title: Treatment Resistant and Resistant to Treatment? Evaluation of 40 Alcohol Dependent Patients Admitted for Involuntary Treatment.
abstract: OBJECTIVE
  To describe the clinical outcomes for a group of patients with severe alcohol dependence discharged from an Involuntary Drug and Alcohol Treatment (IDAT) program.
  
  
  METHODS
  Forty patients admitted to an inpatient IDAT program were prospectively followed up over 6 months using standardized questionnaires.
  
  
  RESULTS
  Patients had high rates of mental health comorbidities (97.5%), cortical atrophy (40%) and socioeconomic disadvantage (92.5% were beneficiaries). Six months after discharge, 25% of patients were abstinent and living in the community and 17.5% had notably reduced alcohol use. A further 7.5% were abstinent due to involuntary hospitalization. A total of 10% of patients were deceased and 40% of patients had relapsed or were lost to follow-up. Number of admissions and admission days reduced by 51 and 45% respectively for the 17 abstinent or improved community-based patients. A total of 82% of this patient group were actively engaged with an Assertive Community Treatment (ACT) team.
  
  
  CONCLUSIONS
  While patient numbers are small, treatment responsiveness was evident for 42.5% of patients, most of whom were followed up with ACT. Evaluation with a comparator group is required to determine whether outcomes are a function of involuntary treatment or an assertive treatment approach.
authors.affiliation: Herbert Street Clinic, Northern Sydney Drug & Alcohol Service, Sydney, NSW, Australia glenys.dore@health.nsw.gov.au.
authors.forename: Glenys
authors.initials: G
authors.lastname: Dore
authors.affiliation: Drug & Alcohol Services, Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia.
authors.forename: Barbara
authors.initials: B
authors.lastname: Sinclair
authors.affiliation: Herbert Street Clinic, Northern Sydney Drug & Alcohol Service, Sydney, NSW, Australia.
authors.forename: Robin
authors.initials: R
authors.lastname: Murray
mesh_terms: D000328:Adult; D000368:Aged; D000437:Alcoholism / Q000453:epidemiology* / Q000523:psychology / Q000628:therapy*; D001284:Atrophy / Q000473:pathology; D001315:Australia / Q000453:epidemiology; D002540:Cerebral Cortex / Q000473:pathology; D003156:Community Mental Health Services; D015897:Comorbidity; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D037141:Mandatory Programs; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D012923:Social Class; D016896:Treatment Outcome; D055815:Young Adult