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AUSTIN, Texas -- A majority of physicians supported adult civil commitment for substance use disorder, according to a recent survey presented here.

From a national sample of 165 addiction physicians, 61% favored laws that permitted adult civil commitment for opioid and other substance use disorders, 21% were opposed, and 18% were unsure, reported Abhishek Jain, MD, of Columbia University in New York City.

Generally, respondents who spent more time with substance abuse patients were more supportive of civil commitment than those who were not, and the strongest support tended to be for opioid and alcohol use, he said at the American Academy of Psychiatry and the Law () annual meeting.

However, the majority of physicians also reported that they were concerned with the amount of resources and facilities needed to impose this treatment, and said they generally supported having medication-assisted treatment (MAT) available if these laws were implemented.

"[The study] suggests that people oppose civil commitment for substance use more based on the lack of resources and the ability to pay for the commitment," rather than other concerns such as losing rapport with patients, or that patients would need motivation for substance use treatment to be effective, Jain said in the talk.

Civil commitment allows family members, or others, to seek court-ordered treatment for individuals with substance abuse on the basis that they pose a substantial threat of harm to themselves or others. However, unlike being processed through a drug court, civil commitment does not require substance abusers to go through the criminal justice system, Jain explained. As of 2013, 32 states and Washington, D.C., had laws permitting civil commitment in these cases.

But he said the literature regarding civil confinement is often extrapolated from other international studies and that U.S. studies in this field tend to have small sample sizes and insufficient treatment details, making it difficult to generalize. The studies also have mixed findings. For example, in a 2007 American Psychiatric Association (APA) survey, just 22% of respondents supported alcohol or drug civil commitment, Jain added.

Those against the implementation of these programs argued that taking patients in against their will was a violation of a civil liberty, and that treatment imposed involuntarily may not be effective. Jain cited a 2017 study in which six of seven patients relapsed immediately after discharge.

For the current study, surveys were sent to addiction physicians actively practicing in the U.S. In addition to yes or no questions, the survey also asked respondents to submit their thoughts on adult civil confinement for substance abuse disorder. One respondent said involuntary treatment "treats addiction like a crime rather than a disease" and that, instead, "voluntary, low threshold treatment" should be made available. In contrast, another respondent reported, "I think all 50 states should have it." However, it is important to note that these views do not necessarily reflect the formal position of any specific professional organization, he stated.

Part of the issue is that these commitment laws vary across states and jurisdictions, Jain said. Within some states with civil commitment legislation, for example, only certain individuals in the community are legally allowed to petition. In others, family members must submit a guarantee of payment stating they claim responsibility for the payment of treatment. Additionally, in some jurisdictions, civil commitment may only be offered for some, but not all, substances of abuse.

Debra Pinals, MD, of the University of Michigan in Ann Arbor, spoke during the session here and discussed her prior involvement in the Women's Recovery from Addictions Program in Massachusetts, which provides women with substance use disorders who are civilly committed with a treatment program in a treatment setting instead of in a correctional setting. Although she acknowledged that the program is new so there is not yet data supporting its success, she said it has been examined as a model for similar developing institutions.

Pinals said many patients who may be subject to civil commitment for substance use disorders can have comorbid mental health disorders like depression and bipolar disorder that need to be addressed. Additionally, since substance use treatment typically utilizes strategies that focus on stages of change and aims toward engaging treatment into voluntary services, motivational interviewing can be helpful in facilitating patients to own their recovery in a personal way. In the civil commitment setting, patients are there involuntarily so there is a paradigm shift in how they get to these treatments, she stated.

Pinals said she was not presenting answers in terms of what best direction is regarding the complex issues surrounding civil commitment, but that more research is certainly needed. "I could certainly say anecdotally, I've seen some people do well, but I've also seen some people not do well," Pinals said during her presentation.

Several policies need to be established where such civil commitment proceedings exist and where it is being established, Pinals said. For example, when a patient states their desire to leave the institution, or not adhere to the court commitment, what measures should be taken?

She also noted that licensure and funding needs to be considered where there are facilities or community-based services. Some AAPL attendees stated that in their states, programs have been designed to address treatment of pregnant women with substance use disorders, pointing out that these women, as well as other vulnerable populations, tend to require more complex treatment that would need to be built into programs that are developed.

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