Involuntary Treatment for Adult Nonoffenders With Substance Use Disorders?
Bibliographic record
Abstract
ABSTRACT Background: Involuntary treatment for adults not in the criminal justice system with substance use disorders (SUD) is controversial. Canadian governments recently have proposed involuntary treatment for adult nonoffenders with SUD based on their morbidity and mortality and impacts on public safety and health care utilization. However, the effectiveness of involuntary treatment using the mental health act or separate legislation for this purpose has not been reviewed based on existing treatment studies. This study aims to provide a narrative review of that literature and discuss the potential pros and cons of involuntary treatment in adult nonoffenders with SUD. Methods: A literature review was conducted using MEDLINE augmented by the references of relevant found studies and reviews. Only treatment studies were included. Ten studies met the inclusion criteria. Results: There are few studies of involuntary treatment of adult nonoffenders with SUD and no Canadian studies. Most studies came from jurisdictions with special legislation for the involuntary treatment of SUD. Patients entering treatment voluntarily did better overall than those admitted involuntarily. However, some studies showed some improvements in those involuntarily treated, with benefits extending beyond acute therapy. Conclusions: Evidence for the involuntary treatment of adult nonoffenders with SUD suggests limited benefits, with voluntary treatment consistently outperforming involuntary treatment. The use of involuntary treatment for SUD would likely require special legislation, the development of designated treatment sites, and extensive aftercare programming that may not justify the costs and potential ethical and legal issues. Resources likely would be better directed towards expanding voluntary treatment options. Contexte: Le traitement imposé à des adultes ne faisant pas partie du système de justice pénale et souffrant de troubles liés à l’utilisation de substances (TUS) est controversé. Le gouvernement canadien a récemment proposé un traitement imposé pour les adultes non délinquants souffrant de TUS reposant sur la base du degré de leur morbidité et de leur mortalité, ainsi que de leur impact sur la sécurité publique et leur utilisation des soins de santé. Cependant, l’efficacité du traitement imposé dans le cadre de la loi sur la santé mentale ou d’une législation distincte à cette fin n’a pas été examinée sur la base d’études de traitement existantes. Cette étude vise à fournir un examen narratif de cette littérature et à discuter des avantages et des inconvénients potentiels du traitement imposé chez les adultes non-délinquants souffrant de TUS. Méthodes: Une revue de la littérature a été réalisée à l’aide de MEDLINE, complétée par des références d’études et revues pertinentes trouvées. Seules les études sur le traitement ont été incluses. Dix études répondaient aux critères d’inclusion. Résultats: Il existe peu d'études sur le traitement imposé des adultes non délinquants atteints de TUS et aucune étude canadienne. La plupart des études proviennent de juridictions disposant d’une législation spéciale pour le traitement imposé des TUS. Les patients entrant volontairement en traitement s’en sortent mieux dans l’ensemble que ceux admis contre leur gré. Cependant, certaines études ont montré des améliorations chez les personnes traitées contre leur gré, avec des avantages qui s'étendent au-delà de la thérapie aiguë. Conclusions: Les données relatives au traitement imposé des adultes non délinquants souffrant de TUS suggèrent des avantages limités, le traitement volontaire étant systématiquement plus performant que le traitement imposé. L’utilisation du traitement imposé pour les TUS nécessiterait probablement une législation spéciale, la mise en place de sites de traitement désignés et des programmes de suivi intensifs qui ne justifieraient peut-être pas les coûts et les problèmes éthiques et juridiques potentiels. Les ressources seraient probablement mieux orientées vers l'élargissement des options de traitement volontaire.
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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 | 0.002 | 0.017 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.008 | 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".