A CLINICAL TOOL FOR RATING RESPONSE TO CIVIL COMMITMENT FOR SUBSTANCE-ABUSE TREATMENT

Objective: The objectives of this study were to develop a measure to a ssess patients' response to civil commitment, to test this measure on two groups of dually diagnosed patients (medically ill alcoholics and patients with dual mental and substance use disorders), and to identif y patient characteristics associated with a positive response to commi tment. Methods: The outcome of 38 male veterans civilly committed to i npatient substance abuse treatment for an average of six months was ra ted by their treating clinicians. Raters used the Commitment Response Form (CRF), a scale anchored to behavioral descriptions that was devel oped for the study and that measures outcome in five areas: patients' attitude toward recovery, substance use, medical condition, engagement in substance abuse treatment, and independence of functioning. Each p atient's medical records were reviewed by two clinical staff members w ho made independent retrospective ratings and a joint rating using the CRE They also made independent and joint dichotomous ratings of wheth er the patient was a positive responder or a nonresponder to civil com mitment. Results: The CRF showed superior reliability when compared wi th the dichotomous rating of outcome. The scale demonstrated reasonabl e psychometric properties. Mean scale scores did not differ significan tly by patient group; slightly more than half were rated as having a g ood to excellent overall response. Better outcome was associated with longer periods of previous abstinence from alcohol and a higher level of education. Conclusions: Use of a scale anchored to behavioral descr iptions improved reliability of outcome determinations by clinical sta ff. Civil commitment resulted in good to excellent outcome in many but not all committed patients.