Patients with substance use disorders need care, not coercion

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A few years ago, I interviewed dozens of people struggling with substance use disorders, from alcoholism to opioid addiction. They all had one thing in common: they were forced into treatment programs through a practice called involuntary commitment. The people I interviewed were often ambivalent about forced treatment. On the one hand, they knew they wouldn’t seek treatment on their own. On the other, they resented the cycle of arrest, release, and eventual relapse. If treatment was so important, they wondered, why wasn’t it working for them?

The reality of addiction treatment in the U.S. is complicated—full of bias, stigma, and outdated practices. That holds true whether the treatment is voluntary or mandatory. But forced treatment also brings up a host of efficacy and ethical concerns.

So when John Messinger mentioned he’d been following patients involuntarily committed to treatment in Boston, I immediately asked him to write about it. Now a medical resident in San Francisco, Messinger works with high-risk, high-need patients who grapple with mental illness and substance use disorders. In his practice, he’s seen dozens of patients forced into treatment, and observed first-hand the dangers and limitations of coercive treatment. He’s part of a research team that recently published a study of 22 patients involuntarily committed for substance use disorders in Boston. They found forced treatment failed for every one of those patients, two of whom died.

As policymakers race to lower the threshold for involuntary commitment to “solve” everything from homelessness to mental illness, Messinger and his co-author, Jacqueline Garza, remind us the practice has stark limitations, and in many ways resembles arrest and incarceration rather than care and treatment. Instead, they recommend that states and hospitals invest in housing, walk-in clinics, and wraparound services for those struggling with addiction, housing instability, or mental illness.

“Let’s invest in a system that doesn’t perpetuate harm, and relies on care, not coercion, to treat the most vulnerable among us,” they write.

• Patients with substance use disorders need care, not coercion | John Messinger & Jacqueline Garza

Related Reading

• Nonprofit hospitals are sitting on $14 billion. Let’s spend it on public health. | Tatiane Santos
• Treating opioid use disorder is difficult; more doctors should do it. | John Messinger

Book review: “Wonder Drug” by Jennifer Vanderbes

Award-winning journalist Jennifer Vanderbes uncovers a previously untold history of thalidomide’s victims in the United States, and the role played by a complacent FDA in failing to stop a dangerous drug from hitting the U.S. drug market in the 1960s. Our reviewer and HPH advisory board member, Richard J. Tofel, writes that Vanderbes “tells her story with verve, power, and empathy.” The story, he writes, “leaves readers with no illusions about the limits” of our collective knowledge on how thalidomide hurt victims, or the lack of remedy for them since.

• “Wonder Drug” draws back the veil on thalidomide’s hidden American victims | Richard J. Tofel

What we’re reading this week

• The essentialism of addiction | Inquest
• How climate change is making us sick | Grist
• How health care may be affected by the high court’s affirmative action ruling | KFF Health News
• The national movement to make school lunches free has hit six states | The 19th
• Experimental drug slows Alzheimer's decline in early-stage patients | Axios

See you next week!

—Christine