Involuntary Hospital Admission in the Treatment of People With Severe Substance Use Disorder
Bibliographic record
Abstract
ABSTRACT Objectives: In Canada, substance-related harms and mortality are a significant public health concern. Recently there have been discussions about the utility of involuntary hospital admissions for patients who have severe substance use disorders (SUDs) and may otherwise not receive or remain in treatment. This case report describes 3 patient cases where involuntary hospital admissions were used and resulted in good outcomes. Methods: Patients provided written informed consent to have their deidentified cases shared in this case report, and to review their electronic medical records for this purpose. Results: Patients ranged in age from early 20s to mid-50s. Each patient had a severe SUD and required inpatient hospitalization to stabilize. In each case, patients were admitted involuntarily to hospital for a brief period of time for safety and stabilization, permitting withdrawal management and initiation of medications to treat their SUDs. Although the patients were admitted involuntarily, they remained capable of consenting to treatment. Conclusions: When utilized for the least amount of time under specific circumstances, involuntary hospital admissions for people with severe SUDs may be productive and result in good outcomes for patients. Care should be taken to debrief involuntary admissions with patients to preserve therapeutic rapport. Future research should explore patient perspectives on involuntary hospitalization in the treatment of SUDs. Objectifs: Au Canada, les méfaits et la mortalité liés à l’utilisation de substance constituent un problème de santé publique important. Récemment, des discussions ont eu lieu sur l’utilité du placement d’office dans un centre hospitalier pour les patients souffrant de troubles graves de consommation de substances qui, autrement, pourraient ne pas recevoir ou terminer leur traitement. Ce rapport décrit trois cas de patients où le placement d’office à l’hôpital a donné de bons résultats. Méthodes: Les patients ont donné leur consentement écrit pour que leurs cas dépersonnalisés soient partagés dans ce rapport de cas, et pour que leurs dossiers médicaux électroniques soient examinés à cette fin. Résultats: Les patients étaient âgés de 20 à 50 ans. Chaque patient souffrait d’un grave trouble lié à la consommation de substances et a dû être hospitalisé pour se stabiliser. Dans chaque cas, les patients ont été admis d’office à l’hôpital pour une brève période pour des raisons de sécurité et de stabilisation, permettant la gestion du sevrage et l’initiation de médicaments pour traiter leurs troubles liés à la consommation de substances. Bien que les patients aient été admis contre leur gré, ils étaient capables de consentir au traitement. Conclusions: Lorsqu’elles sont utilisées pour une durée minimale dans des circonstances spécifiques, le placement d’office en hôpital pour les personnes souffrant de graves troubles liés à la consommation de substances peuvent être productives et donner de bons résultats pour les patients. Il faut prendre soin de débriefer les placements d’office avec les patients pour préserver le rapport thérapeutique. Les recherches futures devraient explorer les perspectives des patients sur le placement d’officedans le traitement des troubles liés à la consommation de substances.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.004 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.001 | 0.002 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".