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Research ArticleRegular Articles

Experiences of Court Clinicians Who Perform Civil Commitment Evaluations for Substance Use Disorders

Paul P. Christopher, Bailey E. Pridgen and Ekaterina Pivovarova
Journal of the American Academy of Psychiatry and the Law Online June 2021, 49 (2) 187-193; DOI: https://doi.org/10.29158/JAAPL.200061-20
Paul P. Christopher
Dr. Christopher is Associate Professor, Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, RI. Ms. Pridgen is affiliated with the Department of Psychiatry, University of Massachusetts Medical School, Amherst, MA. Dr. Pivovarova is Assistant Professor, Department of Family Medicine & Community Health and Department of Psychiatry, University of Massachusetts Medical School, and Research Faculty, Massachusetts Center of Excellence for Specialty Courts, Amherst, MA.
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Bailey E. Pridgen
Dr. Christopher is Associate Professor, Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, RI. Ms. Pridgen is affiliated with the Department of Psychiatry, University of Massachusetts Medical School, Amherst, MA. Dr. Pivovarova is Assistant Professor, Department of Family Medicine & Community Health and Department of Psychiatry, University of Massachusetts Medical School, and Research Faculty, Massachusetts Center of Excellence for Specialty Courts, Amherst, MA.
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Ekaterina Pivovarova
Dr. Christopher is Associate Professor, Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, RI. Ms. Pridgen is affiliated with the Department of Psychiatry, University of Massachusetts Medical School, Amherst, MA. Dr. Pivovarova is Assistant Professor, Department of Family Medicine & Community Health and Department of Psychiatry, University of Massachusetts Medical School, and Research Faculty, Massachusetts Center of Excellence for Specialty Courts, Amherst, MA.
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    Table 1.

    Respondent Characteristics

    Respondent CharacteristicsResponseDid Not Respond
    Female22 (78.57)4
    White27 (81.82)5
    Profession5
        Social work8 (28.57)
        Psychologist20 (71.43)
    Experience performing commitment evaluations, years10.42 ± 10.993
    Professional time performing commitment evaluations, %89.50 ± 16.385
    Frequency of performing commitment evaluations, n3
        Past week3.50 ± 2.35
        Past month11.60 ± 7.81
    • Data are presented as mean ± SD or n. n = 33 respondents.

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    Table 2.

    Characteristics of Civil Commitment Cases Seen by Court Clinicians

    CharacteristicsResponseDid Not Respond
    Respondent substance use, %
        Heroin61.18 ± 19.515
        Fentanyl43.76 ± 24.444
        Other opioid(s)22.40 ± 17.893
        Alcohol59.90 ± 20.944
        Cocaine36.25 ± 22.165
        Stimulants19.27 ± 14.217
        Benzodiazepines36.55 ± 21.91
        Cannabis69.73 ± 28.697
        Other17.33 ± 13.79
    Respondent risk behaviors, %
        Imminent danger to self5.73 ± 0.84
        Imminent danger to others5.26 ± 0.70
        Inability to care for/protect self4.34 ± 0.84
        Miscellaneous/unclear4.20 ± 1.02
    Concordance between judicial decision and evaluator recommendation, %89.66 ± 7.48
    Ever recommended commitment without full criteria met? (yes), n19 (65.52)4
    • Data are presented as mean ± SD or n. n = 33 respondents.

    • View popup
    Table 3.

    Risk Behaviors That Potentially Support Need for Civil Commitment

    Risk BehaviorsResponseDid Not Respond
    Danger to self
        Attempting suicide6.60 ± 0.893
        Overdosing on drugs (e.g., losing consciousness or collapsing)6.37 ± 1.033
        Using fentanyl or fentanyl analog5.90 ± 1.403
        Mixing different kinds of drugs5.53 ± 1.313
        Thinking about suicide without a specific plan5.30 ± 1.153
        Coming close to being struck by a vehicle while walking or biking5.07 ± 1.414
        Using higher amounts of drugs than before4.50 ± 1.533
    Danger to others
        Physically hurting another person in any way on purpose6.27 ± 1.083
        Using a weapon like a stick, knife, or gun in a fight6.17 ± 1.233
        Driving or using heavy machinery while drunk or high6.17 ± 1.123
        Starting a fire on purpose5.97 ± 1.883
        Having trouble caring for one's child because of drug or alcohol use5.77 ± 1.313
        Threatening to physically harm someone5.60 ± 1.073
        Pressuring someone to engage in sexual activity against their will5.27 ± 1.843
        Stealing from someone directly, like mugging or snatching a purse or wallet4.30 ± 1.693
        Breaking into someone else's house, building, or car4.17 ± 1.643
        Having a driver's license suspended or revoked for moving violations4.00 ± 2.243
        Thinking about hurting someone else without acting on it3.97 ± 1.353
        Damaging someone else's property3.59 ± 1.184
    Inability to care for/protect self
        Starting a fire accidentally (e.g., leaving a burning cigarette unattended)5.73 ± 1.443
        Being pressured by someone to engage in sexual activity against one's will5.62 ± 1.644
        Not keeping up with necessary medical treatment5.33 ± 1.213
        Being physically hurt by another person in any way4.97 ± 1.673
        Sharing needles with others4.83 ± 1.553
        Not keeping up with necessary mental health treatment4.83 ± 1.284
        Being malnourished4.23 ± 1.573
        Being threatened by someone to do something one didn't want3.61 ± 1.645
        Having a loved one express general worry about one's safety2.90 ± 1.793
        Neglecting personal hygiene (e.g., bathing, brushing teeth, clean clothes)2.70 ± 1.713
        Having trouble keeping one's home/apartment clean2.27 ± 1.483
    Miscellaneous
        Hurting or being cruel to an animal or pet on purpose5.20 ± 1.963
        Having sex to get money, drugs, clothes, food, transport, a place to stay, or other things4.67 ± 1.543
        Being threatened or losing legal custody of one's child4.57 ± 1.873
        Experiencing a major loss (e.g., job, housing, close relationship)3.43 ± 1.723
        Witnessing someone else overdose on drugs3.30 ± 1.513
        Engaging in minor criminal behavior (e.g., shoplifting, vandalism, trespassing)3.10 (1.58)3
    • Data are presented as mean ± SD or n. n = 33 respondents.

    • View popup
    Table 4.

    Opinions Regarding Civil Commitmenta

    DisagreeNeutralAgree
    Civil commitment is an appropriate intervention for managing substance use and its associated risks.16.7 (5)6.7 (2)76.7 (23)
    I would favor legislation that allowed certain health care workers to hospitalize patients involuntarily for short periods (e.g., up to 72 h) when substance use poses an imminent risk.20.0 (6)10.0 (3)70.0 (21)
    Civil commitment hearings provide an efficient means of intervening to address the safety risks associated with substance use.16.7 (5)16.7 (5)66.7 (20)
    Civil commitment for substance use does more harm than good.73.3 (22)20.0 (6)6.7 (2)
    I feel confident in my ability to determine when there is “a likelihood of serious harm” in the context of civil commitment evaluations for substance use.3.3 (1)3.3 (1)93.3 (28)
    I would like more training on what criteria are needed to justify civil commitment for substance use.26.7 (8)20.0 (6)53.3 (16)
    • Data are presented as percentage (n). n = 30 respondents.

    • ↵a Not answered by 3 respondents.

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Journal of the American Academy of Psychiatry and the Law Online: 49 (2)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 49, Issue 2
1 Jun 2021
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Experiences of Court Clinicians Who Perform Civil Commitment Evaluations for Substance Use Disorders
Paul P. Christopher, Bailey E. Pridgen, Ekaterina Pivovarova
Journal of the American Academy of Psychiatry and the Law Online Jun 2021, 49 (2) 187-193; DOI: 10.29158/JAAPL.200061-20

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Experiences of Court Clinicians Who Perform Civil Commitment Evaluations for Substance Use Disorders
Paul P. Christopher, Bailey E. Pridgen, Ekaterina Pivovarova
Journal of the American Academy of Psychiatry and the Law Online Jun 2021, 49 (2) 187-193; DOI: 10.29158/JAAPL.200061-20
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Keywords

  • civil commitment
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