Commitment to coercive care in relation to substance abuse reports to the social services. A 2-year follow-up

In Sweden, a person with substance abuse can be reported to the social services for an investigation about commitment to coercive care. After a change in legislation, municipalities varied greatly in the ratio of commitments/reports compared with the period before the legislation was amended.

The primary aims of this study were first, to investigate whether subjects from municipalities with a high ratio of commitments/reports have a better outcome compared with subjects from municipalities with a low ratio and second, if a high ratio has an impact on mortality.

The study involved two municipalities with high ratio of commitments/reports with 56 cases reported for substance abuse including 31 committed cases (55%). It also included two municipalities with a low ratio, 50 reported cases including six committed cases (12%). Two social service inspectors at the country administrative board assessed the cases in terms of severity of addiction according to legal criteria (κ(s)=0.66), indicating good inter-rater agreement. A global index based on information about substance abuse, employment and housing was used as outcome measure at the 2-year follow-up.

Global outcome did not differ between cases from high- and low-ratio municipalities. Seven subjects had deceased because of causes related to substance abuse. None of the deceased had been committed to coercive care.

In conclusion, the different ratios of commitments/reports did not influence global outcome. Commitment may reduce substance-related deaths.