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Lee KSK, Bullen LM, Zheng C, Dawson A, Munro A, Conigrave KM. Beliefs and attitudes of drug and alcohol clinicians when considering referral of Aboriginal clients to involuntary drug and alcohol treatment: A qualitative study. Drug Alcohol Rev 2023; 42:169-180. [PMID: 36194535 PMCID: PMC10947027 DOI: 10.1111/dar.13549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Involuntary drug and alcohol treatment occurs in many countries and its role is often controversial. This can be a particular concern in relation to First Nations or other culturally distinct populations. This study explores beliefs and attitudes of drug and alcohol clinicians when considering referral of Aboriginal Australians to involuntary drug and alcohol treatment in New South Wales (NSW), Australia. METHODS The Involuntary Drug and Alcohol Treatment program (IDAT) is legislated by the NSW Drug and Alcohol Treatment Act 2007. There are two IDAT units-in urban (Sydney, four beds) and regional NSW (Orange, eight beds). NSW Health drug and alcohol clinicians who had referred clients to IDAT between 2016 and 2018 were invited to participate in a semi-structured 1:1 interview. Eleven clinicians (n = 2, male) from six local health districts (urban through to remote) agreed to participate. A descriptive qualitative analysis of responses was conducted. RESULTS Two key themes summarised the beliefs and attitudes that clinicians reported influencing them when considering referral of Aboriginal Australians to involuntary drug and alcohol treatment in NSW: (i) dilemma between saving someone's life and being culturally safe; and (ii) need for holistic wrap-around care. DISCUSSION AND CONCLUSIONS Almost all clinicians were worried that being in IDAT would further erode their Aboriginal client's autonomy and be retraumatising. Strategies are needed to support the involvement of Aboriginal-specific services in IDAT processes and ensure local support options for clients on discharge. Future research should examine the effectiveness, acceptability and feasibility of involuntary drug and alcohol treatment programs.
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Affiliation(s)
- K. S. Kylie Lee
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology)Sydney Local Health DistrictSydneyAustralia
- National Drug Research Institute, Faculty of Health SciencesCurtin UniversityPerthAustralia
- Burnet InstituteMelbourneAustralia
- Centre for Alcohol Policy ResearchLa Trobe UniversityMelbourneAustralia
| | - Lynette M. Bullen
- Involuntary Drug and Alcohol Treatment UnitWestern NSW Local Health DistrictOrangeAustralia
| | - Catherine Zheng
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology)Sydney Local Health DistrictSydneyAustralia
| | - Angela Dawson
- Australian Centre for Public and Population Health Research, Faculty of HealthUniversity of Technology SydneySydneyAustralia
| | - Alice Munro
- Research OfficeWestern NSW Local Health DistrictOrangeAustralia
| | - Katherine M. Conigrave
- NHMRC Centre of Research Excellence in Indigenous Health and Alcohol, Faculty of Medicine and HealthThe University of SydneySydneyAustralia
- The Edith Collins Centre (Translational Research in Alcohol Drugs and Toxicology)Sydney Local Health DistrictSydneyAustralia
- Drug Health ServicesRoyal Prince Alfred HospitalSydneyAustralia
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Vuong T, Gillies M, Larney S, Montebello M, Ritter A. The association between involuntary alcohol treatment and subsequent emergency department visits and hospitalizations: a Bayesian analysis of treated patients and matched controls. Addiction 2022; 117:1589-1597. [PMID: 34817096 DOI: 10.1111/add.15755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 11/01/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND AIMS Many nations have provisions for involuntary treatment of alcohol dependence where the person is at serious risk of harm to themselves. To date, there has been little thorough evaluation of its effectiveness. This study aimed to determine if there were differences between involuntary and voluntary treatment for alcohol dependence on subsequent emergency and hospital care. DESIGN A retrospective cohort design using linked routinely collected administrative data on health-care utilization. SETTING Hospital and community-based alcohol treatment, New South Wales, Australia. PARTICIPANTS A total of 231 patients who were involuntarily treated for alcohol dependence and 231 matched controls who received treatment as usual within the period May 2012 to April 2018. INTERVENTION AND COMPARATOR Involuntary treatment comprised a 28-day mandated hospital admission which included supervised withdrawal, comprehensive assessment, rehabilitation and support followed by voluntary aftercare support for up to 6 months. Treatment as usual comprised three not mutually exclusive forms of intensive voluntary alcohol treatment: withdrawal management, rehabilitation and pharmacotherapies for alcohol dependence. MEASUREMENTS Outcome measures: changes in the number of emergency department (ED) visits and number of unplanned hospital admissions 12 months before and 12 months after completion of index treatment. FINDINGS Both groups showed a reduction in ED visits (incidence rate ratio (IRR) = 0.56, 95% credible intervals (CrI) = 0.39-0.78) and unplanned hospital admissions (IRR = 0.49, 95% CrI = 0.37-0.65). There was no statistically significant difference between the two groups (IRR = 0.77, 95% CrI = 0.58-1.03 for ED visits and IRR = 0.79, 95% CrI = 0.62-1.01 for hospital admissions). The Bayes factors were 0.925 and 0.936 for ED visits and unplanned hospital admissions, respectively, interpreted as weak evidence in support of the null hypothesis of no difference between the interventions. CONCLUSIONS Involuntary treatment of alcohol dependence was associated with reduced health service utilization in the year following treatment, and the outcomes did not differ from those of a matched control group.
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Affiliation(s)
- Thu Vuong
- Drug Policy Modelling Program, SPRC, UNSW Sydney, Sydney, NSW, Australia
| | - Malcolm Gillies
- Centre for Big Data Research in Health, Faculty of Medicine, UNSW Sydney, Sydney, NSW, Australia
| | - Sarah Larney
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia.,Département de médecine famille et de médicine d'urgence, Université de Montréal, Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Mark Montebello
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia.,Northern Sydney Local Health District, Drug and Alcohol Services, University of Sydney, NSW, Australia
| | - Alison Ritter
- Drug Policy Modelling Program, SPRC, UNSW Sydney, Sydney, NSW, Australia
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Xavier J, Greer A, Crabtree A, Buxton JA. Police officers’ perceptions of their role at overdose events: a qualitative study. DRUGS: EDUCATION, PREVENTION AND POLICY 2022. [DOI: 10.1080/09687637.2022.2070057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jessica Xavier
- British Columbia Center for Disease Control, Vancouver, BC, Canada
| | - Alissa Greer
- School of Criminology, Simon Fraser University, Burnaby, BC, Canada
| | - Alexis Crabtree
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jane A. Buxton
- British Columbia Center for Disease Control, Vancouver, BC, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Walt G, Porteny T, McGregor AJ, Ladin K. Clinician's experiences with involuntary commitment for substance use disorder: A qualitative study of moral distress. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 99:103465. [PMID: 34619444 DOI: 10.1016/j.drugpo.2021.103465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 09/08/2021] [Accepted: 09/11/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Petitions for involuntary commitment of people living with a substance use disorder (SUD) have almost doubled since 2011 in Massachusetts through the policy Section 35. However, the efficacy of this controversial policy remains unclear, and clinicians differ on whether it ought to be used. This study examines how clinicians decide whether to use Section 35 and their experiences of moral distress, the negative feeling that occurs when a clinician is required to pursue a treatment option against their moral judgement due to institutional constraints, associated with its use. METHODS Qualitative semi-structured interviews with clinicians in Massachusetts were conducted between December 2019 and February 2020 and continued until thematic saturation. Thematic and narrative analysis was conducted with recorded and transcribed interviews. RESULTS Among 21 clinicians, most (77%) experienced some or high moral distress when utilizing Section 35 for involuntary commitment, with clinicians working in emergency departments experiencing less distress than those working in SUD clinics. Clinicians with low moral distress referenced successful patient anecdotes and held an abstinence-based view of SUD, while clinicians with high moral distress were concerned by systemic treatment failures and understood SUD through a nuanced and harm reduction-oriented view. Clinicians across professional settings were concerned by the involvement of law enforcement and criminal justice settings in the Section 35 process. Clinicians employed a variety of strategies to cope with moral distress, including team-based decision-making and viewing the petition as a last resort. Barriers to utilizing Section 35 included restrictive court hours and lack of post-section aftercare services. CONCLUSION Widespread distress associated with use of involuntary commitment and inconsistent approaches to its use highlight the need for better care coordination and guidance on best practices for utilization of this policy.
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Affiliation(s)
- Galya Walt
- Department of Community Health, Tufts University, Medford, MA, USA; Research on Ethics, Aging, and Community Health (REACH Lab), Medford, MA, USA
| | - Thalia Porteny
- Research on Ethics, Aging, and Community Health (REACH Lab), Medford, MA, USA; Department of Occupational Therapy, Tufts University, Medford, MA, USA
| | | | - Keren Ladin
- Department of Community Health, Tufts University, Medford, MA, USA; Research on Ethics, Aging, and Community Health (REACH Lab), Medford, MA, USA; Department of Occupational Therapy, Tufts University, Medford, MA, USA.
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Chau LW, Erickson M, Vigo D, Lou H, Pakhomova T, Winston ML, MacPherson D, Thomson E, Small W. The perspectives of people who use drugs regarding short term involuntary substance use care for severe substance use disorders. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 97:103208. [PMID: 34058669 DOI: 10.1016/j.drugpo.2021.103208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND In the Canadian Province of British Columbia (BC), the BC Mental Health Act permits involuntary care for treating mental disorders. However, the Act has also been applied to provide involuntary care to individuals with a primary substance use disorder, in the absence of specific guidelines and legislation, and with insufficient understanding of perspectives of people who use drugs (PWUD) regarding this approach. METHODS As part of a larger mixed-methods research project providing an overview of involuntary care for severe substance use disorders in BC, three focus groups were convened with: PWUD, families and caregivers, and Indigenous community stakeholders. This analysis examines perspectives from the focus group of PWUD, consisting of nine participants from local and regional drug user and advocacy organizations regarding involuntary care. A qualitative descriptive approach and thematic analysis were conducted, using a coding framework developed deductively and inductively, and participant perspectives were interpreted drawing on problematization theory. RESULTS Participants did not endorse the use of involuntary care, instead emphasizing significant changes were needed to address shortcomings of the wider voluntary care system. When asked to conceptualize what an acceptable involuntary care scenario might look like (under hypothetical and ideal conditions), participants recommended it should include: individual control and autonomy, peer advocacy in decision-making, and elimination of police and criminal justice system involvement from treatment encounters. Participants saw involuntary care to be an inappropriate approach given the shortcomings of the current system, noting also problems inherent in its use to manage severe SUDs and imminent harm, and prioritized alternate approaches to offsetting risks. CONCLUSION Improving voluntary care for substance use, along with addressing the social determinants of health that put individuals at risk of problematic substance use and harm, were prioritized in participant perspectives. Participant comments regarding the use of involuntary care bring forward alternate solutions in the context of the opioid overdose crisis, and a reconceptualization of the 'problem' of managing severe substance use disorders.
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Affiliation(s)
- Leena W Chau
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada
| | - Margaret Erickson
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada
| | - Daniel Vigo
- Department of Psychiatry, Faculty of Medicine, University of British Columbia, David Strangway Building, 4th Floor 209, 5950 University Boulevard, Vancouver, BC, V6T 1Z3, Canada
| | - Hayami Lou
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada
| | - Tatiana Pakhomova
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada
| | - Mark L Winston
- Morris J. Wosk Centre for Dialogue, Simon Fraser University, 3309-515 West Hastings Street, Vancouver, BC, V6B 5K3, Vancouver, Canada
| | - Donald MacPherson
- Canadian Drug Policy Coalition, 101-515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada
| | - Erica Thomson
- BC and Yukon Association of Drug War Survivors, 416 Columbia St, New Westminster, BC, V3L 1B1, Canada; Harm Reduction Program, Fraser Health Authority, BC, Canada
| | - Will Small
- Centre for Applied Research in Mental Health and Addiction, Faculty of Health Sciences, Simon Fraser University, 515 West Hastings Street, Vancouver, BC, V6B 5K3, Canada; British Columbia Centre on Substance Use.
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Coleman M, Ridley K, Christmass M. Mandatory treatment for methamphetamine use in Australia. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2021; 16:33. [PMID: 33836785 PMCID: PMC8033652 DOI: 10.1186/s13011-021-00370-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/30/2021] [Indexed: 11/29/2022]
Abstract
Background In 2016, following a flurry of government inquiries and taskforces including calls for mandatory treatment regimes, the Australian community nominated methamphetamine as the drug most likely to be associated as a problem substance. Mandatory treatment for alcohol and other drug problems in Australia consists of broadly two mechanisms compelling a person into treatment: involuntary treatment or civil commitment regimes; and coercive treatment regimes, usually associated with the criminal justice system. This paper aims to provide a review of the evidence for mandatory treatment regimes for people who use methamphetamines. Methods Using a narrative review methodology, a comprehensive literature and citation search was conducted. Five hundred two search results were obtained resulting in 41 papers that had cited works of interest. Results Small, but robust results were found with coercive treatment programs in the criminal justice system. The evidence of these programs specifically with methamphetamine use disorders is even less promising. Systematic reviews of mandatory drug treatment regimes have consistently demonstrated limited, if any, benefit for civil commitment programs. Despite the growing popular enthusiasm for mandatory drug treatment programs, significant clinical and ethical challenges arise including determining decision making capacity in people with substance use disorders, the impact of self determination and motivation in drug treatment, current treatment effectiveness, cost effectiveness and unintended treatment harms associated with mandatory programs. Conclusion The challenge for legislators, service providers and clinicians when considering mandatory treatment for methamphetamines is to proportionately balance the issue of human rights with effectiveness, safety, range and accessibility of both existing and novel mandatory treatment approaches.
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Affiliation(s)
- Mathew Coleman
- The Rural Clinical School of Western Australia, The University of Western Australia, 35 Stirling Terrace, Albany, Western Australia, 6330.
| | - Kelly Ridley
- The Rural Clinical School of Western Australia, The University of Western Australia, 35 Stirling Terrace, Albany, Western Australia, 6330
| | - Michael Christmass
- Next Step Drug and Alcohol Service, 32 Moore St, East Perth, Western Australia
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A Comparison Between the Involuntary and Voluntary Treatment of Patients With Alcohol Use Disorder in a Residential Rehabilitation Treatment Program. J Addict Nurs 2019; 30:57-60. [PMID: 30830001 DOI: 10.1097/jan.0000000000000248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The purpose of the study was to determine if there was a significant difference between veterans who received treatment voluntarily versus involuntarily in regard to length of sobriety. METHOD A sample of 120 veterans being treated for alcohol use disorder in a residential rehabilitation treatment program was used for this study. Veterans who were admitted under recommendation by court order (n = 60) were matched with veterans who were admitted without recommendation of court order (n = 60). Success of the program was determined by the number of days of sobriety postdischarge. RESULTS The study revealed that there was no significant difference between types of motivation for residential treatment (i.e., voluntary vs. involuntary treatment) and length of sobriety for veterans with alcohol use disorder posttreatment. CONCLUSIONS Findings revealed that there was no significant relationship when comparing types of motivation for treatment in a residential treatment program for veterans in regard to length of sobriety posttreatment. Therefore, a veteran's motivation for treatment may not necessarily be an accurate indicator of treatment outcomes (i.e., length of sobriety posttreatment) for residential treatment settings.
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New Dutch Legislation and Preventive Coercive Home Health Care for Excessive Alcohol Consumers. Int J Ment Health Addict 2018. [DOI: 10.1007/s11469-018-0020-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Morandi S, Silva B, Golay P, Bonsack C. Intensive Case Management for Addiction to promote engagement with care of people with severe mental and substance use disorders: an observational study. SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2017; 12:26. [PMID: 28545572 PMCID: PMC5445418 DOI: 10.1186/s13011-017-0111-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 05/19/2017] [Indexed: 11/13/2022]
Abstract
Background Co-occurring severe mental and substance use disorders are associated with physical, psychological and social complications such as homelessness and unemployment. People with severe mental and substance use disorders are difficult to engage with care. The lack of treatment worsens their health and social conditions and increases treatment costs, as emergency department visits arise. Case management has proved to be effective in promoting engagement with care of people with severe mental and substance use disorders. However, this impact seemed mainly related to the case management model. The Intensive Case Management for Addiction (ICMA) aimed to improve engagement with care of people with severe mental and substance use disorders, insufficiently engaged with standard treatment. This innovative multidisciplinary mobile team programme combined Assertive Community Treatment and Critical Time Intervention methodologies. The aim of the study was to observe the impact of ICMA upon service use, treatment adherence and quality of support networks. Participants’ psychosocial and mental functioning, and substance use were also assessed throughout the intervention. Methods The study was observational. Eligible participants were all the people entering the programme during the first year of implementation (April 2014–April 2015). Data were collected through structured questionnaires and medical charts. Assessments were conducted at baseline and at 12 months follow-up or at the end of the programme if completed earlier. McNemar-Bowker’s Test, General Linear Model repeated-measures analysis of variance and non-parametric Wilcoxon Signed Rank tests were used for the analysis. Results A total of 30 participants took part in the study. Results showed a significant reduction in the number of participants visiting the general emergency department compared to baseline. A significantly decreased number of psychiatric emergency department visits was also registered. Moreover, at follow-up participants improved significantly their treatment adherence, clinical status, social functioning, and substance intake and frequency of use. Conclusions These promising results highlight the efficacy of the ICMA. The intervention improved engagement with care and the psychosocial situation of people with severe mental and substance use disorders, with consequent direct impact on their substance misuse.
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Affiliation(s)
- Stéphane Morandi
- Department of Psychiatry, Social Psychiatry Section, Community Psychiatry Service, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland.
| | - Benedetta Silva
- Department of Psychiatry, Social Psychiatry Section, Community Psychiatry Service, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland
| | - Philippe Golay
- Department of Psychiatry, Social Psychiatry Section, Community Psychiatry Service, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland
| | - Charles Bonsack
- Department of Psychiatry, Social Psychiatry Section, Community Psychiatry Service, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland
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Wild TC, Yuan Y, Rush BR, Urbanoski KA. Client Engagement in Legally-Mandated Addiction Treatment: A Prospective Study Using Self-Determination Theory. J Subst Abuse Treat 2016; 69:35-43. [DOI: 10.1016/j.jsat.2016.06.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 04/26/2016] [Accepted: 06/06/2016] [Indexed: 11/29/2022]
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Dore G, Sinclair B, Murray R. Treatment Resistant and Resistant to Treatment? Evaluation of 40 Alcohol Dependent Patients Admitted for Involuntary Treatment. Alcohol Alcohol 2015; 51:291-5. [PMID: 26362017 DOI: 10.1093/alcalc/agv103] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 08/20/2015] [Indexed: 11/14/2022] Open
Abstract
AIMS To describe the clinical outcomes for a group of patients with severe alcohol dependence discharged from an Involuntary Drug and Alcohol Treatment (IDAT) program. METHODS Forty patients admitted to an inpatient IDAT program were prospectively followed up over 6 months using standardized questionnaires. RESULTS Patients had high rates of mental health comorbidities (97.5%), cortical atrophy (40%) and socioeconomic disadvantage (92.5% were beneficiaries). Six months after discharge, 25% of patients were abstinent and living in the community and 17.5% had notably reduced alcohol use. A further 7.5% were abstinent due to involuntary hospitalization. A total of 10% of patients were deceased and 40% of patients had relapsed or were lost to follow-up. Number of admissions and admission days reduced by 51 and 45% respectively for the 17 abstinent or improved community-based patients. A total of 82% of this patient group were actively engaged with an Assertive Community Treatment (ACT) team. CONCLUSIONS While patient numbers are small, treatment responsiveness was evident for 42.5% of patients, most of whom were followed up with ACT. Evaluation with a comparator group is required to determine whether outcomes are a function of involuntary treatment or an assertive treatment approach.
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Affiliation(s)
- Glenys Dore
- Herbert Street Clinic, Northern Sydney Drug & Alcohol Service, Sydney, NSW, Australia
| | - Barbara Sinclair
- Drug & Alcohol Services, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia
| | - Robin Murray
- Herbert Street Clinic, Northern Sydney Drug & Alcohol Service, Sydney, NSW, Australia
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