[The effectiveness of compulsory treatment for substance use disorder].

Abstract

Background: In a minority of patients with substance use disorders, there is both unwillingness to treat and serious harm or damage to the patient or society. In these situations, compulsory treatment may be considered. However, it is unclear whether compulsory care is effective in reduction of substance use.

Aim: To describe the literature on the effect of compulsory care (in criminal or civil law settings) on substance use in adult patients with substance use disorders.

Method: Literature review, including 17 articles through PRISMA analysis. The risk of bias was severe to critical in most studies.

Results: Compulsory treatment was imposed in 16 studies (similar to a ‘voorwaardelijke strafrechtelijke machtiging’ in the Netherlands), in one study also from the youth protection system and one from the civil law framework. In seven studies there were no significant differences in substance use between compulsory and voluntary treatment, in two studies outcomes were better in the compulsory group and in four studies outcomes were better in the voluntarily treated group. Four studies did not compare the two groups or did not describe significance.

Conclusion: The 17 included studies found varying outcomes regarding the effectiveness of compulsory treatment for substance use disorder, with a considerable risk of bias, ranging from methodological shortcomings to selective reporting of results. This makes it impossible to draw unequivocal conclusions about the effectiveness of compulsory care in achieving long-term abstinence or reducing substance use.