Improved drug-use patterns at 6 months post-discharge from inpatient substance use disorder treatment: results from compulsorily and voluntarily admitted patients

Abstract

BackgroundTreatment services to patients with substance use disorders (SUDs), including those mandated to treatment, needs to be evaluated and evidence based. The Norwegian Municipal Health Care Act calls for mandated treatment for persons with “severe and life-threatening substance use disorder” if these individuals are not otherwise willing to be voluntarily treated and consequently risk their lives over drug use. This study aims to examine substance use–related outcomes at 6 months following inpatient treatment and to analyse factors associated with improved outcomes and abstinence.MethodThis prospective study followed 202 hospitalized patients with SUD who were admitted voluntarily (VA; n = 137) or compulsorily (CA; n = 65). The European Addiction Severity Index was used at baseline and at follow-up to assess socio-demographic and substance use variables. Regression analysis was conducted to investigate factors associated with abstinence at 6 months of follow-up.ResultsThe frequency of use of a preferred substance showed marked improvement for both VA and CA patients (61 and 37 %, respectively) at follow-up. Seventy-five percent of VA patients using amphetamine reported improvement compared to 53 % of CA patients. At follow-up, the CA group continued to have a higher rate of injection use. The CA group had experienced higher rates of overdose in the past 6 months and lower abstinence rates (24 % versus 50 %) at follow-up. A lower severity of drug use at intake (non–injection drug use), voluntary treatment modality, and higher treatment involvement during follow-up all were significant factors associated with abstinence at 6 months after treatment.ConclusionVoluntary treatment for SUD generally yielded better outcomes; nevertheless, we also found improved outcomes for CA patients. It is important to keep in mind that in reality, the alternative to CA treatment is no treatment at all and instead a continuation of life-threatening drug use behaviours. Our observed outcomes for CA patients support the continuation of CA treatment.

Mental distress following inpatient substance use treatment, modified by substance use; comparing voluntary and compulsory admissions

“…This finding suggested that the severity of a SUD was related to the level of mental distress. A previous paper reported improved 6-month follow-up SUD outcomes of the present study (frequency of substance use, injection use, and overdoses), but improved outcomes were reported significantly more frequently in the VA than in the CA group (e.g., 61% versus 37% reported reduction in the frequency of the preferred substance) [37]. The present paper elaborate on these findings; patients that remained abstinent were more likely to show lower levels of mental distress than patients that relapsed at 6 month follow-up..…”

“…In 2012, this law was replaced by the NMHCA, §10.2, sanctions involuntary interventions for adult patients with SUDs [25]. In this manuscript, we followed a similar methodology to one used previously [37]. Recruitment for this prospective study continued consecutively between January 2009 and May 2011 from three different publicly funded treatment centres in the south-eastern part of Norway.…”

Coercion into addiction treatment and subsequent substance use patterns among people who use illicit drugs in Vancouver, Canada

“…Incarceration, non-fatal overdose and cocaine use were significantly associated with an increased hazard of coerced treatment, while daily cannabis use and employment were negatively associated with coerced treatment. The finding that coercion did not lead to measurable improvements in substance use supports evidence that coerced treatment may not effectively decrease substance use [12][13][14][15]. Hence, the prevalence of reported coerced addiction treatment is concerning.…”

“…Other studies examining formal coerced addiction treatment among incarcerated PWUD have found that it is less effective at reducing substance use and recidivism when compared to controls [9][10][11][12][13][14]. In a prospective study of PWUD in a Norwegian hospital comparing those coerced by health-care providers to those attending treatment voluntarily, voluntary participants had higher reductions in substance use frequency than coerced participants (61 versus 37%) [15]. Additionally, a systematic review on compulsory drug treatment determined that existing evidence is inconclusive, suggesting potential harms associated with coercive interventions [12].…”

Secure care: more harm than good

“…Instead, findings showed higher levels of mental duress, homelessness, relapse and overdose among adults after discharge from mandated treatment. 5 The sentences should have been written as follows:…”