Aim: To investigate the baseline and follow-up characteristics of a group of alcohol-dependent patients being treated under civil commitment. Methods: This study involved a cross-sectional comparative analysis of baseline characteristics and a follow-up survey of a group of committed alcoholic patients. The study was undertaken in the Alcohol Unit of a 1,000-bed general and university hospital. The study included 17 consecutive cases of civil commitment (representing 15 patients, of whom 2 were committed twice) and a comparative group of 34 randomly selected age- and sex-matched patients. Baseline characteristics of the cases (at the time of commitment) and of patients from the comparative group were collected from medical records, including sociodemographic data, medical condition, patterns of drinking and number and dates of previous treatments for alcohol-related problems. A structured follow-up interview of the cases provided information on their medical condition, social status, patterns of alcohol use, type and duration of residential treatment as well as their perceptions of commitment. Results: During a 4-year period, our Unit referred 23 cases of alcohol-dependent patients (out of 367) to the Guardianship Authority, requesting civil commitment. On 17 occasions, patients were committed to residential treatment, including 2 patients who underwent commitment on two separate occasions, thus representing a total of 15 different patients. In comparison with age- and sex-matched patients seen at the Unit, the cases were characterized by multiple medical, social and psychological alcohol-related impairments. At the time of follow-up, 14 out of 15 patients were alive, among whom 10 agreed to be interviewed. Eight of these reported complete abstinence, whereas 9 considered their alcohol problem as less severe than before. The average duration of commitment was 29 weeks. The majority of patients retrospectively considered the measure as having been justified and useful. The patients’ satisfaction with the decision to commit was higher among women than among men. Health-related quality of life at the time of follow-up, as assessed by the MOS 36-Item Short Form Health Survey questionnaire, was good on average and better than that usually reported by other cohorts of alcoholics undergoing treatment. Conclusions: The usefulness of residential civil commitment of certain severely impaired alcohol-dependent patients is underscored. This study suggests that civil commitment not only may save the lives of endangered patients but could also be a health-promoting measure that may sometimes allow for recovery from dependence. Unexpectedly, this measure was retrospectively well accepted by many patients, who considered the commitment decision as having been justified and useful.

The series of Veterans Administration Cooperative Studies in Psychiatry has provided continuing support for investigations of the role of the phenothiazines in the treatment of schizophrenic patients. This report is the result of the first cooperative project in geriatric psychiatry. I n the previous studies an upper age limit of 56 years was used; in the present investigation the patients were aged 54 to 74 years.The usefulness of phenothiazine therapy in younger, newly-admitted schizophrenic patients already has been demonstrated in several studies (1-3). Our one major investigation of depressed patients showed that imipramine was the most effective agent tested (4). The situation was less clear regarding the effect of combined drug therapy in patients with chronic schizophrenia ( 5 ) . For this group, the addition of dextro-amphetamine, imipramine or trifluoperazine to maintenance doses of chlorpromazine did not produce a therapeutic gain. Further study (6) revealed that discontinuation of phenothiazine medication in these patients resulted in a 45 per cent relapse rate over a period of sixteen weeks. Thus it may be concluded with confidence that treatment with the major phenothiazines is generally beneficial in schizophrenic patients under 56 years * Portions of this material were presented at the Ninth Annual Conference, VA Cooperative Studies in Psychiatry, by Marcus P. Rosenblum, MD., under the title, "Treatment of the Elderly Psychiatric Patient." The success of the VA program of Cooperative Studies in Psychiatry has depended upon the continued support of field-station personnel, whose tremendous effort is impossible to acknowledge in a footnote. The following list of VA hospitala and Principal Investigators who collaborated in this study must serve as the medium for expressing the gratitude of the authors to the hundreds of VA employees who contributed to this research.