Uses of Coercion in Addiction Treatment: Clinical Aspects

Abstract

Coerced or involuntary treatment comprises an integral, often positive component of treatment for addictive disorders. By the same token, coercion in health care raises numerous ethical, clinical, legal, political, cultural, and philosophical issues. In order to apply coerced care effectively, health care professionals should appreciate the indications, methods, advantages, and liabilities associated with this important clinical modality. An expert panel, consisting of the Addiction Committee of the Group for the Advancement of Psychiatry, listed the issues to be considered by clinicians in considering coerced treatment. In undertaking this task, they searched the literature using Pubmed from 1985 to 2005 using the following search terms: addiction, alcohol, coercion, compulsory, involuntary, substance, and treatment. In addition, they utilized relevant literature from published reports. In the treatment of addictions, coercive techniques can be effective and may be warranted in some circumstances. Various dimensions of coercive treatment are reviewed, including interventions to initiate treatment; contingency contracting and urine testing in the context of psychotherapy; and pharmacological methods of coercion such as disulfiram, naltrexone, and the use of a cocaine vaccine. The philosophical, historical, and societal aspects of coerced treatment are considered.

Anticipating possible policy uses of addiction neuroscience research

“…Caplan has justified this proposal by appeal to a BDMA, arguing that the autonomy of addicted persons is impaired in ways that make them unable to act in their own best interests, so the state should compel them to undergo treatment in their own best interests (Caplan, 2008). He proposed that opioid addicted persons should be mandated by courts to use naltrexone implants (Caplan, 2008;Sullivan et al, 2008). He argues that opioid addiction robs individuals of their autonomy and that providing them with implantable naltrexone restores their autonomy by removing their cravings for heroin and blocking its euphoric effects should they succumb to temptation.…”

Du sable dans l’engrenage : la motivation des clients sous contrainte judiciaire dans les traitements pour la toxicomanie

“…Aux États-Unis, de 40 à 50 % des personnes qui participent aux programmes de traitement de la toxicomanie subventionnés par le gouvernement proviennent du système de justice criminelle (Anglin et coll. 1 , cités par Sullivan, 2008). Ainsi, depuis les dix dernières années, l'intérêt scientifique porté aux enjeux posés par l'intervention en contexte de pouvoir et de subordination n'a fait qu'augmenter.…”

“…Actuellement, la discussion portant sur les traitements sous contrainte s'avère polarisée (voir Hough, 2002 ;Seddon, 2007 ;Sullivan et coll., 2008). D'un côté se trouvent les opposants à ce genre de programme, dont l'opinion se fonde sur des arguments éthiques ou cliniques contre l'imposition d'une intervention, et de l'autre, les partisans qui soulignent que, d'une façon géné-rale, une majorité des toxicomanes ne commencent pas leur traitement sans une pression externe.…”

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

“…In many developed countries over the past century there have been periodic enthusiasms for legally coerced treatment of addiction; that is, addiction treatment that is offered as an alternative to imprisonment [1]. Between the 1930s and early 1970s, for example, the United States established two Federal 'public health hospitals' where opioid addicts were treated compulsorily for 6 months or more [2].…”

“…[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].…”