Journal Article

Commitment to assessment and treatment: comprehensive care for patients gravely disabled by alcohol use disorders

Goldfrank, Lewis R, McCormack, Ryan P, Ross, Stephen, Williams, Arthur R, Rotrosen, John, Caplan, Arthur L

2013

Overview

More than 80% of countries have legislation for compulsory care for addicts.3 These laws--and societal attitudes--vary greatly, ranging from retributive to therapeutic.3 Many statutes are outdated, ambiguous, or deficient in safeguards.4-6 In response to these concerns, legislative reform and innovative, promising models of care have emerged; a recent comprehensive assessment of policies, practices, and outcomes in New South Wales, Australia, led to substantive developments in involuntary commitment practices, which are generally viewed as successful.4,5 By contrast, in New York City, which is otherwise characterised by forward-thinking public health initiatives, the capacity to retain patients was recently constrained by a local court statement that alcoholism is not a committable mental illness.7 To better understand these vulnerable patients, we used administrative databases to identify frequent Bellevue Hospital emergency department users diagnosed with alcohol use disorders for a 2-year period starting in 2008. 51 extreme users visited the emergency department at least 10 times in each year, with an annual mean of 37 visits, 20 inpatient days, and US$75?723 in hospital costs. Since even more health-care services were provided by other hospitals, these figures greatly underestimate total costs.

• Publisher: Elsevier Ltd,Elsevier,Elsevier Limited
• Subject: Addictive behaviors / Adult and adolescent clinical studies / Alcohol use / Alcohol-Induced Disorders - psychology / Alcohol-Induced Disorders - therapy / Alcoholic beverages / Alcoholism / Alcoholism - psychology / Alcoholism - therapy / Alcoholism and acute alcohol poisoning / Biological and medical sciences / Commitment of Mentally Ill / Departments / Disabled Persons - statistics & numerical data / Drug addiction / Emergency medical services / Emergency Service, Hospital - utilization / General aspects / Health promotion / Heart attacks / Hospital costs / Humans / Internal Medicine / Legislation / Medical sciences / Meetings / Mental disorders / Miscellaneous / Mortality / Neurosciences / Patient Acceptance of Health Care - statistics & numerical data / Patients / Personal Autonomy / Psychology. Psychoanalysis. Psychiatry / Psychopathology. Psychiatry / Public health / Substance abuse treatment / Toxicology