Alecia Gordon quickly admits that forced drug treatment was a good thing for her son. He was 19 when he first took part in a judicial program. She believes it saved his life.
"If it hadn't been ordered by the court, he might not have survived," said Gordon.
Compulsory rehab proved to be a good thing for Gordon's son, whose only other option was to go to prison without treatment.
However, many researchers suspect that forcing people to take short-term drug treatment programs to stay sober in the long term may not be enough.
This did not prevent the United States from expanding its involvement in involuntary drug and alcohol addiction commitments. It has also not slowed the growing number of private rehabilitation programs in the country.
Forensic drug treatment on the rise
According to the National Alliance for Model State Drug Laws, currently 37 states and The District of Columbia allows families and medical professionals to file a petition to treat a person .
In general, a person can only be committed under civil law if he or she is considered a danger to the health or safety of himself or others
The emergency obligation varies between 24 hours and 15 days. In some states, family members, healthcare professionals, and law enforcement officers can petition the treatment facility directly without a judge.
Proponents of these programs argue that short-term commitments are a critical void for court closure, such as on weekends and at night.
However, some healthcare providers fear that the involuntary detention of people with substance use disorders could burden the emergency room, the Associated Press reports.
The AP cites data showing that involuntary drug addiction commitments are increasing in some states.
In Florida, requests for commitments in 2016 and 2015 were over 10,000, much higher than in 2000 when they were more than 4,000. In Massachusetts, applications doubled from less than 3,000 in 2006 to more than 6,000 in 2016 and 2017.
In most states, lengthy involuntary commitments require a court order. Stays can last up to a year, but many states have a shorter duration. And these may not be enough to really make a difference.
"If someone's brain is kidnapped by an addiction, six weeks – two months is not even enough – for his brain to stop craving for the drug," said Lisa, an Arizona mother, whose daughter has been driving in and out of addiction for several years.
Does Forced Drug Treatment Work?
The increase in involuntary commitments can be a sign of the severity of the opioid epidemic. According to the National Institute on Drug Abuse (NIDA), more than 115 people die every day from opioid overdoses in the United States.
However, there are few studies showing that it helps them to force someone to take drug treatment in the long term.
Many states do not track whether civil obligations help people with substance use disorders to stay healthy or how often they go into compulsory treatment.
But there are studies that prove this. These programs do not help and can harm people instead.
A report from the Massachusetts Department of Health in 2016 found that people who were involuntarily committed overdosed more than twice as likely to die from opioid than those who opted for treatment.
Another 2016 study published in the International Journal of Drug Policy found little evidence that mandatory drug treatment helps people stop using drugs or reduce criminal relapse.
"There seems to be as much evidence that [compulsory treatment] is ineffective or actually harmful as there is evidence that it is effective," said study author Dan Werb, PhD, who is also an epidemiologist and political scientist at the University of California at San Diego (UCSD).
Most of the studies reviewed by Werb and his colleagues focused on involuntary drug treatment centers outside the United States, many of which are full of human rights violations.
"What we have seen worldwide – in Mexico, Southeast Asia and China – is that" mandated "treatment centers can effectively become internment camps," said Werb.
A 2018 study conducted in Tijuana, Mexico by Claudia Rafful, a doctoral student in public health at UCSD, found that involuntary drug treatment is also associated with an increased risk of non-fatal overdoses.
Part of This may be due to a loss of tolerance t o the drugs if someone suddenly stops using them. This happens not only with mandatory treatment, but also when people end up in prison.
However, Rafful says that interviews with people who were involuntarily taken to the treatment centers in Tijuana showed that most of them were unwilling to quit drugs. This can be another cause of an overdose after involuntarily committed people have been released.
Many of these centers also did not use evidence-based treatments. This is also a problem in the United States.
According to a 2017 report by Physicians for Human Rights, people who go through drug courts can face many obstacles to obtaining evidence-based diagnoses and treatments.
Interventions that have proven to be the most effective to help people with substance use disorders have often not been available or not available to everyone – including support for stable living and employment, and drug treatment.
When these interventions were available, people couldn't always afford them. Or their insurance, including Medicaid, may not have covered them.
Gordon's son spent some time in prison before finally opening a bed in the treatment program. Until then, his addiction remained untreated.
Some researchers view drug courts as forced rather than mandatory treatment, as people still have a choice: to go to prison or to get drug treatment.
When Gordon's son was first tried in court, it was part of his detention, although it took place elsewhere.
"Although you weren't yet free," Gordon said, "it was a lot different than in the district prison. “
Gordon's son was initially sentenced to two years in prison. He was able to reduce it by doing well in the treatment program.
Unregulated Rehabilitation Industry
As many families of people with drug or alcohol addiction know, relapse is a common detour to recovery.
Gordon's son attended several treatment programs after the first legal treatment, another legal, “maternal” treatment and a program in a private rehabilitation center in which he voluntarily participated.
But hard love, which is distributed by families, is another form of forced treatment.
Rafful says there is a very thin line between forced and mandatory drug treatments.
What is missing in both cases is a person with drug or alcohol addiction who voluntarily undergoes treatment.
"If forced treatment works, we would probably all do it," says Lisa. "Ideally, they do better if they ask for it. But you can't always wait for it."
A multi-billion dollar rehabilitation industry has grown around families who are desperately trying to help their loved ones overcome their addiction
There are more than 14,500 specialized drug treatment facilities in the United States, according to NIDA, but this industry is largely unregulated and many programs offer non-research-based treatments, and none Federal standards for rehabilitation programs or counseling practices.
Rehabilitation in residential areas can cost tens of thousands of dollars per month of treatment. In some cases, insurance may cover treatment, but families often pay out of pocket.
Rehabilitation programs are not required to offer drug treatments, some may choose for other types of interventions, including unproven interventions such as horses or other forms of pet therapy.
Rehabilitation programs can offer families a quick fix. But addiction is a chronic illness that cannot be treated with a few weeks of intensive treatment.
Which medicinal treatments work?
A common thread among successful opioid treatment programs is the use of pharmacological treatments.
"We have decades of evidence that methadone and similar opioid-based drugs can really be effective in helping people manage their opioid use," said Werb.
Other options are buprenorphine and injectable naltrexone.
transitions are also important. After all, if a person is forced to take medication due to a court order or family pressure, they still have to take control of their own treatment.
The voluntary treatment ensures that "patients can have a voice in the treatment, that they are cared for and that they can take control of their own health," said Werb.
Rafful adds that treatment programs must also consider a person's environment, which may have contributed to the drug problem. "If we don't help fix the problems related to their drug use – such as housing, employment, or stigmatization – the person is likely to return and use drugs," she said.
This is not the case. It does not mean that forced treatment or rehab will not help some people with addiction. But families need to be careful when choosing the right treatment for their loved ones.
The National Institute on Alcohol Abuse and Alcoholism provides information for families on alcohol addiction, as does NIDA on drug addiction.
The first step is to get help from a qualified doctor like your doctor or a psychiatrist with experience in addiction treatment.
The American Board of Preventive Medicine has a directory of doctors in the United States specializing in addiction medicine.
When choosing treatment for a loved one, pay attention to interventions that are supported by research.
Inpatient treatment is also not the only option. A 2014 study found that outpatient substance treatment programs can be as effective as inpatient programs.
It is also important to remember that relapse is not a failure. People with an opioid use disorder often relapse on the road to recovery.
Gordon attributes to the program at the private rehabilitation center that she has helped her son stay sober for the past 18 months. But not because it was voluntary. The program included a six-month inpatient treatment program as well as a three-month transition to the sober life program.
This made the difference.
"Although my son's last treatment was ordered by a court – and I am grateful that it was ordered by a court – I think that mandatory programs would be much more successful and with much less relapse if people were given a longer term treatment . “