Civil commitment, where a judge can order someone into treatment — usually inpatient — because their substance use poses a high risk of harm, is increasing in the face of the opioid epidemic, but no previous study has looked for factors that might be associated with longer periods of post-commitment abstinence. Now, a new study co-authored by a Boston University School of Public Health (BUSPH) researcher finds that individuals who feel the judicial process of their commitment was fair, and individuals who received medication treatment after commitment, stay off opioids longer.
The study, published in Drug and Alcohol Dependence, used data from a survey of 292 people who sought inpatient opioid detoxification at a program in Fall River, Massachusetts, between October 2017 and May 2018. The average time to relapse after being released was 72 days, but 39 percent of those who had been committed reported that they relapsed on the day of their release. Only 20 percent of participants who had been committed reported that they received medication treatment during their commitment. More positive attitudes after commitment, improvement in attitude during commitment, motivation after commitment, perceived helpfulness of commitment, and a greater sense of procedural justice were all significantly associated with longer periods of not using opioids after commitment. Keeping an appointment for medication treatment after commitment was also significantly associated with staying off opioids for longer.
The authors cautioned against taking the study findings to necessarily mean civil commitment is effective, because of the limits of the sample. Instead, they wrote, these findings point to the importance of medication treatment, and making sure individuals are treated fairly and respectfully in the civil commitment process.
“Civil commitment is happening 8,000 times a year in Massachusetts, at great cost, and we have very little sense who is being committed and whether commitment produces good results, such as introducing persons with opioid problems to long-term medication options or reducing overdose deaths,” says study co-author Dr. Michael Stein, professor and chair of health law, policy & management at BUSPH. “Our study offers a first peek at who’s committed and their attitudes toward commitment.”
Read more about the study.