Court-Mandated Treatment

Court-mandated substance abuse treatment uses extrinsic motivators to enforce treatment engagement and compliance, with the underlying premise that personal choice may be important but not essential to treatment success. Proponents of compulsory treatment cite the high relapse rates found in voluntary treatment programs, increases in addiction and drug-related crime rates, and the high economic, health, and emotional cost of illicit drug use to support legal enforcement of substance abuse treatment. Research also supports the use of social control strategies as intrinsic motivation is not universally sufficient to encourage treatment engagement or sustain treatment involvement long enough to result in posttreatment behavior change. Alternatively, opponents of compulsory treatment assert that forced treatment violates U.S. beliefs in individualism and personal choice.

The U.S. legal system, business employers, families, and friends of those with substance use disorders (SUD) utilize various forms of coercion to pressure individuals into substance abuse treatment. Researchers classify these coercive methods as legal, formal, or informal mandates according to the originating source. For example, judges generate legal mandates following adjudication for criminal behavior such as illicit substance use, possession, or sales, and crimes committed while under the influence of illicit substances. Court orders may stipulate that the SUD client must participate in various treatment programs while on parole or probation. These can include inpatient or outpatient treatment, intensive supervision, diversion programs for first-time nonviolent offenders, day-treatment programs, other contingency management programs, and drug courts. Legally mandated programs also include placement in prison-based programs such as therapeutic community programs. These and similar intensive substance abuse treatment programs are available for nonviolent offenders during the last portion of their incarceration and usually involve postrelease monitoring for continued compliance.

Businesses and government social services agencies, for example, the Child Protection Agency, utilize formal mandates to pressure substance abusing employees or clients to participate in treatment. Employers may require drug screening, for example, urinalysis, breathalyzer, saliva testing, or hair cuticle testing, to monitor employee behavior. Employers also may offer drug abuse treatment as a contingency to remaining employed. Social service agencies may compel addicted clients to seek treatment to maintain or gain custody of their children or to qualify for benefits under programs such as the 1996 Welfare Reform Act (Temporary Assistance for Needy Families—TANF).

Informal mandates occur when families and friends apply social pressure in an effort to convince loved ones to seek substance abuse treatment. Family interventions allow family members to voice their concerns regarding substance use in a nonconfrontational, supportive, yet firm manner and to convince the abuser to seek professional help. Families and friends also utilize consequences for refusal to seek treatment, including ostracism and withdrawal of financial and emotional support.