Real-time substance use urges and suicidal thoughts: predictive utility of average real-time substance use urges, baseline basic psychological needs, and baseline emotion
Creators: name: Harnedy, Lauren E
Publisher: name: No Publisher Supplied
Year: 2025

description: Substance use disorders (SUD) are increasingly prevalent among young adults and have been associated with a greater risk of suicidal thoughts and behaviors (STBs). The co-occurrence of SUD and suicidal thoughts is hypothesized to be attributable to them having shared functions, such as avoiding or escaping one’s emotions. It remains largely unknown as to why some individuals with SUD experience STBs while others do not. One possible explanation is that SUD loses its effectiveness in relieving short-term distress, leaving them more susceptible to any cognitive/behavioral approach that provides them with relief, including STBs. Emotion reactivity may play an important role in helping determine who with SUD will go onto experience STBs as strong emotion reactivity can be aversive and can trigger feelings of avoidance or escapism. Moreover, Self-Determination Theory could likely provide helpful insight into SUD and STBs as individuals who experience frustrated basic psychological needs (BPN)—frustrated feelings of autonomy, competency, or relatedness—are at a heightened risk for maladaptive behaviors. Few studies have examined SUD or STBs in the context of emotion reactivity or frustrated BPN, and no studies have assessed emotion reactivity and frustrated BPN in the context of any psychopathology. Therefore, the current study utilized ecological momentary assessment (EMA) to assess whether (1) baseline levels frustrated BPN and/or baseline levels of emotion reactivity, (2) average real-time alcohol use urges or average real-time drug use urge, or (3) any interactions between the baseline variables and average real-time substance use urge variables can help predict who, among those with real-time alcohol and/or drug use urges will endorse real-time suicidal ideation (SI) during the 8-week EMA period. Participants were 295 college students who were recruited from a large university in the Northeast and endorsed at least one instance of real-time alcohol use urge or real-time drug use urge during the EMA period. Participants completed baseline measures, followed by an 8-week EMA period wherein they would receive up to 6 surveys/day that inquired about affect, thoughts, and behaviors. Baseline frustrated BPN (all subscales) and average real-time drug use urge across data collection were significantly predictive of SI endorsement during the EMA period. Furthermore, the interaction between baseline BPN frustrated relatedness and average real-time drug use urge ratings was significantly related to the presence of SI, such that those with high baseline BPN frustrated relatedness and a high average drug use urge rating during the EMA period were most likely to have endorsed SI during that same time period. Experiencing frustrated BPN and/or having an elevated average drug use urge for a period of time are predictive of experiencing SI. Findings from the study have important clinical implications for prevention and treatment efforts related to co-occurring SUD and SI.