A Last Resort: The Issue of Involuntary Commitment for Addiction Treatment
When a loved one is struggling with substance use disorder, families and friends are forced to make a series of choices they never thought they’d have to make almost on a minute-by-minute basis: Do they believe them when they tell us something? Should they leave them alone to their own devices? Do they offer support or sever contact? One of the most painful, and unfortunately common, questions that loved ones of addicts are forced to ask themselves is whether or not involuntary commitment for addiction treatment is a justified or effective option. A recent story on NPR’s Weekend Edition highlights the complexity and dilemmas that come along with this incredibly difficult question.
The piece discusses a Massachusetts man whose life quickly declined and eventually ended in suicide after being committed to a prison-based program for opioid addiction. His mother, an experienced addiction counselor, wrestled with the thought of involuntary commitment and ultimately asked a judge to sign off on the request on the basis that he was a danger to himself. It should also be noted that this program was run by the Massachusetts Department of Corrections and did not offer key treatment elements, including access to maintenance medications like methadone, Suboxone® or Vivitrol®, which have long been regarded as the gold standard of treatment for opioid use disorder.
We’ve heard, and said, time and again that a person has to want to get clean for themselves. Without emotional buy-in or enthusiasm, the treatment process will be seen as a series of obstacles that offers no real reward. This line of thinking can lead to premature exit from the program, relapse and even a potential safety risk to the other patients in the program.
The reality is that thousands of families per year across 37 states avail themselves of laws that allow involuntary commitment for addiction treatment. In a climate in which over 70,000 Americans are dying from drug overdose year after year, many loved ones of addicts see this measure as a last resort to get them the help they need. The line of thinking behind this practice is that it allows individuals whose brain chemistry and decision-making has been impaired and hijacked by the constant compulsive pursuit of alcohol and other drugs.
Many of us have seen what happens when even the most loving, even-tempered and lucid people are in the throes of addiction; they can become manipulative, erratic and even violent in pursuit of their next fix. They will also exist in a state of complete denial that they have a problem, and do everything they can to avoid treatment, becoming an increasingly apparent danger to themselves and the people around them. Many loved ones see civil commitment as a “nuclear” option to give their loved one a safe place to get compassionate and effective treatment while their brain chemistry is balanced and stabilized. The approval to involuntary commit a person for drug addiction rests upon whether the person is in control of their own actions and whether or not they represent a danger to others.
It’s critically important that those who are entering drug or alcohol addiction, whether voluntarily or through civil commitment, get the right kind of help. The case in the aforementioned article ended in tragedy primarily because the treatment program in question was not equipped to deal with the patient’s needs and failed to provide adequate care. Substance use treatment must include interventions that address the immediate medical and behavioral aspects of the disease of addiction while providing ongoing management to prevent relapse. Loved ones of SUD sufferers who are endeavoring a civil commitment, whatever the circumstances may be, should be mindful of the potential risks involved in enrolling their loved one in an ineffective treatment program.
The decision to pursue a loved one’s involuntarily commitment to addiction treatment is one nobody should ever have to consider; however, it’s one that thousands are forced to make year after year. In a situation in which judgement, actions and the treatment of others is compromised by alcohol and drug addiction, it’s very difficult to know the right thing to do. Whether or not the action of civil commitment is justified, it’s critical that you or your loved one seek professional treatment if you’ve succumbed to substance use disorder.
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