Involuntary Treatment of Alcohol-Dependent Patients: A Study of 17 Consecutive Cases of Civil Commitment

Abstract

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.

Compulsory Substance Abuse Treatment: An Overview of Recent Findings and Issues

“…The ethnographic study of Wolf and Colyer [46] identified subtypes of participants exposed to the same drug court procedures. Finally, several studies have begun to investigate patient perceptions of how justified and useful compulsory treatment is, with one investigation reporting high levels of perceived utility for civil commitment [47] and another reporting negative personal reactions to formal and informal mandates [48].…”

Does Mandatory Inpatient Alcohol Detoxification Reduce Emergency Department Recidivism, Hospital Admissions, and Emergency Medical Services Transports for Patients with Chronic, Severe Alcohol Dependence?

“…Bourquin-Tieche et al followed 15 patients undergoing civil commitment for alcohol dependence for 500 days (14). The study found that, after an average of 29 weeks of involuntary commitment, subjects were able to maintain abstinence, felt the severity of their alcohol problems were less, and that commitment was well tolerated.…”

Les soins sans consentements peuvent-ils s’appliquer en cas d’addiction dans le contexte français ? Une analyse critique des données

“…Dans la plupart de ces études, les personnes en soins sans consentement sont comparées de façon non randomisée à des personnes n'ayant pas eu cette mesure. À l'exception d'une des études (38), les données retrouvées sont en faveur d'une amélioration des troubles, tant que durent les soins sans consentement (39), sans différence retrouvée après la levée de la mesure de soins sans consentement (39)(40)(41). Les données disponibles ne permettent pas d'affirmer que les soins sans consentement sont un obstacle à l'adhésion ultérieure aux soins puisque la majorité des personnes à qui ces mesures étaient appliquées estimaient a posteriori que la mesure était justifiée (38) et qu'on ne retrouve pas de différence significative en termes de recours aux soins à l'issue de la contrainte (40)(41)(42).…”