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Addiction. 2019 Aug 4. doi: 10.1111/add.14769. [Epub ahead of print]

Coercion into addiction treatment and subsequent substance use patterns among people who use illicit drugs in Vancouver, Canada.

Author information

1
British Columbia Centre on Substance Use, 1026 Howe Street, Fourth Floor, Vancouver, BC, CANADA, V6E 4S7.
2
Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, BC, Canada, V6T 1Z4.
3
Department of Medicine, University of British Columbia, 667-1081 Burrard Street, Vancouver, BC, Canada, V6Z 1Y6.
4
First Nations Health Authority, 100 Park Royal S, West Vancouver, BC, Canada, V7T 1A2.
5
Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Room 11300, Burnaby, BC, Canada, V5A 1S6.
6
School of Public Policy, Simon Fraser University, 3271-515 West Hastings Street, Vancouver, BC, Canada, V6B 5K3.

Abstract

BACKGROUND AND AIMS:

Many people who use drugs (PWUD) are coerced into receiving treatment. This study aimed to assess changes in substance use and related outcomes before versus after treatment in people coerced into treatment, voluntarily attending treatment or not attending treatment.

DESIGN:

Data from three linked prospective cohort studies of PWUD were used. McNemar's test and non-linear growth curve modeling were employed to: a) assess changes in substance use patterns before and after coerced addiction treatment and b) compare these changes with changes in PWUD who 1) voluntarily accessed and 2) did not access treatment.

SETTING:

Vancouver, Canada.

PARTICIPANTS:

3,196 community-recruited PWUD.

MEASUREMENTS:

The outcome variables were substance use and related outcomes assessed by self-reported questionnaire. The input variable was self-reported coerced addiction treatment (defined as being forced into addiction treatment by a doctor or the criminal justice system), voluntary treatment versus no treatment.

FINDINGS:

Between September 2005 and June 2015, 399 (12.5%) participants reported being coerced into addiction treatment. In McNemar's test, there were no statistically significant reductions in within-group substance use outcomes for people coerced into treatment, voluntarily attending treatment or not attending treatment. In non-linear growth curve analyses, there were no statistically significant differences in the before and after substance use patterns between those coerced into treatment versus either of the two control groups (all p>0.05). In sub-analyses, we found no statistically significant differences in substance use patterns between people who reported formal coerced treatment through the criminal justice system and people who reported informal coerced treatment through a physician.

CONCLUSIONS:

Among PWUD in Vancouver, Canada, there appear to be no statistically significant improvements in substance use outcomes among those reporting coerced addiction treatment, those voluntarily accessing treatment, and those not attending treatment.

KEYWORDS:

Coerced treatment; addiction treatment; compulsory treatment; longitudinal study; substance use disorders

PMID:
31379008
DOI:
10.1111/add.14769

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