Compulsory treatment for alcohol use disorders: Clinical and methodological studies of treatment outcome

Sammanfattning: This thesis concerns involuntary social treatment for alcoholism. Alcoholics who were compulsorily committed according to the Swedish Act of Care of Addicts in Certain Cases (LVM) were treated together with voluntary patients. They were followed up by mail questionnaires to patients, significant others and social workers. Self-reports were in satsifactory agreement with collateral reports concerning alcohol use and social situation. Discrepancies were not systematic. Both patients and significant others failed to reply more often in case of worse prognosis and outcome, while social workers replied more often in those cases. Thus, a combination of questionnaires to patients and social workers is preferable to get representative data. Telephone follow-up to non-responders failed to compensate for non-response. Ten months post-completion of the programme, 55% were improved, including 13% totally abstinent. Improvements were related to "living with spouse" and participation in self-help group participation. Coercion was not related to outcome. The same sample was followed up 8.5 years post-discharge. 24% had died - i.e. 8,7 times more than expected. All abstainers had survived. There were no differerences in mortality between the non-abstinent improved group and those not improved. Only abstinence prevented premature death. One paper studied a motivational programme on a locked detoxification ward based on structured assessment, motivational interviewing, 12-step-oriented groups and lectures. It aimed to motivate the coerced patients to enter intensive programme at the unlocked units. Implementation of the programme reduced the time at the locked ward without increasing of abscondings and was therefore considered successful.