Compulsory treatment of alcoholics, psychiatric comorbidity, psychological characteristics, coercive experiences and outcome

Sammanfattning: This thesis concerns involuntary treatment of alcoholism. Clients committed according to the Swedish Act on Care of Addicts in Certain Cases were treated in the same residential treatment setting as voluntarily admitted clients. After informed consent, 104 clients (73 men and 21 women of whom 56 were compulsorily committed and 47 voluntarily admitted) participated in a test-series, including assessments of alcholic patterns, psychiatric diagnosis, psychiatric symptoms, cognitive functioning, psychological defenses, field-dependence, locus of control, quality of life, social stability and perceived coercion. Sixty-four percent of the sample was without stable housing conditions; 81% without stable partner and 86% had no employment or structured daytime activities. Prevalence of psychiatric comorbidity was 78%. On axis I, frequency of lifetime/current mood disorders was 41%/36%, of anxiety disorders 31%/26%, and of non-organic psychosis, 20%/13%. Drug dependence was present in 39% of the cases. On axis II, 24% had a cluster A personality disorder, 32% a cluster B disorder and 26% a cluster C disorder. Compulsorily committed subjects reported more frequent negatively perceived coercion (91%) during the index period of care than did voluntarily treated subjects (56%). Female subjects reported more negatively perceived experiences of coercion than did male subjects (93% /70%). Subjects with an internal locus of control reported negatively perceived coercion in a higher extent than subjects with an external locus of control (84%/22%) and were also less inclined to justify the coercive experiences at the discharge interview than externally oriented subjects. (2%/14%). Compared to alcoholic outpatient controls, the sample reported fewer adaptive ego defenses (6%/22%).The sample was followed-up 18 months after initial data collection. The follow-up included re-tests and interviews with the clients, interview with their social counsellor and an analysis of medical records. Follow-up data was available for 92 subjects (personal interview and re-tests, n=56; data from medical journals, n=74; interview with social counsellors, n=56; all three sources, n=46). At the time of the follow-up study, 22 subjects had died (expected standardised mortality rate; 22/1.7=12.4x). Seventeen percent had a significant improvement of drinking patterns compared to the year prior to treatment data. Four percent were abstinent and 5% had not more than 21 drinking days.