Substance Abuse and Involuntary Commitment: Will It Work?
https://www.medpagetoday.com/meetingcoverage/aapl/75972
AUSTIN, Texas — A majority of physicians supported adult civil commitment for substance use disorder, according to a recent survey presented here.
From a national sample of 165 addiction physicians, 61% favored laws that permitted adult civil commitment for opioid and other substance use disorders, 21% were opposed, and 18% were unsure, reported Abhishek Jain, MD, of Columbia University in New York City.
Generally, respondents who spent more time with substance abuse patients were more supportive of civil commitment than those who were not, and the strongest support tended to be for opioid and alcohol use, he said at the American Academy of Psychiatry and the Law (AAPL) annual meeting.
However, the majority of physicians also reported that they were concerned with the amount of resources and facilities needed to impose this treatment, and said they generally supported having medication-assisted treatment (MAT) available if these laws were implemented.
“[The study] suggests that people oppose civil commitment for substance use more based on the lack of resources and the ability to pay for the commitment,” rather than other concerns such as losing rapport with patients, or that patients would need motivation for substance use treatment to be effective, Jain said in the talk.
Civil commitment allows family members, or others, to seek court-ordered treatment for individuals with substance abuse on the basis that they pose a substantial threat of harm to themselves or others. However, unlike being processed through a drug court, civil commitment does not require substance abusers to go through the criminal justice system, Jain explained. As of 2013, 32 states and Washington, D.C., had laws permitting civil commitment in these cases.
But he said the literature regarding civil confinement is often extrapolated from other international studies and that U.S. studies in this field tend to have small sample sizes and insufficient treatment details, making it difficult to generalize. The studies also have mixed findings. For example, in a 2007 American Psychiatric Association (APA) survey, just 22% of respondents supported alcohol or drug civil commitment, Jain added.
Those against the implementation of these programs argued that taking patients in against their will was a violation of a civil liberty, and that treatment imposed involuntarily may not be effective. Jain cited a 2017 study in which six of seven patients relapsed immediately after discharge.
For the current study, surveys were sent to addiction physicians actively practicing in the U.S. In addition to yes or no questions, the survey also asked respondents to submit their thoughts on adult civil confinement for substance abuse disorder. One respondent said involuntary treatment “treats addiction like a crime rather than a disease” and that, instead, “voluntary, low threshold treatment” should be made available. In contrast, another respondent reported, “I think all 50 states should have it.” However, it is important to note that these views do not necessarily reflect the formal position of any specific professional organization, he stated.
Part of the issue is that these commitment laws vary across states and jurisdictions, Jain said. Within some states with civil commitment legislation, for example, only certain individuals in the community are legally allowed to petition. In others, family members must submit a guarantee of payment stating they claim responsibility for the payment of treatment. Additionally, in some jurisdictions, civil commitment may only be offered for some, but not all, substances of abuse.
Debra Pinals, MD, of the University of Michigan in Ann Arbor, spoke during the session here and discussed her prior involvement in the Women’s Recovery from Addictions Program in Massachusetts, which provides women with substance use disorders who are civilly committed with a treatment program in a treatment setting instead of in a correctional setting. Although she acknowledged that the program is new so there is not yet data supporting its success, she said it has been examined as a model for similar developing institutions.
Pinals said many patients who may be subject to civil commitment for substance use disorders can have comorbid mental health disorders like depression and bipolar disorder that need to be addressed. Additionally, since substance use treatment typically utilizes strategies that focus on stages of change and aims toward engaging treatment into voluntary services, motivational interviewing can be helpful in facilitating patients to own their recovery in a personal way. In the civil commitment setting, patients are there involuntarily so there is a paradigm shift in how they get to these treatments, she stated.
Pinals said she was not presenting answers in terms of what best direction is regarding the complex issues surrounding civil commitment, but that more research is certainly needed. “I could certainly say anecdotally, I’ve seen some people do well, but I’ve also seen some people not do well,” Pinals said during her presentation.
Several policies need to be established where such civil commitment proceedings exist and where it is being established, Pinals said. For example, when a patient states their desire to leave the institution, or not adhere to the court commitment, what measures should be taken?
She also noted that licensure and funding needs to be considered where there are facilities or community-based services. Some AAPL attendees stated that in their states, programs have been designed to address treatment of pregnant women with substance use disorders, pointing out that these women, as well as other vulnerable populations, tend to require more complex treatment that would need to be built into programs that are developed.
Filed under: General Problems
This makes me sick. Not Only is it against our rights, what I Don’t hear Anyone addressing is the fact that “They” the Government along with Big pharma Are Experimenting on us W/O our Informed Consent And Knowledge. If the Medications I Require For Chronic Illnesses Have Been Covertly Reconfigured, and Containing Arsenic, and other Mystery Meds, And I now have More Severe And Disabling health; the Active ingredient Cut by almost one half, what do you think I will end up doing- Short of Ending my life-My Way. Why isn’t ANYONE Speaking Up To The Fact That This Isn’t America….is it England ? All this Language of Civility, Commons, Colonies….911 put our country in a perpetual War State, with Congress supposed to meet every 6 most; . they Only Met Once !!! We Need Our RIGHTS and Constitution Back Before The Majority End-Up Tortured To Death By A Wealthy–But Sociopathic Few-Who Just Want Us Dead and In Pain. Also, Consider All Of The Suicides By People With Lyme Disease And Undetected !! You Don’t Want The CDC MANAGING your Life. Look at how disgusting our Health Care system has Evolved Post 911 ? For Those People Who Truly Want Help For ADDICTION, They Should Get it. For those who don’t, (who knows why, are they sick, in pain, or just legitimatlle Depressed and Hopeless). Which is very understandable. We Have Been Lied To, Deceived, Poisoned, and Severely MANIPULATED. Wake-Up Before You Agree.
1) This does not work for the majority of those who are forced into treatment. (Just look at the statistics regarding drug courts – though those are better than just tossing them into prison).
2) Most will “do their time,” going through the motions, then when it comes time for them to be released, they will simply pick up where they left off. They’ll simply take up a bed that should be reserved for those who WANTS treatment..
3) Once they’re free after a period of so many days, most will go on to abuse, however, they are now “opioid-naïve” and will put themselves at a major risk of overdosing. (This even happens to some who voluntarily enter treatment. No doubt it will happen to many who are forced into treatment).
4) Does the government own our bodies? No, they don’t. We simply can’t lock those who are self-destructive up. They have rights. Again, this is a slippery slope. Who is next? Diabetics who eat unhealthy? How about those with high cholesterol? Where does it stop?
I think civil commitment is a great idea. Especially for the people that are being saved almost weekly by narcan administered by our first responders. These people get saved from overdosing over and over again, with no legal repercussions.
With the new opioid law that was just passed by our federal government the monies should be there so that families aren’t financially burdened. If families can start legally civilaly committing a family member into treatment when they first learn about a loved ones substance abuse disorder maybe if it is caught early on the treatment will be more effective.
This may be a way to get the public become aware of the reality that the overdose epidemic we have, otherwise known as the “opioid crisis”, isn’t really due to prescription opioid pain medications. But to the illegally manufactured and distributed substances that are out there.
Since the crackdown on prescription opioid pain medication the increase in the use of cocaine and meth is rising. And the FDA is now monitoring and stopping incoming shipments of Kratom. Now not only intractable pain patients that can’t get what they need for their pain legally might be forced to go to the streets drugs in an effort for pain relief, now the intractable pain patients that utilized Kratom are going to be forced to the streets as well. The people that were using Kratom to help them treat their substance abuse disorder are going to be forced to go back to the streets drugs to self treat also. I see the crackdown on Kratom as a way to try to force those people into Suboxone. That’s where we need to follow the money trail. I only see the support of legalized medical or recreational marijuana in some states as it has been realized by some that there are large amounts of money to be made by investing in this area.
Since the people with substance abuse disorder will many times not seek professional medical help, even with the new programs that are supposed to be able to be implemented due to the new legislation, and they aren’t being criminally charged even after the multiple saves from narcan delivery from our first responders, and law enforcement, civil commitment may be the answer. Unfortunately there will be abuses of this. As there is anytime money is involved.
Here’s a drastic idea on how to save money with MAT. Instead of using the highly expensive Suboxone, why don’t we just treat with Vicodin?
Really,,”great idea,” u do know they have changed the legal definition of a ,”addict,” right?To anyone who does anything that MAY cause them harm..Sooo what makes u think they are not going to civil comitte medically ill humans who need the medicine opiates at EFFECTIVE level to lessen their physical pain??maryw
Boy is America going backwards.Well of course shrinks agree’d to this,,,its called $$$$..dahhh..Furthermore,,maybe someone who knows how,,should pull out the cbs special of Pennhurst,,,that showed the inhumane atrocities preformed on normal human beings who’s only crime was they were medically ill cripples,,with deformities that were terrible painful,,Instead of giving these humans the pain medicines they needed,,,they tied them up or left them to rock on floors in agony,,it ,The forced physical pain, drove them nuts,,Sickos,,,all of those who voted yes,,the 61%%% and why I have always call shrinks like kolodny and these types,,,THE-RAPIST,,,tHIS IS WHY IF U LOOK UP BLOOMBERGH AND KOLODYN,,HE IS INTO REALESTATE,BIG OLD BUILDING,HOTELS ETC,,,,Gee,,,why do u think??,,This was all started by jmo a true psychopath, and now all thee other god complex psychiatrist are jumping on board,,,but always why 95% of these warehouses were shut-down by 1 CBS special,,showing these 61% type of god shrinks,did not give a rats ass about truth,or care of thee actual patient,,,all they cared about was the financial funding from the federal government,,,our tax dollars,,wake up folks,,we said this 2 years ago,,,they want us locked up in these warehouses,like the days of old,,all based on liers,,I hate it when were right,,,but if we don’t stop this,,,we’ll all be locked up,,for having physical pain,,,maryw ,
Yup…like I said “FOLLOW THE MONEY”.
I think you misread what this is about. It’s not about treating pain patients. It’s about letting families civilly committing a loved one for substance abuse disorder. Since these people are being saved over and over again with narcan by our first responders and law enforcement by narcan and not having any legal repercussions, and many times no financial ones either, if families would be able to step in when they first realize there is an issue, many may be able to get the treatment they need. Maybe some of the underlying mental health issues, like depression and bipolar disease, could be finally treated. New federal legislation was passed to put more money into addiction treatment. If families could access these funds to get their loved ones treated, maybe we could stem the tide of the young addicts.
Getting the intractable chronic pain patients their much needed treatments with the legally prescribed opioid pain medications is an entirely different issue.
I don’t see the powers that be wanting to warehouse chronic pain patients. Do I think that there may be the underlying thought that we will take care of the financial burden we are by ourselves by committing suicide? Yes.
To Ms.Adams,,I did not miss read it,,,,1000’s of true chronic pain patiens have FALSEY BEEN LABELED substance abuse disorder,,because doctors did not want to loose their licenses by the dea,,by giving these truly medically ill humans in physical pain from their MEDICAL illness the needed opiate MEDICINE,, to lessen their physical pain,,Sooo no Ms.Adams,,I read it exactly how it is meant,,,1000’s of innocent medicaly ill people who are in need of opiate MEDICINE,, for truly medically painful desease,,doc’s error are falsely labelled Substance Abuse Disorders,,,then they will all be forced into lunatic warehouses,,,just like pennhurst,,,the days of old,,and literally tortured to death,again,again and again,,,until the forced physical pain drives them crazy,,,their game plan alll along,,,,maryw
yep, that’s how I read it too; the same ”addiction specialists’ who are so keen to lock ‘substance abusers’ up are the ones who declare that anyone taking pain meds iare, ipso fact, abusers.
And screw is it effective, how ’bout is it legal? not to mention, there’s millions more severe, destructive alcohol abusers than there are pain patient abusers; lock up them first!
pss Ms Adams,,,”u don’t see them locking up chronic pain patients,”’ Thier already doing it,,,,They have done it in the past,,,,Why do u think Pennhurst Waverly allll those asylums built after the civil war…They,,the Shrinks working for our government prohibitions,,,claimed even back then ALLLL our civil war soldiers who use pain medicine were addicts,,hell they locked up children for haven club foot or a adult for being deaf,,point is THEY ABUSE THEIR POWER ,LIED TO THE PUBLIC AND KILLED OFF THE MEDICALLY ILL,,, gee sound familier??jmo,,,,,I think u trusting shrinks/government will not abuse their power,,,,history has shown,,,,never have they NOT abused their power accept in the beginning of this country,,maryw