IS COERCED TREATMENT FOR SUBSTANCE ABUSERS THE RIGHT APPROACH?
A recent study that has garnered a lot of attention is the finding by two Princeton economists, one a Nobel prize winner, that there is what has been termed an “epidemic” of substance abuse by middle-aged white Americans. In fact, the study found that for white Americans aged 45 to 54 with no college education, the increase in deaths attributed to substance abuse, which includes alcohol, heroin and prescription opioids increased at an extraordinary rate from 1999 to 2014. The debate swirls around the causes of this increase but of more pressing concern is how to abate this phenomenon.
Enter Massachusetts Governor Charlie Baker. In that state, 1,200 people died from drug overdoses in 2014. Addressing what has been termed a “brutal opioid epidemic” in his state, Governor Baker has proposed legislation that would give hospitals authority to force treatment on drug addicts who are a danger to themselves or others. The legislation, if signed into law, would be similar to Massachusetts statute that permits the commitment of mentally ill individuals, often against their will. The proposed legislation would give hospitals the power to hold addicts for three days, against their will, in order to evaluate them. If the hospital determines that a longer commitment is needed, the proposed law would allow the hospital to seek legal permission to hold the addict for a longer commitment. The law would apply not only to drug addicts but to those addicted to alcohol as well. Massachusetts already has a law that allows families, police officers, and doctors to seek 90-day civil commitments for addicts who pose a serious risk to themselves or others, but this new law would up the ante for what is called “coerced treatment” by shifting the focus and authority to the hospitals.
Is this the best approach?
Some critics argue that overdose victims might be afraid to seek medical care for fear that they will be held in treatment against their will. Others worry about that these commitments are a violation of civil rights; indeed in 1972, the Supreme Court termed civil commitment a “massive deprivation of liberty.” Others are concerned that the funds for these programs will be abused.
But does “coerced treatment” work? Research on the effectiveness of coerced treatment has shown mixed results. There are studies that show coerced treatment is effective and other studies with the opposite results. Some professionals maintain that forcing someone into recovery is not effective because it is, by its very nature, harsh and confrontational. But the problem with voluntary treatment, as others point out, is that the drop-out rates are very high. Those who maintain that coerced treatment is more effective than voluntary treatment point out this fact and argue that the longer one stays in treatment, the more time the addict has to address and overcome the addiction.
The issue is a difficult one. On the one hand there is the concern about an individual’s right to be free from commitment against his or her will; on the other hand, society and the families of the individuals wish to not only help and protect the addict but often desire to protect others from the addict’s behavior. To compound the ambiguity, there is no final answer on whether coerced treatment is effective. Yet, the problem of addiction not only persists but is apparently increasing among certain segments of society. Ultimately, we must understand the underlying causes for addiction. But until that day, we might watch Massachusetts. If Governor Baker’s proposed legislation becomes law, it may provide one solution to the tragedy of addiction.