A recent article on slate.com discussed the topic of forced substance abuse treatment, trying to determine if it is a successful option for addicts. Ultimately, the article stated that the answer is inconclusive, and more research is needed. Here at Addictions.com, we wanted answers, and a deeper understanding of this topic so we consulted Diane Jones, a Registered Nurse Practitioner, and Addictions Specialist, to ask her about the practice of forced addiction treatment.
Difference Between Formal and Informal Forced Addiction Treatment
Before diving into the topic of forced substance abuse treatment, we need to differentiate between formal and informal addiction treatment.
Formally forcing addiction treatment:
- When a court or hospital forces you to get treatment. This is usually done instead of jail time and is mandatory.
Informally forcing addiction treatment:
- When a family member, friend, or employer force you to get treatment. Social consequences such as losing a job, relationship, or financial support make treatment feel “forced.”
Being Unable to Accept Treatment When You Are Addicted
Below are excerpts from an interview with Addiction Specialist Diane Jones, who believes in the merits of forced substance abuse treatment.
Nancy Lee: In the Slate article states that “up to 75% of people in treatment programs say they are there because of some formal or informal pressure,” in your experience, is this the case for most addicts?
Diane Jones: Absolutely. The vast majority of people tell us initially that they have come for treatment because of someone – generally their partners or children.
NL: There is a tragic treatment gap in the United States. Approximately one in seven Americans suffer from addiction, but only ten percent of those suffering will get help at an addiction treatment facility. Do most people require a push to get formal addiction treatment?
DJ: Yes. Coming in for treatment is, in effect, making a public declaration of the inability to control an important aspect of their lives and for most people that is difficult. Even today, the majority of those whom I see presenting for treatment still see their addictive behavior as something that they have chosen to do – their “vice” – which naturally leads them to think that it should be something that they can control if they only make enough effort. For this reason, that “push” into treatment by caring family or friends becomes a vital part of steering the addicted person towards the help that they need.
NL: Are people willing or able to get treatment on their own?
DJ: In some cases, yes. Generally speaking, this tends to be the group of people who recognize addiction as a chronic illness and who therefore recognize the need for treatment. Often people in this general group will come for treatment hoping to treat their problem before the consequences which they can foresee start to happen. Some examples of this include, the entrepreneur who wants to protect the image of his business, the worker who doesn’t want his boss to find out, the young man or woman who is heading toward formalizing their relationship and who doesn’t want their significant other to find out the extent of their problem, or the parent who doesn’t want his / her child to realize.
NL: Ultimately, if the decision to get and stay sober rests on the individual, wouldn’t voluntary treatment be more successful?
DJ: Ideally yes. However, a great deal of harm (both physical and psychological) can be avoided by earlier treatment. One of the key features in addiction is the inability of the sufferer to put limits on their own behavior, so having someone else put limits in place can help guide the addict towards the realization that they do, in fact, need help. In reality, it is more important that the addicted person reaches an awareness of their addiction at some point in their treatment. Whether that be at the beginning or not is less important.
Forcing a Loved One into Substance Abuse Treatment
Coercion is when you persuade someone to do something through threat or force. Forcing a loved one into treatment by giving an ultimatum with consequences attached is an example of social coercion. Social pressures, such as your partner telling you to get treatment or they will leave you, or your friend saying they can’t be around you which you are drinking to excess, are what many people cite as their motivation for getting treatment.
NL: How effective is forcing a friend or family member into treatment going to be for their recovery?
DJ: People presenting for treatment as a result of family pressure (and remember that this is the majority of cases that we see), still feel a degree of choice and control. They will often tell us initially that they are “doing this for my wife/children/family, but here the key factor is the sensation that they have in some degree chosen to do this for their loved ones. As a result, the patient is more receptive to treatment, engages earlier and better and is more likely to reach the stage of recognizing the need for treatment in and of itself – the “actually, I am doing this for myself” moment.
NL: Is there a point people reach when addicted where they cannot or will not accept that they need help, and an intervention needs to occur for their own well-being?
DJ: In my experience, this is a reality for many people. The denial which is a trait of addiction in many cases will not allow the person to give up on the idea that they can control their addictive behavior. Some form of coercion – whether by formal or informal intervention or simply persistent family or social pressure – is needed to bring the person to a point where they will admit their need for help.
NL: The article said many organizations are against coerced treatment, specifically the U.N. which calls treatment harmful. Why would forcing treatment be viewed that way?
DJ: Taking away choice from an individual violates that individual’s human rights. This can be applied to forced treatments of any kind. The difference (and it is an important difference) is that forcing someone into treatment is, in effect, because they are demonstrating behavior which could prove a danger to themselves or others. However, the reason does not change the effect and at a psychological level, this can be harmful.
NL: What negative impact does forced treatment have on the individual?
DJ: Feeling forced into something can lead to feelings of helplessness and shame on the one hand and heightened resistance on the other, neither of which is beneficial to positive outcomes. Additionally, resentment at having been forced into treatment can give way to rejection at a later date. In the case of addiction treatment, which requires a long-term commitment, this can give rise to relapse.
Offering Substance Abuse Treatment as an Alternative to a Prison Sentence
Many experts promote the idea of formal forced treatment being used as an alternative to a prison sentence, especially considering the fact that 46.2% of federal inmates in the U.S. are incarcerated for drug-related offenses. The strain that these offenders put on our judicial system and economy is considerable, and without substance abuse treatment, these individuals are likely to re-offend after release from prison. They will continue to engage in criminal activity as long as they remain active in their addiction.
NL: Do you think mandating forced treatment as an alternative to incarceration would be a viable option?
DJ: I would certainly back mandated treatment as opposed to punitive sentencing. Punishing someone for suffering from an addiction is neither logical nor constructive. Obviously, where criminal acts have been committed, then there need to be consequences. But if we hope to prevent reoffending then rehabilitation must be the key. Where addictive behavior is the cause and criminal behavior the result, then simple logic would say that it has to be more effective to treat the addiction and thereby reduce the chances of reoffending.
NL: Are people forced into treatment by the court system likely to engage with the program?
DJ: As the article clearly states, there is a huge difference between treatment forced judiciously and that brought about by family pressure. In my experience, those patients who come to treatment in order to avoid court orders tend not to engage in treatment. They “do their time”, but little else.
The Ideal Length of Forced Substance Abuse Treatment Programs
Once you have been able to persuade your friend or family member to check into a drug and alcohol treatment facility, many people wonder – how long should they stay there?
NL: NIDA states that those who are legally forced into treatment facilities generally stay within the program longer (for the duration of their sentence). Does length of stay factor into addiction recovery success rates?
DJ: For a forced program, the longer duration can give the patient more opportunity to recognize his / her problem and to break down denial which would enable the patient to engage more fully and effectively in treatment. However, for those patients who are not in denial, extending their treatment, in theory, would not add any benefits to it and may, in fact, lead to the problem of institutionalization meaning that going back into their normal environment becomes more difficult.
NL: What is the ideal/average length of stay in a facility for successful recoveries?
DJ: Anything less than 28 days is likely to be ineffective, but much depends upon the individual, their substance, and use, physical and mental condition, social support network, background and family history. Many require much longer periods of treatment than 28 days. This is why treatments need to be flexible and individualized wherever possible. There is no “one size fits all” in addiction care. What is ideal for one person falls short for another and is overlong for someone else.
Ending the Myth of Waiting Until Addicts Hit “Rock Bottom”
One of the reasons that many people assume forced substance abuse treatment won’t be effective is because they believe a person needs to hit “rock bottom” before they can benefit from treatment. But the myth of waiting to hit rock bottom is not merely inaccurate, it is also quite tragic.
NL: The Slate article mentions “hitting rock bottom” can you elaborate on why this is a harmful myth associated with addiction treatment?
DJ: The idea that someone with an addiction problem needs to “touch rock bottom” before they can effectively engage in treatment is, sadly still perpetuated at many levels. I say sadly because the only true “rock bottom” is death. There is always further to fall.
Successful Treatment Comes from Engagement in the Program
The difference between being formally forced into substance abuse treatment and informally forcing a friend or family member into treatment is considerable, and should always be taken into account when discussing the effectiveness of coerced treatment.
Court mandated treatment can work, but in some cases, people are merely using treatment as a way to manipulate the court system. If they don’t fully engage with treatment, then treatment can’t work. If an individual does fully engage in the process, however, then it doesn’t matter why they entered into treatment.
As Diane Jones puts it:
The key to successful outcomes in treatment is the level of engagement with and commitment to treatment and there are many ways to achieve this many of which require some degree of coercion.
Any kind of forced treatment has the potential to succeed, although informal forced treatment by friends or family tends to be more effective, and is very commonplace among individuals in drug or alcohol treatment. Individuals may be pushed into rehab by loved ones initially, but once there, they are able to recognize their need for help and commit to the process of recovery.
Do you think forced addiction treatment works? Send us an email and share your story of addiction anonymously at firstname.lastname@example.org
Read Part II of our forced addiction treatment series