Perceived coercion to enter treatment among involuntarily and voluntarily admitted patients with substance use disorders
Open accessAbstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
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Many voluntary patients also reported feeling coerced.
“Notably, many voluntary patients also reported feeling coerced [15,35,44,54,60,64,93,105,115]”
From Factors Associated with Perceived Coercion in Adults Receiving Psychiatric Care: A Scoping Review (2025) · cites this paper as [115]
Involuntary admission was associated with a higher burden of psychotropic medication use in the short term.
“A small number of studies suggested that involuntary admission was associated with a higher burden of psychotropic medication use in the short term (34,35).”
From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [34]
The Methods (Study subjects; page unavailable) list pharmacotherapy among treatments offered, but do not compare medication use between admission groups. The Results (Patient characteristics and substance use; page unavailable) compare other characteristics, not short-term psychotropic medication use. Searches for psychotropic medication and related prescribing terms found no passage addressing the claimed association. (LLM, conf=0.76)
Experimental — accuracy not yet measuredOnce a person was admitted as an involuntary patient they were more likely to be subject to use of coercive treatment modalities such as restraint and seclusion than people admitted on a voluntary basis.
“A similar cycle of coercive care provision may also be evident during admission, with the available literature indicating that once a person was admitted as an involuntary patient they were more likely to be subject to use of coercive treatment modalities such as restraint and seclusion than people admitted on a voluntary basis (34,76–88), and may be more likely to display aggressive behaviours (”
From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [34]
The Results and Discussion compare perceived coercion among involuntarily and voluntarily admitted patients, not their exposure to restraint or seclusion. Searches for restraint, seclusion, and coercive treatment modalities found no passage assessing whether either group was more likely to receive them; the Discussion says the groups were treated almost equally but does not measure those specific practices. Page numbers were unavailable in our copy. (LLM, conf=0.76)
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- Authors
- Opsal, A., Kristensen, Ø., Vederhus, J. K., & Clausen, T.
- Affiliations
- University of Agder (NO)
- Sørlandet Sykehus (NO)
- University of Oslo (NO)
- Corresponding author
- Opsal, Anne
- Venue
- BMC Health Services Research
- Published
- 2016-11-15
- Volume
- 16
- Issue
- 1
- Pages
- 656-656
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC5111249
- OpenAlex
- W2549246978
- Cited by
- 25
- References
- 30
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 3 · 2022: 4 · 2021: 4 · 2020: 3 · 2019: 3 · 2018: 2
- FWCI
- 2.23
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- BIBSYS Brage (BIBSYS (Norway)) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- NORA - Norwegian Open Research Archives (submittedVersion, other-oa)
- NORA - Norwegian Open Research Archives (submittedVersion, cc-by)
- Funders
- Norges Forskningsråd
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Keywords
- perceived coercion, involuntary admission, voluntary admission, substance use disorders, involuntary treatment, Social Services Act, legal coercion, patient experience, psychiatric inpatient treatment
- MeSH terms
- Adult, Mental Disorders, Coercion, Commitment of Persons with Psychiatric Disorders, Female, Hospitalization, Humans, Male, Middle Aged, Norway, Patient Admission, Perception, Psychiatric Department, Hospital, Surveys and Questionnaires, Social Work, Substance-Related Disorders
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