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Messinger JC, Vercollone L, Weiner SG, Bromstedt W, Garner C, Garza J, Joseph JW, Sanchez LD, Im D, Bukhman AK. Outcomes for Patients Discharged to Involuntary Commitment for Substance Use Disorder Directly from the Hospital. Community Ment Health J 2023; 59:1300-1305. [PMID: 36995493 DOI: 10.1007/s10597-023-01112-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 03/07/2023] [Indexed: 03/31/2023]
Abstract
To evaluate the outcomes of patients discharged to involuntary commitment for substance use disorders directly from the hospital. We performed a retrospective chart review of 22 patients discharged to involuntary commitment for substance use disorder from the hospital between October 2016 and February 2020. We collected demographic data, details about each commitment episode, and healthcare utilization outcomes 1 year following involuntary commitment. Nearly all patients had a primary alcohol use disorder (91%) and had additional medical (82%) and psychiatric comorbidities (71%). One year following involuntary commitment, all patients had relapsed to substance use and had at least one emergency department visit while 78.6% had at least one admission. These findings suggest that patients discharged to involuntary commitment directly from the hospital universally relapsed and experienced significant medical morbidity during the first year following their release. This study adds to a growing literature recognizing the harms of involuntary commitment for substance use disorder.
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Affiliation(s)
- John C Messinger
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
- Brigham and Women's Hospital, Boston, MA, USA.
| | - Lisa Vercollone
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Scott G Weiner
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - William Bromstedt
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Carol Garner
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | | | - Joshua W Joseph
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Leon D Sanchez
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Dana Im
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
| | - Alice K Bukhman
- Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
- Brigham and Women's Hospital, Boston, MA, USA
- Brigham and Women's Faulkner Hospital, Boston, MA, USA
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Slocum S, Paquette CE, Walley AY, Pollini RA. Civil commitment perspectives and experiences among friends and family of people who use illicit opioids in Massachusetts, USA. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 117:104074. [PMID: 37244144 DOI: 10.1016/j.drugpo.2023.104074] [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: 02/09/2023] [Revised: 05/14/2023] [Accepted: 05/15/2023] [Indexed: 05/29/2023]
Abstract
BACKGROUND Civil commitment statutes allow qualified individuals to petition for court-mandated commitment for someone with a substance use disorder (SUD). Despite a lack of empirical evidence showing efficacy of involuntary commitment, these statutes are prevalent worldwide. We examined perspectives on civil commitment among family members and close friends of people who use illicit opioids in Massachusetts, U.S.A. METHODS Eligible individuals were Massachusetts residents, ≥18 years of age, did not use illicit opioids but had a close relationship with someone who did. We used a sequential mixed methods approach in which semi-structured interviews (N=22) were followed by a quantitative survey (N=260). Thematic analysis was used to analyze qualitative data and survey data were analyzed using descriptive statistics. RESULTS While some family members were influenced by SUD professionals to petition for civil commitment, influence from social networks based on personal experience was more common. Motivations for civil commitment included initiating recovery and believing that commitment would reduce overdose risk. Some reported that it afforded them respite from caring for, and worrying about, their loved one. A minority discussed increases in overdose risk following a period of forced abstinence. Participants expressed concerns about the variable quality of care during commitment, largely based on the use of corrections facilities for civil commitment in Massachusetts. A minority endorsed the use of these facilities for civil commitment. CONCLUSIONS Despite participants' uncertainty and the harms stemming from civil commitment, including increased risk of overdose after forced abstinence and the use of corrections facilities, family members resorted to this mechanism to reduce immediate overdose risk. Our findings indicate that peer support groups are an appropriate forum to disseminate information about evidenced-based treatment and that family members and others close to those with SUD often lack adequate support for, and respite from, the stress of caring for them.
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Affiliation(s)
- Susannah Slocum
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, United States
| | - Catherine E Paquette
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, United States
| | - Alexander Y Walley
- Grayken Center for Addiction, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, Boston, MA, United States
| | - Robin A Pollini
- Department of Behavioral Medicine & Psychiatry, School of Medicine, West Virginia University, Morgantown, WV, United States; Department of Epidemiology and Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, United States.
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