Welfare, Temperance and Compulsory Commitment to Care for Persons with Substance Misuse Problems: A Comparative Study of 38 European Countries

Abstract

Aims: The study explores the existence and types of law on compulsory commitment to care (CCC) of adult substance misusers in Europe and how such laws are related to variations in demographics, alcohol consumption and epidemiology in misuse of opiates, cocaine, amphetamines, temperance culture heritage, health and welfare expenditure, and involvement and role of the state in welfare distribution. Material and Methods: Legal information on laws on CCC of misusers was obtained primarily through a survey of 38 European countries. Predictors of laws on CCC, and types of such, were analyzed from country descriptors in multivariate models. Results: A majority (74%) of the explored countries have a law concerning CCC. The most common type of CCC law is within criminal justice legislation (45%), but civil CCC is almost as frequent (37%). These two models of CCC legislation are related to differences in cultural heritage and welfare distribution models. Conclusions: Temperance cultures, i.e. countries with a history of a strong temperance movement, and countries with a Beveridgean distribution of welfare, i.e. through the state, tend to favor civil CCC, while countries with a Bismarckian distribution of welfare, i.e. through insurance with less state interference, tend to favor CCC within criminal justice legislation.

Compulsory Commitment to Care of Substance Misusers: International Trends during 25 Years

“…With these added to compulsory civil commitment, Israelsson and Gerdner [4] concluded that 82% of the 90 countries had some law on CCC at the eve of the 20th century. In a more recent study on 38 European countries, Israelsson [5] found that 74% had some such law. Room [6] reports from 147 countries that 42.5% have law on ‘special legislation for the compulsory treatment of substance use disorder’, while 20.5% have drug courts, and 52.2% have programs on diversion to treatment.…”

“…Porter et al [1] report on legislations up to 1982, while Israelsson [5] report on legislations up to 2009. Thus, there is a time span of at least 27 years between data collections.…”

“…they are by law mandated to care or treatment’ [p. 118]. The data collection for Israelsson [5] is based on the same definition. The demarcation line in this definition is congruent with the philosophic analysis by Tännsjö [7], who mentions a specific type of legal restrain, which is in fact based on consent by the individual at an initial stage to be held against his or her will later, if he/she then wants to leave treatment prematurely.…”

“…Thus, the definition can be applied when comparing data from previous WHO reports [1,2,3], as well as the data collected by Israelsson [5]. The latest WHO report and its chapter on compulsory care [6] provides a summary based on aggregated figures, but neither lists of countries with various legislations, nor legal texts that make it possible to distinguish diversion to treatment with full consent from mandated treatment.…”

“…The variation in quantity of countries included in the reports is partly due to their special foci. Some studies had a worldwide scope in sampling, while WHO Europe [3] had its special attention to post-communist countries, and Israelsson [5] collected data from European countries. Even the largest report [6] lacks 15 countries that are present in others.…”