I write this post not as a clinician, but as an individual who has personally experienced this interesting topic in my own life from both ends of the personal/professional spectrum. I came across this article and it brought up some interesting thoughts within myself. I know for a fact that others face the same question(s) when determining whether or not treatment is a viable option for someone struggling with a substance abuse disorder. “Is forcing people with a substance use disorder into drug treatment a good idea?” Literally the title of the article and it sparked, not only some contemplation for the subject, but contemplation within my own experience as a recovered addict/alcoholic who was forced into treatment…. A couple of times!
Now the article focused on primarily the avenue in which a person can be involuntarily committed to a drug and alcohol treatment program, whether an adult or minor under a petitioned court order. This differs from drug offense related mandates in the circumstance that no offense need take place. A petition can be filed by the guardian to a judge to have such an order issued. I did not experience that route, but for my story I was faced with admission into a therapeutic “boarding school” for at-risk teens at the age of 15. Though not ordered by a judge, the school was three states away from California in the woods of Montana. Prior to that I was sent to an intensive outpatient program at the age of 14. Speaking in regards to my own story, I was a minor and under the direction of my parents to attend these programs due to my actions and drug use. I am sure that I questioned my purpose of being in these programs as I, and I assume most at those young ages feel, felt that I didn’t have a problem with drugs and alcohol and the whole situation was being blown out of proportion. I questioned and battled the decision made by my family but I never flat-out refused to go. From the reading of this article and experience working in the field of addiction treatment, there are more hearty fighters than I at that age. Within the article I came across some information that I did not know about our legal system and it’s varied approach to treatment.
“About three dozen states have laws allowing judges to order people into treatment for drug or alcohol addiction. These laws are similar to civil commitment statutes that allow judges to order individuals into a psychiatric facility if a physician determines he or she is a threat to the safety of him or herself or others.”
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How It Helps – Willingness to Enagage
A common question discussed, asked and challenged in modern methods of treating addiction, especially in the widely utilized 12-Step model of care, is; “Is the addicted one truly willing?” Recovery, sobriety, wellness or whatever a person decides to call the process, takes time and actual WORK to attain. Or at least to attain a sustainable recovered state that not only aides someone in remaining abstinent but allows the individual to experience genuine happiness in their life. I believe most working in the field of behavioral healthcare can agree that remaining abstinent is not usually enough. Any manner of effective treatment will challenge an individual to change behavior patterns, belief systems, relationship dynamics and to develop a motivation for continued improvement. This process looks different for anyone and everyone who partakes as addiction and the resulting consequences vary from person to person. That kind of work does take willingness to follow through on. What I find to be one of the major benefits to court mandated treatment under the civil commitment is that willingness to go the full length can be cultivated and does not have to necessarily be present in the beginning. Just because an individual arrives at treatment against their will, in the moment, does not mean that through the beginning stages of the process one cannot develop a desire to then jump into the “deep end of the pool” themselves. How many people show up to addiction treatment “willingly” in order to just attain abstinence without going the full distance? I would put money on the fact that if you asked most professionals who work in addiction treatment they would say 60% – 70%.
Reading this article opened me up to what the definition of willingness could mean when it comes to attaining recovery. Having attended my share of 12-Step meetings I am no stranger to the common phrase “We must go to any lengths…” in order to stay recovered from a drug and alcohol problem. I arrived at my last treatment program completely unwilling to go through the process of recovery. Fear of being homeless and the consequences of my lifestyle kept me within the walls of that program, but the willingness to actually partake in the vulnerability was not present. My first 6 months of “sobriety” were merely abstinence and fear based conformity and it wasn’t until the mental and emotional pain of an untreated, abstinent addiction finally confronted me with two choices: Either jump in and claim my recovery for my own or hit the streets and go back to using, smoking and drinking to numb the pain. I did not go into this program by court order and by definition is was not involuntary but my story is not that different than a number of individuals who enter a program. My point is that whatever the circumstances that get someone into the door, to experience some abstinence from the chemicals and associated lifestyles gives that individual a window of time. The tragic thing about addiction is that we often don’t know how long that window is. For some it is a matter of hours and for others a matter of months as was my story. What happens in that window, however, can make all the difference in whether or not someone takes hold of the help being offered. Just because someone is court mandated to a center doesn’t take away from the possibility that the treatment could make a difference. Something, a conversation or interaction, can shift someone’s thinking just enough to open their mind to other possibilities. Though present for fear of the repercussions, that time spent in a quality treatment program can be the catalyst to spark the change that an addicted individual can benefit from.
The Outcome – Taking Action
In an effort to remain objective on a matter that is truly subjective, although some would argue that statistics don’t lie, there are some potential pitfalls when it comes to involuntary commitment to a drug and alcohol program. I won’t get into the statistics aforementioned, although I have included the link to the article to read further if you so choose. I did want to share a quote from the article about the conflict amongst clinicians regarding involuntary treatment.
“The study did not analyze why those patients suffered a fatal overdose at a greater rate, says Elissa Snook, a spokeswoman for the Massachusetts Department of Health and Human Services. ‘Patients who are committed for treatment under Section 35 are appropriately among the sickest, most complex and at the greatest risk for an overdose,” Snook says. “It is inappropriate to directly compare the treatment outcomes of two different populations: one group that is actively seeking treatment and the other [that] is not.'”
I do agree with the statement above, that to compare the outcomes of these two different demographics is invalid because of the circumstances that separate them. Someone who does show up to treatment of their own volition has a measure, sometimes very minute, of willingness that those court mandated do not. Though difficult and still deserving of care, those that do enter a program under court direction require, at times, more focus and more determination on behalf of the treatment team in order to possibly have a breakthrough. Addiction is a cunning and manipulative foe and for some that desire to fight is just not there. Addiction will have the afflicted believe there is no existing problem and no need for treatment, though the sad reality is ever so clear to that individual’s loved ones. The sad fact of the matter is that we, addicts, are masters of disguise and the fear of jail or prison can motivate someone to just go through the motions of the treatment program. The same could be said of the individual who “willingly” enters program for the sake of his parents leaving them alone and to continue their financial support. There is a reason why clinicians, sponsors and healers would agree that abstinence is often times just the beginning. Abstinence can be attained with respective ease when you are forced into a drug treatment program and your supply is suddenly taken away from you. Addiction will wait until that court commitment is satisfied and the judge is gone, as I have seen many times before in my professional history. Again, the tragic fact is that addiction is a powerful foe and can, often it does, return stronger than ever in those who don’t take the necessary steps to fight. The price is often death by overdose or a lengthy prison sentence.
What I took away from the article and my own process is that we have to try. We, as parents, brothers, sisters or anyone else involved, cannot just sit by and watch our loved ones destroy themselves. I do believe in a healthy sense of detachment that one has to develop when dealing with an addicted loved one otherwise you will lose your own sanity in the cycle of destruction that addiction can cause. Steps can be taken, however, to potentially push your loved one in the right direction and quite frankly a court mandated treatment episode is a much better alternative to changing the locks of your house, hiding your prescriptions or asking your loved one to leave your home. Sometimes those steps are necessary though. If you have a loved one struggling with a drug and alcohol problem, reach out for help. Talk with a treatment professional about the decision to seek civil commitment, and accept the possibility that it may not hold. Or it just may. Hopefully you can gain some peace in the fact that you took action on their behalf…. the rest is up to them.
Please click the link to view the article mentioned on the U.S. New & World Report website