Involuntary Treatment

People with substance use disorders (SUD) should have the right to choose if and when they would like to engage in treatment services. However, many people are subjected to mandated, coerced, or involuntary treatment for substance use. 

The criminal legal system, the child welfare system, and others often mandate treatment as a condition to stay out of prison or jail, maintain child custody, keep a job, or avoid other punishments. In these cases, if a person does not successfully complete treatment or rejects the treatment mandate, they may face incarceration, family separation, and job loss. Although many argue that treatment is still technically “voluntary,” these are impossible choices for anyone to have to make. 

“Treatment of drug use disorders should be based on the universal ethical standards – respect for human rights and dignity…The choice to start treatment should be left to the individual. Treatment should not be forced or against the will and autonomy of the patient. The consent of the patient should be obtained before any treatment intervention.” - United Nations Office on Drugs and Crime and World Health Organization, 2016

How Are People Coerced Into Treatment?

There are many ways people are coerced into treatment, including:

  • Mandated treatment from the criminal legal system (drug courts, probation/parole conditions)
  • Involuntary commitment or court-appointed conservatorships for people who have overdosed or who have been diagnosed with mental health and substance use disorders
  • Withholding of benefits or services or threatening of negative governmental action for failure to access or complete SUD treatment

Proponents of involuntary and coercive treatment argue that this approach is justified because it gives people the opportunity to access treatment to address their substance use and that it can motivate individuals to be more engaged in treatment in order to avoid a more punitive outcome. They assume that someone is currently not in treatment because of a lack of motivation, but there are many reasons people don’t seek treatment, including:

  • Cost
  • Lack of access
  • Excessive policies and requirements for enrolling in and remaining in treatment programs
  • Lack of evidence-based treatment options
  • Other more pressing needs such as housing, secure access to food, medical treatment, or gainful employment

In addition, many of the same social and structural issues that contribute to mass criminalization are behind involuntary and coercive treatment, including:

  • Racism – People of color are more likely to be system-involved, and so are forced into treatment more often than white people.
  • Stigmatization – People who use drugs are viewed as “bad” and deserving of punishment, instead of being treated with compassion.
  • Myths about the nature of addiction – People who use drugs are often seen as unable to make rational choices for themselves instead of being recognized as autonomous individuals who can direct their own care.
  • Profit over people – SUD treatment can be a lucrative business, and some policies prioritize their profits over the needs of patients.

Involuntary Treatment and COVID-19 

In light of the COVID-19 pandemic, many treatment facilities have had to adapt to maintain social distancing requirements, including reducing days and hours of treatment and increasing telehealth appointments. While many programs have stopped or reduced in-person drug testing requirements, these are often a large part of the conditions of mandated treatment. Many people are struggling to manage these requirements during the pandemic, especially if they have rigid in-person drug testing schedules, they must remain in congregate housing or residential treatment, or if they have limited access to technology for required telehealth sessions. 

Patients should not be punished for taking preventative measures to reduce COVID-19 exposure in the midst of a global pandemic. We should make sure they have adequate resources to remain in the community and keep their families together, rather than punishing them for struggling during this time. The Drug Policy Alliance (DPA) continues to advocate to reduce involuntary treatment and will focus on the new potential harms brought by the COVID-19 emergency.

Watch our discussion about improving substance use disorder treatment during and after the COVID-19 pandemic.

Ways DPA is Fighting Involuntary Treatment

SUD treatment should be held to the same ethical standards as the treatment of other health conditions, where provision of services without informed consent is considered highly unethical. Providers must recognize and base their services in the inherent rights and dignity of the people they serve, including the right of autonomy and self-determination. In addition, a systematic review of research concluded that the evidence does not, on the whole, suggest improved outcomes related to coercive treatment approaches and that some studies indicate potential harms. Adequate access to attractive, affordable, evidence-based SUD treatment and other support services will increase voluntary treatment initiation and render mandated treatment unnecessary. 

DPA views involuntary and coercive treatment as an outgrowth of the insidious stigma around people who use drugs and is committed to ending coercion in SUD treatment.

  • DPA advocates for policies and resources to increase access to ethical, attractive SUD treatment and opposes policies that use legal mechanisms to force people into treatment. We are active at the local, state, and federal legislative and administrative levels. We also support litigation to protect the civil liberties of people subject to coercive practices.
  • In 2020, we helped pass Measure 110 in Oregon which made the state the first in the nation to decriminalize drug possession, significantly expanding access to much-needed evidence-based treatment, harm reduction, and other health services. The Measure promotes voluntary assessment and engagement in treatment rather than requiring treatment to avoid criminal penalties for drug possession.
  • In March 2021, we sent a letter opposing AB 1542 (McCarty), a bill that would authorize California's Yolo County to create a pilot program allowing judges to sentence people convicted of “drug motivated crimes” to a secured residential treatment facility.
  • DPA educates the public about the root causes of SUDs and why coercion is an inappropriate solution. Watch the keynotes and panel sessions from our conference Coercive Treatment – Moving Beyond “For Your Own Good.”
Drug Treatment