Coercion and Treatment

Studies have shown that there is a strong association between drug use and crime. Drug use is directly related to crime in that it is a crime to use, possess, and manufacture illegal drugs. Drugs are also related to crime through the effects they have on the user's behavior (such as committing violent offenses or by committing offenses to get money to support their continued use). Even though treatment is seen as the most effective way of breaking the cycle between drug use and crime, many individuals with drug problems do not receive treatment. The National Survey on Drug Use and Health estimated that in 2006, 21.1 million people ages 12 or older needed but did not receive treatment for an illicit drug or alcohol problem. Some of the reasons why people did not receive treatment were (a) they encountered barriers related to cost, (b) they did not think they had a problem, and (c) they were not ready to stop using. The consequences of an untreated substance use problem can lead to significant costs to society. These include costs associated with drug-related crimes, prison expenses, court and criminal costs, emergency room visits, reduced productivity, and unemployment. In fact, a report released by the Office of National Drug Control Policy estimated that the costs associated with drug abuse in 2002 came to approximately $181 billion, $107 billion of which was associated with a drug-related crime. Based on the evidence supporting that the successful completion of drug abuse treatment helps reduce drug-related crime and the costs associated with it, there has been a push to employ more forceful means of pressuring substance users into treatment through the use of legal coercion.

The use of coercion as a way to get people into treatment has been employed throughout the United States for decades, starting with the morphine maintenance clinics in the early 1920s. The 1960s saw the implementation of civil commitment procedures in the federal system, as well as in New York and California. The civil commitment procedures have since been replaced with the process of providing legal referrals to treatment from various criminal justice sources. The current system, which has been in place since the 1970s, emphasizes community-based treatment as an alternative to incarceration or as a condition of probation or parole. It is estimated that the criminal justice system is responsible for almost half of the referrals to community-based treatment programs. The criminal justice system also provides treatment to offenders while incarcerated, which can also be coercive, depending on whether or not the offender can make the decision to enter treatment. For instance, some states have recently developed prison-based treatment programs where the inmates identified as needing treatment are mandated to participate in the program while other prison-based treatment programs leave it up to the offender to decide if they want to participate in the treatment program.

Coercion through legal pressure can take on many different forms. It can be a recommendation to receive treatment through the criminal justice system; an option of having legal sanctions deferred, reduced, or lifted if a person enters and completes treatment; or even a requirement, sending inmates involuntarily to a prison treatment program. Coercion through the criminal system can also be defined based on the amount of control a criminal agency has over the client. For example, low coercion would be a referral to a treatment program without having to undergo drug testing while enrolled; moderate coercion would be where an offender is formally ordered to enter treatment but not required to submit to drug testing while enrolled; high coercion would take place when an offender is ordered to enter treatment and to undergo drug testing.

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