Three years ago, I had a minor medical issue at work. I asked to leave early for the day so I could see my doctor. Instead, my supervisor called 911 against my will. I began to panic.
When the police arrived and saw my state of panic, they gave me two options: I could get in the ambulance, or they could handcuff me and take me to the hospital by force. I opted for the ambulance and spent the rest of the afternoon under unnecessary observation at the hospital. No one ever addressed my original health concern.
I was lucky. If I’d been suffering from an addiction, I wouldn’t have gotten off so easily.
A Tradition of Forced Treatment
People with mental illnesses are mistreated time and again by emergency services and healthcare providers, but people with substance abuse disorders really seem to get the short end of the stick. More than half of the patients in addiction care are not there by choice, and bed shortages often lead to addicts being placed in prisons in lieu of actual treatment facilities.
This year, Massachusetts Governor Charlie Baker proposed a new piece of legislation that would make it even easier for medical professionals to force addicts into treatment programs without their consent.
Currently in Massachusetts, doctors need to petition a court order before they can keep a patient against their will. The proposed legislation would eliminate that need and let doctors make that decision at their own discretion, no court order required.
Some might argue that involuntary addiction treatment is a necessary evil. No one is claiming it’s pleasant, but at least it saves lives—right? But does involuntary commitment to addiction treatment really save lives, or does it ruin them?
An Ethical Dilemma
Are we trying to help addicts or punish them? Based on how our medical system treats substance abuse, the latter seems to be the case.
When addicts are involuntarily committed to treatment programs, they aren’t treated like patients—they’re treated like criminals. Addiction treatment programs tend to be built around punishment, humiliation and moral control, not around kindness or empathy towards their patients.
Involuntary commitment is often a traumatic experience for psychiatric patients, including those dealing with substance abuse. The mere possibility of being involuntarily committed scares some addicts so much that they avoid healthcare entirely, sometimes even healthcare unrelated to their addiction. This can put their health at risk and deter them from pursuing sobriety in the future.
An Ineffective Practice
As it turns out, there isn’t much proof that involuntary commitment even works. If anything, it puts patients in more danger.
Substance abuse doesn’t happen in a vacuum. Many addicts suffer from other mental illnesses or chronic pain. Others are dealing with bad home situations. People don’t become addicts for fun. More often than not, they become addicts out of desperation to escape an awful reality.
Many addicts are forced into treatment programs that are not sensitive to their living situations or other health needs. As a result, they’re likely to relapse not long after they leave the program.
These involuntary treatment programs are also notorious for forcing patients to quit cold turkey. Unfortunately, abruptly quitting substance use can lead to unbearable and even dangerous withdrawal symptoms. Here are some of the more serious symptoms that can affect recovering addicts during withdrawal:
- Diarrhea and vomiting
- Heart attacks
- Suicidal thoughts
A cold turkey approach also fails to take into account that recovery is a long-term process. It doesn’t happen overnight, and it requires more than just willpower. People recovering from addictions need an individualized treatment plan and a full social, psychological and medical support network to beat their addictions.
Such a shortsighted approach to addiction care does little more than set patients up for relapse and possibly overdose.
A Sensitive Alternative
The good news is that there are lots of ethical and effective alternatives to involuntary commitment. Instead of stripping addicts of their rights and independence by forcing sobriety on them, perhaps we should focus on opening up more opportunities for them to choose sobriety for themselves.
The first step is to make more beds available in addiction treatment programs. The lack of available beds means voluntary patients may spend months or years on a waitlist before receiving treatment, and involuntary patients may end up in traumatizing prison-based treatment programs.
Increasing awareness of and access to life-saving medications, like buprenorphine and naltrexone for opiate addicts, is another step in the right direction. When paired with caring professional support, these medications can help ease patients out of challenging addictions.
Perhaps the most important step of all, though, is to make addiction care safe and enticing for patients. It’s important to remember that substance abuse disorder is an illness, and a positive environment is conducive to recovery. Kind, empathetic care will attract far more patients and lead to far more success than a forceful and punitive approach.
Ultimately, people can only choose sobriety for themselves. We can’t fight substance abuse by forcing sobriety on people. It’s neither ethical nor effective. Instead, we have to make sobriety a safe and attainable goal that people can, and want, to choose for themselves.