Research & Reviews
Bahji, A., Leger, P., Nidumolu, A., Watts, B., Dama, S., Hamilton, A., & Tanguay, R. (2023). Effectiveness of involuntary treatment for individuals with substance use disorders: A systematic review. Canadian Journal of Addiction, 14(4), 6-18.
"Forty-two studies met the review criteria, with 354,420 participants. Most studies were from the United States, Canada, and China: most measured substance use changes, criminal recidivism, and retention in treatment. Only 7 studies comparing involuntary to voluntary intervention reported improved outcomes in the involuntary group, with most for retention in treatment and only one showing a reduction in substance use. Six out of 7 studies comparing different involuntary interventions occurred in the context of prison or probation. No studies compared the involuntary treatment to no treatment. Only 11 described evidence-based treatment for SUDs, while 5 diagnosed and co-treated psychiatric comorbidity and 11 discussed the motivation for treatment. There is a lack of high-quality evidence to support or refute involuntary treatment for SUD. More research is needed to inform health policy."
Chau, L. W., Erickson, M., Vigo, D., Lou, H., Pakhomova, T., Winston, M. L., ... & Small, W. (2021). The perspectives of people who use drugs regarding short term involuntary substance use care for severe substance use disorders. International Journal of Drug Policy, 97, 103208.
"Participants did not endorse the use of involuntary care, instead emphasizing significant changes were needed to address shortcomings of the wider voluntary care system. When asked to conceptualize what an acceptable involuntary care scenario might look like (under hypothetical and ideal conditions), participants recommended it should include: individual control and autonomy, peer advocacy in decision-making, and elimination of police and criminal justice system involvement from treatment encounters. Participants saw involuntary care to be an inappropriate approach given the shortcomings of the current system, noting also problems inherent in its use to manage severe SUDs and imminent harm, and prioritized alternate approaches to offsetting risks. Improving voluntary care for substance use, along with addressing the social determinants of health that put individuals at risk of problematic substance use and harm, were prioritized in participant perspectives. Participant comments regarding the use of involuntary care bring forward alternate solutions in the context of the opioid overdose crisis, and a reconceptualization of the ‘problem’ of managing severe substance use disorders."
Cooley, E., Bahji, A., & Crockford, D. (2023). Involuntary treatment for adult non-offenders with substance use disorders?. Canadian Journal of Addiction, 14(2), 25-31.
"Evidence for the involuntary treatment of adult nonoffenders with SUD suggests limited benefits, with voluntary treatment consistently outperforming involuntary treatment. The use of involuntary treatment for SUD would likely require special legislation, the development of designated treatment sites, and extensive aftercare programming that may not justify the costs and potential ethical and legal issues. Resources likely would be better directed towards expanding voluntary treatment options."
Kisely, S., Bull, C., & Gill, N. (2024). Extending the reach of involuntary treatment to substance use disorders: Is it ‘compassionate’ or coercive care?. Australian & New Zealand Journal of Psychiatry, 58(12), 1017-1019.
"Of most concern, is the evidence of possible harm. In Massachusetts, people not otherwise connected with the criminal justice system can be detained if their substance use is deemed to ‘put them at immediate risk of harm’ and can be sent against their will to ‘treatment’ (Massachusetts Department of Public Health, 2016). This can be in a dedicated treatment facility or in the worst case, corrections, where they can be held for up to 90 days and often live under the same conditions as those convicted of criminal charges. Of most concern is the finding that people subject to such compulsory treatment were 2.2 times more likely to die of opioid-related overdoses and 1.9 times more likely to die of any cause following compulsory treatment compared to those who received voluntary care. There were similar results from a nationwide study from Sweden of people discharged from 6 months of compulsory care between 2000 and 2017 (Ledberg and Reitan 2022). The risk was greatest in the initial 2 weeks following discharge."