Coerced or involuntary treatment comprises an integral, often positive component of treatment for addictive disorders. By the same token, coercion in health care raises numerous ethical, clinical, legal, political, cultural, and philosophical issues. In order to apply coerced care effectively, health care professionals should appreciate the indications, methods, advantages, and liabilities associated with this important clinical modality. An expert panel, consisting of the Addiction Committee of the Group for the Advancement of Psychiatry, listed the issues to be considered by clinicians in considering coerced treatment. In undertaking this task, they searched the literature using Pubmed from 1985 to 2005 using the following search terms: addiction, alcohol, coercion, compulsory, involuntary, substance, and treatment. In addition, they utilized relevant literature from published reports. In the treatment of addictions, coercive techniques can be effective and may be warranted in some circumstances. Various dimensions of coercive treatment are reviewed, including interventions to initiate treatment; contingency contracting and urine testing in the context of psychotherapy; and pharmacological methods of coercion such as disulfiram, naltrexone, and the use of a cocaine vaccine. The philosophical, historical, and societal aspects of coerced treatment are considered.

No abstract

Coercion as a strategy for treatment of addiction is an effective but often negatively perceived approach. The authors review current policies for involuntary commitments and explore coercive dimensions of treating alcohol and drug dependence in the workplace, sports, and through professional licensure. Gender-specific issues in coercion are considered, including evidence for improved treatment retention among pregnant and parenting women coerced via the criminal justice system. Social security disability benefits represent an area where an opportunity for constructive coercion was missed in the treatment of primary or comorbid substance use disorders. The availability of third-party funding for the voluntary treatment of individuals with substance use disorders has decreased. This unmet need, coupled with the evidence for positive clinical outcomes, highlights the call for implementing socially sanctioned mechanisms of coercion.

This study describes the devetopment of a 24:-item instrument dealing with attitudes toward alcoholics and alcoholism. Data are presented for 135 graduate students on six conceptually derived scales referable to attitudes toward alcoholics: Psychological Etiology, Physical-Genetic Etiology, Social Rejection, Humanism, Moral Weakness, and the Medical Illness Model. The scales were found to be relatively independent of one another and only minimally related to social desirability, sex of respondents, education, and age. In addition, a factor analysis was done. Satisfactory test-retest reliabilities were established for the scales on a new sample of 3OSs. Validation data are also reported revealing that 41 hospitalized alcoholics had more negative views of alcoholics and were more likely to regard alcoholism as an illness caused by a physical disturbance than were non-alcoholics. Moreover, for nonalcoholics there was a significant inverse relationship between the reported quantity of alcohol consumed and the tendency to characterize the alcoholic as morally weak.