COERCIVE TREATMENT? OLD ARGUMENT WITH FRESH EYES

New York Times

The Opinion Pages

Should Drug Addicts Be Forced Into Treatment?

Massachusetts Gov. Charlie Baker wants to give hospitals the power to commit substance abusers. Is this the right approach?

 Drug Addiction Recovery Often Starts With Coercion

Robert L. DuPont, a psychiatrist, is the president of the Institute for Behavior and Health Inc. He was the director of the National Institute on Drug Abuse from 1973 to 1978.

UPDATED NOVEMBER 11, 2015, 3:21 AM

Addiction hijacks the brain. Families dealing with addicted loved ones know this. Research shows that 95 percent of people suffering from substance use disorders do not think that they have a problem or need treatment. Few addicts enter treatment without meaningful coercion, most often from families or the criminal justice system.

The challenge in responding to this seemingly simple question about coerced treatment is in the details. Surely not everyone who is addicted to drugs should be committed to treatment. The opposite is also true. Some addicts should be committed to treatment against their will. Not all coercion is commitment and not all commitment has the force of law.

Two good examples of effective coercion that overcome addiction are HOPE Probation and the state-based Physician Health Programs, both of which are enforced by intensive random monitoring and permit no use of alcohol or other drugs. While these two programs share many similar features, they deal with very different populations of serious substance users: one with convicted felons on probation and the other with  

physicians. Both are voluntary in the sense that individuals can choose to not abide by the program requirements, but in both cases the consequences may be serious. For probationers in HOPE, the risk of failing is prison and for physicians in P.H.P., it is the loss of a medical license. Both programs produce excellent outcomes for most participants.

Families faced with addiction often reluctantly, and only after many failures, use “tough love” to promote treatment and recovery while insisting that their addicted loved ones be drug-free. Families usually have to use a significant measure of coercion not only to get addicts into treatment but also to keep them there and to prevent relapse upon discharge.

As a psychiatrist specializing in the treatment of addiction, I am struck by the stark contrast between addicted people who are using alcohol and other drugs actively and those who are in stable recovery. In the process of recovery there is a transition from near-universal denial of problems and rejection of treatment to gratitude for and acceptance of the coercion that got them on that path. The addict’s will is different when using drugs and when in recovery.

Recovery from addiction may or may not involve treatment. It takes years of hard work – usually with the sustained support of recovery communities. Because of the denial that characterizes the cunning, baffling and powerful disease of addiction, recovery often starts with substantial coercion.