Although the great majority of individuals with substance use disorders never require civil commitment for involuntary hospitalization for treatment, there is a sub-population of patients with complex conditions for whom addiction is so gravely disabling that they are unable to make rational treatment decisions or care for themselves independently,necessitating a higher level of care. In New York City, for example, there is a sub-population of individuals with substance use disorders who repeatedly present to public hospital emergency rooms, never stay in treatment for more than several days, and often sign out of the hospital despite clinical recommendations otherwise, and never stay in either inpatient or outpatient treatment for more than several days. These patients have become chronically homeless and socially isolated. They have a multitude of untreated chronic medical conditions despite having hundreds of hospital admissions and accruing immense hospital costs; the minimum annual mortality rate in this sub-population is 8.6%, or roughly 20 times the age-adjusted rate (1).
Although the great majority of individuals with substance use disorders never require civil commitment for involuntary hospitalization for treatment, there is a sub-population of patients with complex conditions for whom addiction is so gravely disabling that they are unable to make rational treatment decisions or care for themselves independently,necessitating a higher level of care. In New York City, for example, there is a sub-population of individuals with substance use disorders who repeatedly present to public hospital emergency rooms, never stay in treatment for more than several days, and often sign out of the hospital despite clinical recommendations otherwise, and never stay in either inpatient or outpatient treatment for more than several days. These patients have become chronically homeless and socially isolated. They have a multitude of untreated chronic medical conditions despite having hundreds of hospital admissions and accruing immense hospital costs; the minimum annual mortality rate in this sub-population is 8.6%, or roughly 20 times the age-adjusted rate (1).
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