Clinical Experience with Civil Commitment

Abstract

Unstable motivation has represented a major problem in the treatment of opioid dependence. Early followup studies at the two Public Health Service Hospitals found that legally coerced treatment, especially when combined with compulsory posthospital care, led to better outcomes than did voluntary treatment. During the years 1967–1973, over 10,000 patients were admitted to the two hospitals under the NARA for evaluation of their suitability for treatment under civil commitment. Over one-third were found not suitable. Followup studies suggested that the outcomes of committed patients were somewhat better than those of voluntary patients. While civil commitment may bring some opioid users into treatment who would not voluntarily enter, it cannot overcome deficits in services, and it cannot insure that patients will participate in treatment.

The Use of Legal Coercion in the Treatment of Substance Abusers: An Overview and Critical Analysis of Thirty Years of Research

“…the consistent finding that treatment (e.g., residential and outclient treatment) reduces substance use and crime (Makkai, 2000;Anglin, 1988;Platt et al, 1988;Trace, 1990;Turnball, Stimson, Stillwell, 1994;Looney and Metcalf, 1974;Maddux, 1988;Wild, 1999) 2. increasing social pressure and criticism of traditional criminal justice approaches to deal with addicted offenders (Anglin, 1988;Platt et al, 1988) 3. increasing evidence suggesting that incarceration may not be an effective means of curtailing illicit drug use (Trace, 1990;Turnball, Stimson, Stillwell, 1994) 4. the problem that compulsive substance users seem to enter treatment only when under some form of external coercion (Looney and Metcalf, 1974;Maddux, 1988) 5. concerns relating to the rising economic costs of providing judicial and correctional services to substance abuser offenders (Wild, 1999) there is an increasing willingness to employ more forceful means of pressuring substance users into treatment, involving the use of legal coercion (Rotgers, 1992). According to estimates, 40% to 50% of referrals to community-based treatment programs are from the criminal justice system (Maxwell, 1996;Price and D'Aunno, 1992).…”

“…Informal coercion involves pressures that substance users typically experience from their social environment, including friends, family, employers, and others that can be viewed as coercive. For example, family members and friends create pressure by voicing their frustration, highlighting the destructive impact the individual's behavior has on their environment, or by threatening the substance user with an ultimatum to sever the relationship (Maddux, 1988). Evidence shows that family and friends can be effective sources of social pressure for substance users to enter treatment (Hasin, 1994;Room, Greenfield, and Weisner, 1991;Wild, Newton-Taylor, and Alleto, 1998).…”

“…concerns as to the extent to which society should curtail the liberty of substance users (Maddux, 1988). Some critics argue that treatment must not supplant basic civil rights in the service of larger societal aims (e.g., reducing the risk of harm to others that is associated with substance use; Bersoff, 1992;Kleinig, 2004).…”

“…However, the question remains how much damage should society be expected to endure as a result of individuals' alcohol and drug use? This conflict highlights the dual and at times conflicting goals of coerced treatment, which are to help the individual on the one hand and to protect the community from harm on the other (Maddux, 1988).…”

Mandating treatment for drug possessors: The impact of Senate Bill 123 on the criminal justice system in Kansas

“…Community-based drug treatment approaches for offenders historically have been a part of drug policy in the United States (for reviews see Anglin & Hser, 1991;Inciardi, 1988;Maddux, 1988), and have included the imposition of treatment as a condition of prosecutorial diversion, a drug court sentence, or a probation sentence (Anglin & Hser, 1991). Evaluations of such diversionary approaches have found them to be effective at reducing both drug use and criminal behavior (Anglin, 1988;Anglin & Hser, 1991;Gottfredson, Najaka, & Kearley, 2003;Harrell, 1998;Huebner & Cobbina, 2007;Lang & Belenko, 2000;Simpson, Joe, & Brown, 1997;Wild, Roberts, & Cooper, 2002;Young, Fluellen, & Belenko, 2004).…”