CPCP: Involuntary Treatment for Substance Abuse by Medical Student Sara Reed

Sara Reed M4So here’s a brand new, thought-provoking Clinical Problems in Consultation Psychiatry (CPCP) by a hard-working 4th year medical student, Sara Reed, who plans to do her residency in pediatrics. This one involved looking into the evidence-base for studies that would guide us on whether or not involuntary treatment of persons with addictions is any more or less effective than voluntary treatment.

Psychiatric consultants have to reflect on questions like this almost every day. There’s a lot of soul-searching and ethical arguments back and forth on whether seeking court orders for those with addictions can be life-saving or whether this is a serious violation of autonomy that undercuts the principle of beneficence.

There are many angles on this and because of time constraints regarding Sara’s presentation, we didn’t get to do more than touch on the Motivational Interviewing techniques which can be an extremely valuable strategy which helps patients decide for themselves when they’re ready to begin alcohol and drug treatment.

I can anticipate at least a few readers out there who may have strong opinions on this issue and I welcome hearing your thoughts.

In order to see the picture galleries of photos or powerpoint slides, click on one of the slides, which will open up the presentation to fill the screen. Use the arrow buttons to scroll left and right through the slides or up and down to view any annotations.

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Comments

  1. This was a major part of what I did for 23 years (up until 4 years ago) so I definitely have an opinion. Any psychiatrist who is currently doing civil commitments for substance use disorders is essentially on their own. The results of these studies cannot be generalized based on the wide variability of commitment standards and administratve procedures used in each county and the resources available.

    In Minnesota when I first started to practice in the 1980s, we could generally commit people with uncontrolled drinking and significant disability and they would have treatment resources available.

    Today, civil commitment for substance use is generally not possible unless the person has life threatening illness associated with the substance use disorder and even then available resources are questionable. In order to meet the life threatening aspects, many of these hearings require multiple hospitalizations with clear cut medical complications or associated suicide attempts.

    http://real-psychiatry.blogspot.com/2014/05/will-changing-commitment-standard.html

    There are clearly substance use problems that are only treatable on an involuntary basis whether that is from a drug court or commitment intervention. I would encourage any psychiatrist who is doing this work to keep a registry and try to track the outcomes of commitments. The survival of some people depends on it.

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