Mandatory addiction treatment for people who use drugs: global health and human rights analysisBMJ 2016; 353 doi: https://doi.org/10.1136/bmj.i2943 (Published 09 June 2016) Cite this as: BMJ 2016;353:i2943
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This response is in relation to your article discussing mandatory addiction treatment for people who use drugs. I must say that this was a very interesting and timely article and a very interesting read for persons involved in Psychiatric/Mental health care like myself. Results from this study indicated that…where effective medical treatment and counselling interventions were absent, detaining patients for drug use or addiction in the absence of evidence eventually causes more harm than good and places patients at high risk. Having worked in the field of Psychiatric/Mental Health Nursing and Addiction Treatment for over ten years, this measure produces more negative than positive outcomes for patients and their families for example lack of cooperation with treatment and increased relapse rates, especially in the absence of effective substance abuse care and counselling. Using evidence-based care has proven to be effective in producing positive outcomes, such as crime reduction (Gossop, et al., 2000).
With the high level of stigma and discrimination that continues to exist for mental health/illness and substance abuse, it is quite duplicitous that any government would think that detention of substance abusers would help to solve the issue of addiction. Research has shown as stated in your article that there has to be a multidisciplinary approach to substance addiction treatment. Ziedonis (2007) alludes to this as they found that staff attitudes about, lack of adequate staff training, unfounded fears among treatment staff and administration, and limited treatment resources are significant barriers to treatment. Individuals desiring cease their addictive use of substances must make a conscious decision to do so and be actively involved in the process of transformation, through evidence-based treatment and interventions. This can be facilitated as you have stated through a cooperation among medical personnel and the courts, which will lead to more efficient outcomes.
With the global initiative to move away from centralized mental health and substance abuse care towards a system that is more community based it is no wonder, as stated in your article that the United Nations has called for such centres to be closed and for voluntary, evidence and rights based health and social services to be implemented in the community. Legislative approaches to mandating care for substance addiction is unethical and a clear violation of the International Covenant on Economic, Social and Cultural Rights.
Terry J. Campbell
The College of The Bahamas
Gossop, M., Marsden, J., Stewart, D., Rolfe, A. (2000). Reductions in acquisitive crime and drug use after treatment of addiction problems: 1-year follow-up outcomes. Drug and Alcohol Dependence, 58(1-2), 165-172.
Ziedonis, D., Guydish, J., Williams, J., Steinberg, M., and Foulds, J. (2007). Barriers and solutions to addressing tobacco dependence in addiction treatment programs. Psychiatry Publications & Presentations. Paper 215.
Competing interests: No competing interests
Mandating treatment for people who have problems with substances is appealing to many governments, including the current UK administration. They have asked Dame Carol Black to provide a report based on the idea that treatment will be a requirement for drug dependent individuals who are in receipt of social security benefits (1). This will please some tax payers who will no doubt view substance use problems as self inflicted and not a lifestyle that should be subsidised with their money.
As Lunze and colleagues point out there is no evidence to support compulsory treatment. So we can only assume that this idea is meant to appeal to a section of the electorate and not to advance
If this proposal is implemented and coercive treatment is introduced the drug treatment sector will require substantial investment to cope with the tens of thousands of welfare recipients referred. A marked change for a sector which has seen funding reduced and in effect been contracted out to the voluntary sector (2).
Any worker involved in this forced form of treatment will need to consider the ethical situation they find themselves in. Treatment must be based on consent, but this is compromised if you are faced with a scenario where you will loose your entitlement to benefits if you refuse treatment. So workers will be complicit in state sponsored coercion.
It is unfortunate that addiction, a symptom of complex social problems, invokes a punitive non evidence based response by those in power. We must be more ambitious about the way we help people access help for drug and alcohol problems but this should be underpinned by evidence and compassion, not voter appeal.
1. Department of work and pensions (2015) Drug and alcohol addiction, and obesity: effects on employment outcomes (independent review). https://www.gov.uk/government/consultations/drug-and-alcohol-addiction-a...
2. The Guardian (2014) Cuts in drug treatment funding. http://www.theguardian.com/politics/2014/nov/05/cuts-in-drug-treatment-f...
Competing interests: No competing interests