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Does Mandatory Addiction Treatment Work?

photo of a judge gavel and law book from a courtroom next to illegal drug needles

Drug and alcohol addiction treatment in the United States has evolved considerably in the last 50 years. Our nation has slowly moved away from the philosophy of incarcerating people with addictions to providing treatment. While it has been shown that treatment is much more successful in helping people with substance use disorders (SUDs) than punishment, the question of whether or not mandatory rehabilitation can be effective remains unanswered.

Many subscribe to the belief that an addicted individual must “hit rock bottom” before he or she can get better, thus making mandatory treatment inherently flawed. The “rock bottom” theory implies that a person must get to a certain low-point in his or her life (either professionally or personally) in order to make the decision to get help and be treatable. This theory would make mandatory treatment useless, because the addicted individual did not choose to get help. Others argue that a person with a drug or alcohol addiction is unlikely to voluntarily seek treatment and needs to be pushed into it, making mandatory rehab a viable option. 

Boston Medical Center's global analysis of mandatory drug treatment programs determined there was no evidence that these programs were effective.

The Boston Medical Center is the most recent group to offer its two cents. In June 2016, the organization conducted a global analysis of the efficacy of mandatory drug treatment programs and determined there was no evidence that these programs were effective.[1] In addition, the medical center found that these programs violate human rights principles laid out in the Covenant on Economic, Social and Cultural Rights, a U.N. treaty signed by 160 states.[2]

Not All Mandatory Treatment is the Same

For the purposes of the global analysis (which did not include drug courts in America), mandatory treatment was defined as “any form of drug treatment that is ordered, motivated, or supervised by the criminal justice system.” But within this broad definition lies differing degrees of severity:

  • Quasicompulsory: Person is offered a choice between incarceration and treatment.
  • Compulsory: Authorities mandate treatment without allowing the person the option to give consent, decline treatment or choose the type of treatment received.[3]

Most mandatory drug treatment programs within the U.S. and around the world fall somewhere in between these two extremes. In this global analysis, mandatory detention was a part of many of the programs observed by the Boston Medical Center, where hundreds and even thousands of people are detained for periods ranging from a couple of months to multiple years. These facilities are run by police officers and members of the military, rather than by medical and addiction care professionals.

This is an oppressive form of addiction rehabilitation and is not allowed in the United States or in many other developed nations. Instead, our country has relied on drug courts as a diversionary programs since the late 1980s. The first drug court was established in Miami-Dade County, FL in 1989.[4] The program was created in response to growing frustrations over repeatedly seeing the same faces in court for non-violent drug offenses. As of June 30, 2014, there were 2,968 drug courts in the United States, with programs operating in every U.S. state and territory.[5]

Specifics about U.S. Drug Courts

Drug courts combine drug treatment with the structure and authority of a judge and court system. The programs provide nonviolent people with substance abuse problems with intensive court supervision, mandatory drug testing, addiction treatment and other social services in an effort to keep them out of jail or prison. When faced with the alternative of incarceration, many happily choose drug courts. Ideally, these programs help participants break the cycle of substance abuse and addiction.

It’s important to note that these programs are optional. Drug offenders must agree to all of the program’s requirements and successfully meet all obligations in order to avoid jail, have their sentences lessened or have charges reduced or dismissed. While there could be some debate as to how “optional” these programs are in reality, the fact that U.S. Congress has continuously supported its development is a sign that drug courts are considered to be effective.

Since their creation, drug courts have been evaluated on the following three types of analyses:

  • Cost Savings: The amount saved in comparison to what would’ve been spent with incarceration, adjudication (court trying and sentencing) or criminal victimization.
  • Impact: Whether or not drug courts improved the lives of drug offenders compared to those who were incarcerated. Recidivism rate, employment and future substance abuse are among the factors evaluated and compared.
  • Process or Operations: This type of analysis focuses on the program’s details, such as the number of participants, referrals to treatment and the number of individuals successfully graduating from the program.[6]

How Successful Have Drug Courts Been?

While it’s widely believed that drug courts are certainly an improvement over the incarceration-focused policies of the past, there is some debate about their effectiveness in reducing substance abuse. According to the National Association of Drug Court Professionals (NADCP), drug court programs have been wildly successful in America. Here are some of their supporting facts:


  • Nationwide, 75 percent of drug court graduates remain arrest-free for at least two years following the program’s conclusion.

 


  • Drug courts reduce crime by as much as 45 percent, compared to other sentencing options (probation, jail or prison)

 


  • Drug courts produce cost savings ranging from $3,000 - $13,000 per client. These savings reflect reduced prison cost, lower recidivism and reduced victimization.

 


  • Parents who are in family drug court are twice as likely to go to treatment and complete it.[7]

Despite these supporting facts and figures, there have been many criticisms of the programs, namely in the evaluations themselves. Since funding is often dependent on a drug court’s ability to demonstrate effectiveness, many argue that the programs’ operators may be inclined to only report positive results or create evaluation methodologies that will ignore negative outcomes.

For example, the majority of drug court evaluation programs have no comparison group, such as offenders who refused treatment. This means that any success numbers reported by drug courts lack the context to put them in proper perspective.

"drug court programs do not have much interaction with participants following graduation – meaning there are no long-term success or failure rates to examine."

Another criticism is that treatment outcomes are only reported for those who graduate the program – meaning that it is not a true measure of the program’s overall effectiveness. Additionally, much of the drug court data is based on the self-reporting of participants (who are obviously motivated to report no drug use), adding another flaw. Lastly, drug court programs do not have much interaction with participants following graduation – meaning there are no long-term success or failure rates to examine.

Addiction Treatment is a Must

Though opinions vary on the efficacy of drug courts and the validity of their success-rates, there is little argument that they are more effective than incarceration. Many researchers believe that despite criticisms of drug courts, they are one of the most effective tools for combating addiction available.[8] This is because after centuries of research and observation, it has been shown that you can’t incarcerate a person’s addictions away. Drug courts allow addicted individuals to remain employed and to be productive members of their household and society.

At Behavioral Health of the Palm Beaches, we firmly support a treatment over punishment approach to addiction rehab. We offer an intensive DUI rehab alternative program and professional intervention services to help give your loved one the push he or she needs into treatment.

While it would be great if people addicted to drugs and/or alcohol took it upon themselves to get treatment, there are many who need extra motivation. We believe that the only thing stronger than addiction is love. If there’s a person in your life who needs help defeating an addiction, show how much you love and care for him or her by calling one of our representatives at 888-432-2467 to learn more about our treatment options.

 

[1] http://www.bmj.com/content/353/bmj.i2943
[2] https://treaties.un.org/Pages/ViewDetails.aspx?src=TREATY&mtdsg_no=IV-3
[3] http://www.medicaldaily.com/drug-addiction-united-nations-human-rights-3902
[4] http://www.nadcp.org/learn/what-are-drug-courts/drug-court-history
[5] http://www.ndcrc.org/content/how-many-drug-courts-are-there
[6] https://www.fas.org/sgp/crs/misc/R41448.pdf
[7] http://www.nadcp.org/learn/facts-and-figures
[8]http://www.americanbar.org/content/dam/aba/publishing/criminal_justice_sect