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.
Highlights
Treatment services to patients with substance use disorders (SUDs), including those mandated to treatment, needs to be evaluated and evidence based
A lower severity of drug use at intake, voluntary treatment modality, and higher treatment involvement during follow-up all were significant factors associated with abstinence at 6 months after treatment
It is important to keep in mind that in reality, the alternative to compulsory admitted patients (CA) treatment is no treatment at all and instead a continuation of life-threatening drug use behaviours
Summary
Treatment 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 risk their lives over drug use. Formal coercion is an option when voluntary treatment has proven unsuccessful, but the compulsory hospitalization of SUD patients has been a controversial option [5]. This controversy sometimes centres on ethical or due process issues associated with use of forced entry into treatment and often focuses on debate about the effectiveness of such compulsory treatment because motivation for change is likely to be low among those coerced into treatment [6]. Despite over 20 years of practice under these compulsory treatment acts, little is known about the outcomes for the patients, as this question has not been previously addressed
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