample found that more than 50% of all subjects with life-time alcohol dependence reported periods of abstinence lasting 3 months or more, with 16.1% reporting abstinence of 5 or more years. Similar to the relatives in the current study, abstainers were older than individuals who never abstained, had a greater number of life-time symptoms and were more likely to have sought formal treatment and to have attended self-help groups. Other sampling frames also show similarities to the current data. Abstinent individuals with life-time AUD from population-based data had more AUD symptoms than remitted non-abstinent individuals. In a national sample of individuals self-identified as ‘in recovery’, abstainers compared to non-abstainers were older, more likely to have received professional treatment and to have attended self-help meetings, and had significantly more life-time alcohol dependence symptoms. These similarities across a range of samples suggest that individuals who become abstinent, regardless of sampling frame, represent a severe end of the AUD continuum. In the current study, abstinence may represent a common end-point for individuals with severe AUD. It is possible that non-abstinent remitters will become abstinent for a period, or periods, of time. Given that nearly half of abstinent relatives in the current study had been remitted for 10 or more years, abstinence may indeed represent an end-point for subjects who remit from severe AUDs.Despite efforts to improve mental health over the last 60 years, planting table suicide remains a critical public health concern worldwide.Suicide was the second leading cause of death globally in 2012 among individuals aged 15–29years,with an estimated 80%–90% of suicide deaths attributable to mental health or substance use disorders.Significant gaps remain in empirical research examining suicidality among marginalised populations. Marginalised women, such as sex workers who are street involved or use drugs, experience disproportionately high levels of social and health-related risks and harms, including stigma, discrimination and violence as a result of dynamic structural drivers including poverty, criminalisation and racism.
While sex workers are a diverse population working from indoor in-call and out-call venues to street-based settings, previous studies high light substantial unmet mental health needs of more marginalised and street-involved sex workers. Studies among street-based sex workers and those who use drugs underscore the associations of social exclusion, depression and post-traumatic stress disorder with suicidality.Research demonstrates greater risk for suicidality among those with a history of trauma and among street-involved sex workers who report historical experiences of violence and childhood abuse.Furthermore, indigenous women are vastly over-represented among street-based sex workers in North America and face devastating and multi-generational effects of trauma and socioeconomic dislocation as a result of colonialism, racialised policies and displacement from land and home communities.Various biological, interpersonal and sociostructural factors contribute to our understanding of suicidal behaviours. While evidence has demonstrated that some forms of cognitive behavioural therapy and pharmacological interventions may reduce suicidality, the literature is hampered by publication bias and significant heterogeneity of strategies and outcome measures.Due to ethical challenges and limitations to studying suicide and its proxies , there remains a paucity of evidence from randomised controlled trials to support the efficacy of prevention interventions.Researchers have largely focused on examining suicidality outcomes , which may not be fully generalisable to understanding suicide or accurately evaluating treatment approaches.Furthermore, stigma continues to hinder research and reporting of suicidality.There remains an urgency to better understand pathways to suicidality, with literature highlighting the need for innovative psycho logical and psychosocial treatments and tailored inter vention approaches for key marginalised populations.Given the complex aetiological pathways to suicide and limited effectiveness of well-established evidence-based interventions to reduce the burden of suicidality, the US National Institute of Mental Health has called for innovative research on suicide prevention and treatment for suicidality. A number of psychedelic drug therapies are being revisited following a 40-year hiatus in research into their potential for the treatment of depression, anxiety, PTSD, eating disorders and addiction.Psychedelic drugs include the classic serotonergic psychedelics or ‘hallucinogens’ lysergic acid diethylamide , psilocybin, dimeth yltryptamine and mescaline, as well as the ‘enactogen’ or ‘empathogen’ methylene dioxymethamphetamine ,all of which are being investigated in clinical/preclinical studies for their neuropharmacological functions and potential as adjuncts to psychotherapy.While renewed interest in psychedelic medicine is challenged by various funding and methodological and legal impediments, the emerging evidence indicating improved outcomes for some individuals suffering from mental health and addiction issues has generated new scientific inquiry and an imposing obligation to advance this research.Recent observational studies in the USA demonstrate significant associations between life time psychedelic use and reduced recidivism and intimate partner violence among populations of prison inmates and reduced psychological distress and suicidality among the general adult population.
Despite the multifaceted structural and social inequities that shape poor mental health burden among margin alised and street-involved sex workers, there remains a paucity of data on suicide rates and research that system atically examines factors that potentiate or mitigate suicidality among sex workers, particularly in the global north. Some evidence suggests that psychedelic drug use may be protective with regard to suicidality and is associated with significant improvements in psychological well-being and reductions in depression and anxiety in clinical settings,yet existent research is characterised by large gaps. Given the urgency of addressing and preventing suicide and calls for prioritising innovative interventions, this study aimed to longitudinally investigate whether life time psychedelic drug use is associated with a reduced incidence of suicidality among a community-based prospective cohort of marginalised women. We postulated that psychedelic drug use would have an independent protective effect on suicidality over the study period.Data for this study were drawn from a large, communi ty-based, prospective cohort of women sex workers initiated in 2010, known as An Evaluation of Sex Workers Health Access . Eligibility criteria for study participants included cisgender or transgender women, 14 years of age or older, who exchanged sex for money within the last 30 days. AESHA participants completed interviewer-administered questionnaires and HIV/sexually transmitted infection /hepatitis C virus serology testing at enrolment and biannually. Experiential staff are represented across interview, outreach and nursing teams, including coordinators with substantial community experience. Participants were recruited across Metro Vancouver using time–location sampling and community mapping strategies, with day and late-night outreach to outdoor sex work locations , indoor sex work venues and online. Weekly outreach by experiential staff is conducted to over 100 sex work venues by outreach/nursing teams operating a mobile van, with regular contact as well as encouraging drop-in to women only spaces at the research office, contributing to an annual retention rate of >90% for AESHA participants. The main interview questionnaire elicits responses related to sociodemographics , the work environment , client characteristics , intimate partners , trauma and violence and comprehensive injection and non-injection drug use patterns. The clinical questionnaire relates to overall physical, mental and emotional health, and HIV testing and treatment experiences to support education, referral and linkages with care. The research team works in close partnership with the affected community and a diversity of stakeholders and regularly engages in knowledge exchange efforts. AESHA is monitored by a Community Advisory Board of over 15 sex work, women’s health and HIV service agencies, as well as representatives from the health authority and policy experts, and holds ethical approval through Providence Health Care/University of British Columbia Research Ethics Board. All participants receive an honorarium of $C40 at each biannual visit for their time, expertise and travel. To capture initial episodes of suicidality, analyses for this study were restricted to AESHA participants who had never thought about or attempted suicide at base line and completed at least one follow-up visit between January 2010 and August 2014. Those with missing observations for suicidality at baseline were excluded from analysis, and one additional participant was excluded because reported suicidality was missing at follow-up.