The Use of Legal Coercion in the Treatment of Substance Abusers: An Overview and Critical Analysis of Thirty Years of Research

Abstract

Drug and alcohol use presents a serious social problem for most countries in the world. Of particular concern is the well-documented relationship between substance use and crime, which has contributed to an increased popularity and willingness to utilize more forceful means to pressure substance users into treatment. Although compulsory/legally mandated treatment is appealing, it has been one of the most fiercely debated topics in the addiction field, raising a number of issues including ethical concerns and motivational considerations. In this context, the most important question to be answered is whether or not compulsory treatment is effective in the rehabilitation of addicted offenders. Regrettably, three decades of research into the effectiveness of compulsory treatment have yielded a mixed, inconsistent, and inconclusive pattern of results, calling into question the evidence-based claims made by numerous researchers that compulsory treatment is effective in the rehabilitation of substance users. The present paper provides an overview of the key issues concerning the use and efficacy of legal coercion in the rehabilitation of substance users, including a critique of the research base and recommendations for future research.

The influence of legal coercion on dropout from substance abuse treatment: Results from a national survey

“…On the other hand, coercion is seen as a legitimate solution to problems of community safety and a response to society's disillusionment with incarceration as a means of curbing the problems of this population (Klag et al, 2005). In other words, it can help provide treatment to individuals who would otherwise not access these resources (Anglin et al, 1989).…”

“…Therefore, it is important to consider whether retention can be improved through the use of legal coercion. Despite the potential of legal coercion to keep people in treatment, a recent review of the literature by Klag et al (2005) shows mixed evidence on the positive influence of legal coercion on retention in substance abuse treatment. They argued that the current knowledge is based on small, nonempirical, single-site studies that have serious conceptual and methodological problems (Klag et al, 2005).…”

“…Despite the potential of legal coercion to keep people in treatment, a recent review of the literature by Klag et al (2005) shows mixed evidence on the positive influence of legal coercion on retention in substance abuse treatment. They argued that the current knowledge is based on small, nonempirical, single-site studies that have serious conceptual and methodological problems (Klag et al, 2005). It is important to consider this question using large samples that are generalizable to publicly funded programs and include controls for potentially confounding variables.…”

Substance Use, Symptom, and Employment Outcomes of Persons With a Workplace Mandate for Chemical Dependency Treatment

“…Study participants who had a workplace mandate were more likely than those who did not have a workplace mandate to be abstinent at follow-up, and they did as well in treatment, both short and long term. Pressure from the workplace likely gets people to treatment earlier and provides incentives for treatment adherence.Treatment mandates are a major predictor of entry into chemical dependency treatment (1)(2)(3)(4)(5). In the public sector, individuals are often pressured to enter treatment by criminal justice or welfare agencies; in private programs the pressure is often from employers (1,3).…”

The use of depot naltrexone under legal coercion: the case for caution

“…[1] in the absence of compelling evidence of its efficacy [3,4]). In the case of heroin addiction, the renewed interest has been stimulated by the development of depot forms of the opioid antagonist, naltrexone, which promises to be more effective in ensuring abstinence from opioids than psychosocial treatment or oral naltrexone [5].…”