Compulsory treatment of addiction in the patient's best interests: More rigorous evaluations are essential

July 2014
Hall, W., Farrell, M., Carter, A. (2014). Compulsory treatment of addiction in the patient's best interests: More rigorous evaluations are essential. Drug and Alcohol Review, 33, 268-271.

There has been renewed advocacy in Australia and the USA for the revival of compulsory treatment of severely addicted persons for their own good. The reasons for this revival are unclear but probably include a convergence of factors that includes the frustration of health providers in dealing with repeated hospital presentations for alcohol-related problems and pressure from family members for the health system to intervene in the self-destructive or harmful alcohol and drug use of their members. 

Involuntary treatment of inebriety was introduced in Australia and the USA in the mid to late 19th century. It largely fell out of favour in the 20th century because of its high cost and low success rates. Paternalistic compulsory addiction treatment is again being trialled in two Australian states, New South Wales (NSW) and Victoria.  

A failure to properly evaluate the current trials of compulsory addiction treatment would be a major missed opportunity. It could result in another policy experiment with compulsion that falls into disuse for reasons that are not understood. If this happens, the addictions field will be no better informed after these trials about whether it is ethical, effective and cost-effective to compulsorily treat severely addicted persons.

The authors suggest five evaluation steps for any for governments that have reintroduced compulsory addiction treatment: 

  1. Assess how these schemes operate over substantial periods of time and do not rely on uncontrolled case reports of persons who have been treated when in well-resourced programs with well-trained and highly motivated staff.
  2. Conduct more rigorous randomised controlled trials of compulsory addiction treatment. Evaluation should include cost and cost effectiveness.
  3. Examine the effects that providing compulsory treatment may have on voluntary addiction treatment.
  4. Examine how well procedural protections of civil rights perform in compulsory treatment systems, especially after treatment becomes more routine.
  5. Investigate how compulsory addiction treatment interacts with legally coerced addiction treatment such as that provided for addicted offenders in the criminal justice system.