Psychiatric comorbidity in alcoholics treated at an institution with both coerced and voluntary admission

Abstract

SummaryPsychiatric comorbidity in alcoholics admitted to a rehabilitation center on either a voluntary or a coerced basis were studied. A group of 104 alcoholics (37 coerced and 35 voluntarily admitted men; and 21 coerced and ten voluntarily admitted women) with a mean age (SD) of 43 ± 8 years were assessed by means of a Structural Clinical Interview in accordance with the Diagnostic and Statistical Manual (DSM)-III-R (SCID). The interview took place a mean of 7 days after admission. The frequencies of lifetime/current axis I psychiatric comorbidity (substance use disorders excluded) were 66 and 61%, respectively. Drug dependence was present in 41 and 39%, respectively, of the cases. Thirty-seven percent had a lifetime diagnosis, and 33% a current diagnosis of affective disorders, 27 and 23%, respectively, of anxiety disorders and 20 and 13%, respectively, of non-organic psychotic disorders. In a subsample of 20 subjects, depressive symptoms were found to be stable during the course of treatment. No differences in frequency of psychiatric comorbidity were found between coerced and voluntarily admitted patients (67 and 56%, respectively) or between men and women (65 and 52%, respectively). The combination of psychiatric comorbidity and drug dependence was overrepresented among the coerced patients (50 vs 16%). It was concluded that the frequencies of psychiatric comorbidity were high in the present group. The co-occurrence of alcohol dependence, drug dependence and psychiatric comorbidity was more frequent among subjects who were coercively treated.

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

“…Given that compulsory treatment samples exhibit substantial variability in perceptions of coercion [41], readiness to change their behaviour [55] and perceived justifiability of social control tactics [48], it is perhaps not surprising that studies simply comparing referral sources do not provide strong and persuasive evidence with regard to outcomes. Moreover, our review identified several examples of variability in the social 'handling' of mandated treatment clients.…”

“…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].…”

Outcomes of mandated treatment for women with histories of abuse and co-occurring disorders

“…One study found that prevalence of psychiatric comorbidity was equivalent for those mandated to treatment for alcohol dependence and those voluntarily seeking treatment (Sallmen, Nilsson, & Berglund, 1997). They also found no gender differences.…”

The Rorschach in Planning Treatment of Alcohol Addiction Patients

“…Alcohol addiction frequently occurs within a broader cluster of psychiatric problems. High rates of comorbid disorders are found in clinical samples (Driessen, Veltrup, Wetterling, John, & Dilling, 1998; Sallmen, Nilsson, & Berglund, 1997) as well as in epidemiological surveys (Kessler et al, 1997; Regier et al., 1990). The most common comorbid disorders found in such studies are mood, anxiety disorders, and personality disorders.…”