Civil commitment of individuals with SUD—with or without co-occurring mental illness—must be implemented in a way that maximizes benefits to them while minimizing harm, according to an essay published as part of a “Controversies in Psychiatric Services” column exploring the ethics of involuntary behavioral health treatment in the journal Psychiatric Services.
“Implementation of civil commitment for people with substance use disorder in the United States has historically been characterized by considerable ambivalence and inconsistency, both in legislation and in clinical practice,” wrote Kenneth Minkoff, M.D., at ZiaPartners Inc. in Tucson. Despite this, a growing number of states—37 in all, along with the District of Columbia—have now passed legislation to allow the practice.
Minkoff acknowledged that “the moral argument for such legislation is powerful,” citing the example of an individual with severe opioid use disorder who overdoses, is revived with naloxone by first responders, and immediately wants to use opioids again; or another individual with SUD whose brain has been “so affected by the disease of addiction that they clearly are unable to protect themselves from harm.”
Balanced again those dangers, Minkoff noted, is the fact that “the limited available data on the effectiveness of civil commitment of people with substance use disorder often do not show favorable results.” To combat this, he calls for leaders and experts in the field to craft data-informed guidelines for the involuntary commitment of individuals with SUD.
“These guidelines could begin with targeting specific populations and carefully delineating commitment criteria, length of commitment, types of settings, and appropriate interventions and outcomes,” Minkoff wrote. He suggested that such guidelines “target harm reduction and overdose prevention as goals rather than necessarily serving as the formal commencement of long-term recovery from opioid use disorder.”
Minkoff concluded: “Beginning with small steps with an eye toward maximizing benefits, minimizing avoidable harms, and continually gathering data that can be used to improve involuntary interventions may be better than either doing nothing or implementing involuntary interventions that do not work.”
For more information, see the Psychiatric News article “Harm Reduction Approach to Substance Use Provides Realistic Support for Patients.”
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