This application is in response to RFA# RFA-MH-04-003, "Developing Centers on Intervention for the Prevention of Suicide (DCIPS)." While there is a high incidence of suicide and suicide attempts in the United States, research on effective treatments for this population has lagged far behind. Fewer than forty randomized controlled trials of suicide interventions, either pharmacological or psychosocial have been conducted. Thus, the most deadly condition in psychiatry has received the least attention from a clinical trials perspective and many commonly-used interventions have never been tested empirically. The most significant risk factors for suicide are prior suicidal behavior, serious and persistent suicide ideation and co-morbid alcohol (AUD) and substance use disorders (SUD). In an effort to develop interventions that have a direct impact on reducing suicide attempts and suicide, this high-risk segment of the suicidal population is the focus of our Center. Interventions that are readily exportable and easily trained, such as medication strategies and brief psychosocial interventions will be targeted. The primary goals, each with a training component, are related to high suicide risk individuals, both adolescent and adult: 1. to promote, develop and conduct efficacy studies that test and adapt pharmacological, psychosocial and combined interventions targeting suicidal behaviors; 2. to stimulate ethically and clinically-sound inclusion of suicidal individuals in intervention studies, from which they are typically excluded targeting their primary disorder, e.g.depression, bipolar disorder, AUD and SUD; 3. to develop a model of partnership and network with local Psychiatric Emergency Rooms to develop a more effective referral and follow-up process for suicidal individuals; and 4. to develop strategies to enhance treatment engagement, adherence and retention of suicidal individuals both following ER visits and after recruitment into intervention trials; 5. to enhance reliable and accurate suicide assessment and measurement development for suicide intervention trials; and 6. to develop strategies for understanding and managing the complex clinical and ethical issues in conducting suicide intervention research.