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
There are many ways people are coerced into treatment, including:
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:
In addition, many of the same social and structural issues that contribute to mass criminalization are behind involuntary and coercive treatment, including:
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.
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.