The article in the Sunday edition, “Addiction Treatment Can Work Even When It’s Not Voluntary”, provides a well-supported argument for mandatory addiction treatment. To date, the sparse peer-reviewed work conducted on compulsory treatment has been antagonistic to the idea. “Given the potential for human rights abuses within compulsory treatment settings, non-compulsory treatment modalities should be prioritized by policymakers seeking to reduce drug-related harms.” (“The Effectiveness of Compulsory Drug Treatment”, A Kamarulzaman, et al., Dec. 2015) Newer evidence shared by Satel and Sabet in their article contradicts the cited work. Further, it fails to contemplate nearly a century of history of involuntary commitments for a multitude of reasons. The theory that drug addiction is a disease and that those who suffer from addiction should not face the danger of “consequences” has unfortunately taken hold. As a community we began to accept responsibility for the negative personal choices of our fellow Americans, viewing challenges such as the drug scourge as our failure as a society rather than bad personal choices. Decriminalization of very dangerous narcotics is the most recent manifestation of this. Addiction researchers should broaden their focus to include case studies of mental health wholly unrelated to drugs. Severe mental illness, referred to before it became an insensitive and politically incorrect term (“crazy”), would be a good start. There is a corollary, an issue which forms part of our public discourse on almost a daily basis, . . . gun violence.
Before the notorious mafia murders during prohibition and post-prohibition, any adult citizen could walk into a gun store and legally purchase any type of firearm available. It was very rare to hear of a mass shooting, children murdered by their classmates or any other horrific act with a firearm outside of the criminal underworld. Passage of the NFA in 1938, the GCA in 1968, and various state gun control regimes emerged however the increase in gun violence continued to grow. The commonsense observation, immediately applicable to the compulsory treatment question, is that we used to “lock up crazy.” Simplistically, an individual walking down the street arguing with an imaginary person in the 1940s or 1950s would likely have found him or herself the guest of a psychiatric institution. Within the context of the gun violence question, the Sandy Hook Elementary School shooter Adam Lanza may have been deprived of the opportunity to commit his heinous act.
Before the 1960s cultural revolution and posterior changes in public opinion about personal responsibility for one’s behavior, involuntary commitment was prevalent. Advances in pharmaceutical science from the 1950s forward supported the theory that a “pill” was the magical bullet, further eroding the view that involuntary commitment was a necessary evil. The courts likewise offered little help to the supporters of commitment. The 1975 case of O’Connor v. Donaldson is instructive. It represented a change in the justifying criteria for commitment from a broader test to that of almost exclusively one of the dangers that an individual presents to society. Writing for Psychiatry (Edgemont Journal), Doctors Megan Testa and Sara West wrote, “Through interviews of mothers of individuals with mental illness, Copeland learned that current civil commitment criteria force relatives to watch their loved ones go through progressive stages of psychiatric decompensation before they can get them any help at all.” (“Civil Commitment in the United States”, Megan Testa, MD and Sara G. West, MD, Oct 2010, Psychiatry) The court-imposed restrictions on involuntary commitment exacerbated the problem.
The curtailment of involuntary treatments, whether it be for drug addiction or mental illness, has impaired our ability as a society to address some of the gravest challenges to our safety as well as the happiness and well-being of those addicts and mentally ill. Authors Sally Satel and Kevin Sabet’s article on mandated treatment is prescient and the involuntary commitment question merits renewed attention.