150 - Youth Civil Commitment to Substance Use Treatment in Massachusetts, 2015-2021

Publication Number: 1140.150

Jessica B. Calihan, Mass General Brigham Hospital for Children, Boston, MA, United States; Amy Bettano, Massachusetts Department of Public Health, Boston, MA, United States; Shapei Yan, Boston Medical Center, Boston, MA, United States; Elizabeth Erdman, MDPH, Boston, MA, United States; Alicia S. Ventura, Boston Medical Center, Alpharetta, GA, United States; Marc LaRochelle, Boston Medical Center, Boston, MA, United States; Alexander Y. Walley, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States; Benjamin Bovell-Ammon, UMass Chan Medical School-Baystate, Springfield, MA, United States; Sarah Bagley, Boston University School of Medicine, Newton, MA, United States

Background: In 34 US states, an individual can be civilly committed for substance use disorder (SUD) treatment if a court finds the individual's SUD is likely to cause imminent serious harm. Civil commitment of youth for SUD treatment has not previously been described.

Objective: This work describes demographics, substance use patterns, health care utilization, and subsequent overdose among youth civilly committed to inpatient SUD treatment in Massachusetts.

Design/Methods: Linked longitudinal healthcare, government, and insurance claims data for all Massachusetts residents with at least one medical insurance claim was used to identify adolescent ( < 18 years) and young adult (YA; 18-25 years) civil commitment SUD treatment episodes from 2015 to 2021. Bivariate analyses (Chi-Square) were used to compare patient demographics, diagnoses, and substance-related or psychiatric acute health utilization between adolescents and YA in the 12 months preceding admission and 12 months following discharge. Receipt of follow-up care, repeat civil commitment to treatment, and opioid overdoses following discharge were also analyzed.

Results: From 2015 to 2021, 347 adolescents (mean age 16.4 + 0.9 years, 59% male) and 4706 YAs (22.5 + 2.0 years, 53% male) were civilly committed to SUD treatment. Adolescents were more likely to report primary cannabis use and less likely to report primary opioid use (Figure 1). YA were more likely to have a previously documented SUD diagnosis (67% adolescents v 77% YA; p< 0.001). Most youth had a documented psychiatric diagnosis (66% v 63%; p=0.02) with high prevalence of depression (59% v. 49%; p< 0.001), schizophrenia (23% v 14%; p< 0.001), suicidal ideation or self-injurious behavior (29% v 22%; p< 0.001), and ADHD (36% v 17%; p< 0.001). Many committed youth used acute care, particularly the emergency room, for psychiatric and/or substance-related concerns in the year preceding admission (Table 1). In the year after discharge, receipt of acute care remained elevated (Table 1). One in 10 YA and almost 1 in 20 adolescents had an overdose post-discharge (Table 2).

Conclusion(s): Most youth committed to treatment had prior psychiatric diagnoses and acute care presentations in the year prior to admission. These findings suggest improved linkage to substance use treatment during healthcare system touchpoints, particularly for psychiatric concerns, may be intervention opportunities to reduce utilization of involuntary treatment. There is also a need to evaluate efficacy of and alternatives to civil commitment, particularly for adolescents with cannabis use.

Figure 1: Primary substance reported by adolescents and young adults on civil commitment admission to SUD treatment in Massachusetts, 2015-2021.


Table 1: Acute care utilization by adolescents and young adults 12 months preceding and 12 months following civil commitment admission to SUD treatment in Massachusetts, 2015-2021.
*Different from <18-year-olds civilly committed to treatment with p-value p<0.05, **p < 0.01, ***p < 0.001.

Table 2: Receipt of follow-up care and overdose experience following discharge from civil commitment treatment in Massachusetts, 2015-2021.
*Different from <18-year-olds civilly committed to treatment with p-value p<0.05, **p < 0.01, ***p < 0.001.