The association between history of civil commitment for severe substance use and future imprisonment: A Swedish registry study

Robert Grahn

doi:10.1016/j.jsat.2021.108613

Abstract

BackgroundCivil commitment for individuals with severe substance use is fairly common and a part of many treatment systems worldwide. In Sweden, individuals with severe substance use and experience with civil commitment are more likely to use higher levels of alcohol and drugs, to be younger, and be more socially marginalized compared to their counterparts. The study examined whether civil commitments for severe substance use increased the likelihood of imprisonment following the civil commitment. MethodBaseline ASI-data merged with national registry data on prison sentences (2007 through 2016). Cox regression was used to estimate, for a Swedish sample of 12,044 adults assessed for risky substance use, the importance of having a history of civil commitment for severe substance use, controlling for age, gender and baseline assessment of ASI composite scores in seven areas (alcohol, drugs other than alcohol, legal, mental- and physical health, family & social relationships and employment) on the likelihood of future imprisonment. ResultsThe regression showed that being a male, those with experience of civil commitment and elevated ASI composite scores for both legal and employment were significantly associated with imprisonment post-civil commitment. Civil commitment for severe substance use showed 1.29 (HR = 1.29, 95% CI: 1.03–1.49, p < 0.001) increased likelihood of imprisonment post-civil commitment. ConclusionHaving been in treatment through civil commitment due to severe substance use was strongly associated with imprisonment post-civil commitment episode. This is concerning since civil commitment is supposed to mediate against the consequences of severe substance use and promote voluntary treatment participation. Those with severe substance use and a history of civil commitment are in need of a well-coordinated and integrated system of extensive aftercare services to reduce the likelihood of imprisonment.

Highlights

In many countries, courts can order compulsory care for individuals with severe alcohol and drug use disorders; the design and implementation of civil commitment varies between countries (Israelsson, 2011; Israelsson et al, 2015; Israelsson & Gerdner, 2010; Israelsson & Gerdner, 2012; Jain et al, 2021; Palm & Stenius, 2002)
This study examines the association between a history of civil commitment for severe substance use and future imprisonment in a sample of 12,044 adults who completed an Addiction Severity Index (ASI) assessment for substance use between 2007 and 2017 and adds to the understanding of civil commitment interventions for individuals engaged in severe substance use
The bivariate analysis found that men experienced an elevated risk of future imprisonment (HR 3.23, 95% confidence intervals (CI) 2.76–3.78, P < 0.001)

Summary

Introduction

Courts can order compulsory care (i.e., civil commitment) for individuals with severe alcohol and drug use disorders; the design and implementation of civil commitment varies between countries (Israelsson, 2011; Israelsson et al, 2015; Israelsson & Gerdner, 2010; Israelsson & Gerdner, 2012; Jain et al, 2021; Palm & Stenius, 2002). Individuals who receive civil commitment for severe substance use are, in comparison to clients in voluntary treatment, more likely to a) use higher levels of alcohol and drugs, b) be younger, and c) are more socially marginalized (Grahn et al, 2015; Storbjork, 2010). In Sweden, individuals with severe substance use and experience with civil commitment are more likely to use higher levels of alcohol and drugs, to be younger, and be more socially marginalized compared to their counterparts. Cox regression was used to estimate, for a Swedish sample of 12,044 adults assessed for risky substance use, the importance of having a history of civil commitment for severe substance use, controlling for age, gender and baseline assessment of ASI composite scores in seven areas (alcohol, drugs other than alcohol, legal, mental- and physical health, family & social relationships and employment) on the likelihood of future imprisonment. Those with severe substance use and a history of civil commitment are in need of a wellcoordinated and integrated system of extensive aftercare services to reduce the likelihood of imprisonment

Methods

Results

Conclusion