Opinion | Why Forced Addiction Treatment Fails

Now, however, the consensus has shifted. “The data does not show that it’s beneficial to put someone in jail or prison or force them against their will to go to treatment,” said Dr. Nora Volkow, the director of the NIDA She notes that people frequently use anecdotes (like Mr. Norelli’s) to favor mandatory treatment. “There are absolutely instances where people may have had a positive outcome,” she said. “But it’s the minority.”

A 2016 research review shows why. Of the nine studies included, five found no significant reductions in drug use or crime among people who underwent required treatment, and two studies found that mandated therapy made those measures worse. Only two studies found a small benefit in short-term recovery. This is in contrast with the strong literature on voluntary medication use for opioid addiction, which shows that it can reduce mortality by 50 percent or more.

Massachusetts has one of the most frequently used civil commitment systems for addiction, and the results are grim. Much of the treatment takes place in prisons, and lawsuits and reporting has described filthy conditions and lack of access to addiction medications proven to save lives. The state’s statistics show that people who have been committed are twice as likely to die of opioid-related overdose as those who seek help voluntarily. A meta-analysis looking at studies in the United States and around the world of involuntary treatment and HIV and overdose-related risk found similar results.

So why is forced rehab so politically popular? One answer is that it comes across as centrist, mixing law and order with therapy. Another is that families often aren’t aware that there are more effective ways to motivate recovery.

Legal coercion undermines many aspects of effective addiction therapy. It can be difficult to trust providers whose job involves reporting on you to a court. Since relapse is common and often leads to legal consequences, this can discourage disclosure. Coercion can also smother the internal desire to change, which is known to be critical for long-term success.

Fortunately, the same people who balk at commands will often voluntarily take action if persuaded that it will help them get what they want. One of the most successful addiction treatments, motivational enhancement therapy, focuses on helping people build relationship and career goals. Proponents of this approach say it allows people to see for themselves that their drug use is an obstacle, creating desire to change.

Another therapy, called Community Reinforcement and Family Therapy (CRAFT), teaches families to lovingly motivate people with addiction and is more effective than other treatments. A third highly effective approach, known as contingency management, uses rewards like free movie tickets instead of punishment. But these therapies are, unsurprisingly, rarely available in mandated treatment.


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