Perceived coercion related to psychiatric comorbidity and locus of control in institutionalized alcoholics

One-hundred and four alcoholics, 73 men and 31 women, were treated at Karlsvi Rehabilitation Center between November 1990 and December 1992. Fifty-eight subjects were compulsorily treated and 46 voluntarily treated. Experiences of negatively perceived coercion were assessed in the beginning of treatment and at discharge after 5-6 months by using the semi-structural interview according to Eriksson-Westrin. Locus of control was measured by using the Swedish version of the Rotter-scale for external/internal attribution. Axis I psychiatric comorbidity was assessed according to the Structural Clinical Interview, DSM-III-R (SCID). Ninety-one percent of the compulsorily committed and 56% of the voluntarily admitted subjects reported violations of integrity or negatively perceived coercion during treatment (p < 0.001); women to a higher extent than men (93%/70%, respectively; p < 0.01). At the discharge interview 87% of the compulsorily treated subjects and 52% of the voluntarily treated subjects still reported that the coercive experiences were wrong or violating to personal integrity. Female subjects were less inclined to justify earlier reported coercive examples than male subjects (0%/8%, respectively; p < 0.05). Coercive implementation fait accompli was reported in 70%, persuasion in 21% and threat in 9% of the cases. No experiences of force were reported. Subjects with an internal locus of control reported negatively perceived coercion to a higher extent than subjects with an external locus of control (84%/22%, respectively; p < 0.001). Internally oriented subjects were also less inclined to justify the coercive experiences at the discharge interview than externally oriented subjects (2%/14%, respectively; p < 0.01). Prevalence of psychiatric comorbidity was high (78%). Reports of negatively perceived acts of coercion and locus of control were unrelated to psychiatric comorbidity. Sixty-seven percent of the subjects were homeless. Homelessness was unrelated to locus of control, coercive reports and psychiatric comorbidity.