title: Perceived coercion to enter treatment among involuntarily and voluntarily admitted patients with substance use disorders.
abstract: Perceived coercion is a sense of pressure related to the experience of being referred to treatment. The sense of pressure arises from the patient's internal perception of coercion. The sources of coercion may be the legal system, the family, the health system, or self-criticism (internal sources). Here, we studied patients diagnosed with substance use disorders that were involuntarily admitted to hospital, pursuant to a social services act. We sought to determine whether these patients perceived coercion differently than patients that were admitted voluntarily.
  
  
  
  This study included patients admitted to combined substance use disorder and psychiatry wards in three publicly funded treatment centres in Norway in the period 2009-2011. Participants included 63 patients that were admitted involuntarily, pursuant to the Norwegian Public Health Act, and 129 patients that were admitted voluntarily. All participants completed the Perceived Coercion Questionnaire. Sociodemographic variables were determined with the European Addiction Severity Index. The range of psychopathological symptoms was evaluated with the Symptom Checklist-90-R. Independent sample t-tests, the chi-squared test, and Fisher's exact test were used to detect statistically significant differences between groups.
  
  
  
  Scores on the Perceived Coercion Questionnaire showed that patients admitted voluntarily and those admitted involuntarily experienced similar levels of perceived coercion. Those admitted voluntarily reported higher levels of perceived coercion from internal sources, and those admitted involuntarily perceived significantly higher coercion from legal sources. No differences between groups were found with the other tests.
  
  
  
  Our results suggested that assumptions about involuntary admissions should be evaluated carefully to determine how best to alleviate counterproductive feelings of coercion when a coerced admission is planned. Informing and collaborating with the patient will most likely facilitate a better experience during admission and treatment. Moreover, the patient is more likely to experience a better recovery process.
authors.affiliation: University of Agder, Faculty of Health and Sport Sciences, Postboks 422, Kristiansand, 4604, Norway. anne.opsal@uia.no.|Sørlandet Hospital, Addiction Unit, Postboks 416, Kristiansand, 4604, Norway. anne.opsal@uia.no.
authors.forename: Anne
authors.identifier: 0000-0001-5495-6460
authors.initials: A
authors.lastname: Opsal
authors.affiliation: Sørlandet Hospital, Addiction Unit, Postboks 416, Kristiansand, 4604, Norway.
authors.forename: Øistein
authors.initials: Ø
authors.lastname: Kristensen
authors.affiliation: Sørlandet Hospital, Addiction Unit, Postboks 416, Kristiansand, 4604, Norway.
authors.forename: John Kåre
authors.initials: JK
authors.lastname: Vederhus
authors.affiliation: Sørlandet Hospital, Addiction Unit, Postboks 416, Kristiansand, 4604, Norway.|Centre for Addiction Research (SERAF), Institute of Clinical medicine, University of Oslo, Postboks 1039 Blindern, Oslo, 0315, Norway.
authors.forename: Thomas
authors.initials: T
authors.lastname: Clausen
mesh_terms: D000328:Adult; D003068:Coercion; D003134:Commitment of Persons with Psychiatric Disorders / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy; D008875:Middle Aged; D009664:Norway; D010343:Patient Admission / Q000706:statistics & numerical data*; D010465:Perception; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data; D012947:Social Work; D019966:Substance-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D011795:Surveys and Questionnaires
keywords: Involuntary admission; Perceived coercion; Substance use disorder