Here with You: Supporting People with Substance Use and Suicide Concerns

Episode Description:

This episode of Never the Same delves into addressing suicide concerns among loved ones who use substances. Featuring lived experience insights from Jack Stem and his daughter Kim, alongside Dr. Ken Connor (University of Rochester) and Morica Hutchinson (University of Connecticut), the conversation combines lived experiences and professional insights.

The episode coincides with the release of a no-cost online training resource developed by SafeSide Prevention in collaboration with the UR Medicine Recovery Center of Excellence on SUD Prevention to support those standing together with someone grappling with substance use and suicide challenges. Explore the resource here.

Key topics include:

• How to start difficult conversations about suicide and substance use
• Ways to ask about suicide directly and sensitively
• How to respond effectively when someone shares their concerns.

In this episode, participants share personal experiences and professional insights, creating a balanced discussion that addresses both the practical and emotional aspects of supporting someone at risk of suicide who also struggles with substance use.

Guests:

• Jack Stem: A seasoned counselor and recovery advocate with decades of experience navigating addiction and peer support.
• Kimberly Hribar: A passionate speaker on addiction and mental health, sharing her lived experiences to foster understanding and hope.
• Dr. Kenneth Conner: Professor in Emergency Medicine and Psychiatry at the University of Rochester, specializing in suicide prevention and substance use research.
• Morica Hutchison: Faculty in Public Health Sciences at the University of Connecticut, focusing on family and community-based approaches to substance use and mental health.

Host: 

Dr. Tony Pisani: Dr. Tony Pisani is a professor, clinician, and founder of SafeSide Prevention, leading its mission to build safer, more connected military, health, education, and workplace communities.

Referenced Resources (Timestamped)

• Skills to help someone struggling with substance use and suicide concerns module (01:30): Developed in collaboration with the University of Rochester Recovery Center of Excellence.
• Three Steps to Ask About Suicide (10:18): A guide for friends and family.
• 988 Crisis Line (01:03:00): National resource for immediate support.
• Hope Kit (01:03:30): Mentioned as a resource for stabilization.

Resources to contact if you need crisis help

SafeSide does not provide crisis intervention. These crisis resources are there for you:

• United States 988 Suicide & Crisis Lifeline
• Australia LifeLine Australia
• Canada Crisis Services Canada
• New Zealand LifeLine

Transcript

Tony: Today’s episode is about addressing suicide concerns with a friend or family member who uses substances. Joining me are Jack Stem and his daughter Kim, who share lived experience, along with Dr. Ken Conner from the University of Rochester and Rica Hutchison from the University of Connecticut. We discuss how to start conversations, ask directly, and respond effectively. This episode coincides with the release of a new online training resource developed with the University of Rochester Recovery Center of Excellence. Both suicide and substance use are sensitive topics, so please take care as you listen.

Jack: In my experience, no one seemed to know what to do as my addiction progressed. Even surrounded by healthcare professionals, no one said a word. After an overdose brought me to the hospital, I finally admitted my addiction to a colleague. His response surprised me: "We thought you had AIDS or cancer." I realized people didn’t speak up because they didn’t know how. Having resources to guide those conversations is so important.

Tony: Even as someone who works in suicide prevention, I often struggle with what to say. Jack, what has been most helpful for you when people approach these topics?

Jack: Now, I’m straightforward. If I notice someone struggling, I say, “What’s going on? You’re not yourself.” Being open helps build trust. People know I’ve been there and won’t judge them.

Kim: I’ve learned the same. Being honest and open from the start is key. But it’s hard. Sometimes I hesitate, wondering if I’ll make things worse or if they’ll hide their struggles better. There’s a fine line between being proactive and tiptoeing around the issue.

Tony: Walking on eggshells is a common experience for families. The fear of pushing someone further away or triggering substance use adds to the challenge.

Jack: Exactly. When Kim was struggling, I worried my words might lead her to isolate or relapse. It’s a tough balance, but I’ve learned that being honest and supportive is crucial.

Kim: When you do speak up, the response can be unexpected. Once, when I confronted someone, they immediately assured me everything was fine. That response can be even more concerning than if they acknowledged the problem.

Tony: We often teach a three-step process in these situations: Start the conversation, ask sensitively and directly, and respond effectively. Rica, can you share how this approach came to be?

Rica: Our research revealed a lack of resources addressing both substance use and suicide risk for families. This online learning module fills that gap, offering tools and language to navigate these complex conversations.

Ken: Substance use contributes to suicide risk in multiple ways. Addiction creates life disruptions, and substances themselves can amplify distress. People with substance use disorders also face the same risks—like depression or relationship challenges—that affect everyone. Addressing these issues together is essential.

Tony: How can family members help without solely focusing on substance use?

Jack: Stigma plays a huge role. People assume addiction is a choice. Understanding that addiction alters the brain helps shift that perspective. Support groups have been key for my recovery, providing perspective and connection when I’ve needed it most.

Kim: Explaining the biology of addiction helps people feel less broken and more understood. It’s empowering to know it’s not a moral failing but a matter of how the brain functions.

Tony: Starting the conversation can be daunting. What strategies have worked for you?

Rica: Be compassionate. Find a private space and ask directly, “Have you been thinking about killing yourself?” Directness, paired with genuine concern, can open the door.

Jack: Sometimes casual settings help. A drive or a meal can create a space for honesty without the pressure of a formal conversation.

Kim: I’ve found that sharing my own struggles first can encourage others to open up. Vulnerability builds trust.

Tony: What about situations where someone says they’re fine, but you’re still worried?

Jack: Watch for sudden, unexpected happiness after prolonged struggles. It might signal they’ve made a dangerous decision. If you’re concerned, be direct: “You seem better, but is that how you feel inside?”

Ken: If someone denies feeling suicidal but you’re still concerned, stay engaged. Let them know you’re there and offer support if things worsen.

Tony: And when the risk feels immediate?

Ken: In cases of acute risk, prioritize safety. Remove access to lethal means, and ensure they’re not alone. If intoxicated, staying with them until they’re sober can significantly reduce risk.

Rica: Call 988 or reach out to a mobile crisis unit. Trained professionals can help de-escalate the situation and provide guidance. If safety can’t be ensured, consider involving emergency services.

Tony: How can families balance helping their loved ones while caring for themselves?

Rica: Self-care is essential. Even small acts, like enjoying a hot coffee or a walk, can help you stay grounded during stressful times.

Ken: Remember, you can’t control everything. Do your best, but don’t blame yourself for outcomes beyond your control.

Kim: Boundaries are crucial. Knowing when and how to step back helps both you and your loved one.

Tony: Thank you all for sharing your experiences and insights. Links to the online resources will be in the episode notes. We hope this conversation provides support for those navigating these challenges.