When New York Mayor Eric Adams proposed forcing addicted individuals into treatment if they posed risks to themselves or others, the backlash was immediate. One activist called the plan “horrific.” Another said it “sends a chill up my spine.” Yet this visceral opposition may overlook a crucial reality: mandated drug treatment, when properly executed, can transform lives and restore communities.

The debate over compulsory care has intensified as cities grapple with unprecedented drug crises. With the most lethal illicit drug supply in American history flooding streets, the question is no longer whether intervention is necessary, but what form it should take.

The Legal Framework for Mandated Drug Treatment

Civil commitment for mental health treatment has existed for a century in the United States. All 50 states have laws governing the practice, typically requiring evidence that individuals are gravely disabled or pose threats to their communities. The underlying principle remains consistent: governments can provide care to seriously ill people even against their wishes.

However, New York is amongst the minority of states that do not consider addiction alone sufficient legal foundation to mandate care. This distinction matters because the alternative to mandated drug treatment in cities like New York often isn’t voluntary treatment, but no treatment at all. For many, it means life on the street with fentanyl and other deadly substances.

What Research Reveals About Compulsory Treatment

One of the largest long-term studies examining mandated drug treatment followed 2,095 addicted patients. The findings challenge common assumptions: one year after treatment, patients who received mandated care are slightly more likely to avoid drug use than those who entered treatment voluntarily. Moreover, mandated patients are less likely to face rearrest than peers who voluntarily sought treatment within the justice system.

Other studies have produced mixed results, with some finding mandated patients do somewhat worse or the same as voluntary patients. A recent review of 22 studies found “a lack of high-quality evidence” either supporting or opposing involuntary treatment for addiction.

Yet these studies share a critical limitation: none compared involuntary treatment results with receiving no treatment whatsoever, the most relevant comparison for policy decisions.

Why People Resist Treatment Despite Devastating Consequences

The notion that mandated drug treatment undermines autonomy assumes typical treatment seekers spontaneously decide to change their lives with strong internal motivation. Reality tells a different story. Such patients are exceptionally rare.

In a national sample of 476 individuals who had sought treatment for alcohol problems, more than nine in 10 reported being pressured to quit or change their drinking by family, spouses, partners, friends or others. People under legal pressure to seek care thus find themselves in situations similar to others in the same treatment programmes.

Drug use feels good, at least short-term, making many people ambivalent about giving it up. Treatment requires hard work before bringing long-term relief. Continuing to prioritise substance use despite harm defines addiction itself. Addiction reduces people’s ability to exercise self-control, accurately weigh long-term versus short-term consequences, and make beneficial decisions.

Critics of mandated drug treatment who assert that intervention undermines autonomy forget that addiction itself destroys autonomy. Compulsory treatment that restores good judgement represents an autonomy restoration, not violation.

The Community Impact of Untreated Addiction

Addicted people are not the only ones affected by their behaviour. Many addiction burdens fall on others: loved ones waiting by phones, scared they will ring and scared they won’t; people exposed to aggressiveness caused by certain drugs, particularly alcohol and stimulants like methamphetamine; and communities and businesses overrun by public drug use.

Those bearing such burdens have every right to pressure addicted individuals to change, including by engaging the criminal justice system where necessary.

For decades, public health officials worried about addiction’s impact on users’ children, co-workers, neighbours and communities, as well as users themselves. The public health field supported laws restricting smoking and campaigns against tobacco, even when smokers objected, because they reduced secondhand smoke damage and helped persuade non-smokers not to start.

Yet many drug policy activists in recent years have adopted stances akin to gun rights activists or vaccine resisters, namely that individual desires to use drugs should outweigh community consequences.

When Harm Reduction Ignores Community Concerns

In San Francisco, harm reduction activists and public health officials collaborated on billboards portraying opioid users as young, attractive, successful people. The theory was this would destigmatise drug use and encourage people to consume with friends who might rescue someone who overdosed. This approach proved a slap in the face to parents who didn’t want their children persuaded that fentanyl use was desirable, and to many people having difficult interactions with street fentanyl users who were not of the friendly, healthy variety portrayed on billboards.

As one police chief turned public health researcher recently observed, if there has been one blind spot amongst drug policy reformers, harm reduction activists and their government allies, it is the need to compassionately but effectively address the highly disruptive consequences of public drug use and heed how resentful communities become when problems fester.

The decriminalisation and harm reduction wave that swept the Pacific Northwest beginning in 2020 went from popular to unpopular not just because it failed to reduce overdoses, but also because property and violent crime increased, even as they fell nationally. Ignoring how drug use and associated disorders harm people who don’t use drugs undermines popular support for entire reform agendas.

Making Mandated Drug Treatment Work

Mandated drug treatment programmes can only succeed if well resourced and thoughtfully executed. Many enthusiastic proposals have emerged to force legions of people into programmes that didn’t even meet current demand. Mandatory initiatives depend not just on adequate quantity of treatment but also on appropriate quality.

Treatment programmes should be guided by best evidence, and should be clean, safe and respectful. Judges evaluating requests for involuntary commitment from health professionals or overseeing addicted patients in drug courts must be well versed in scientific evidence on addiction’s nature and its treatment.

Establishing a mandatory treatment programme in a thoughtful, careful way may seem demanding for already overstretched bureaucracies. But the degrading and dangerous reality on streets makes the status quo unacceptable. If cities can build well-resourced and well-designed mandatory treatment initiatives, addicted people, their loved ones and broader communities will all benefit enormously.

The choice is not between perfect voluntary treatment and imperfect compulsory care. It is between mandated drug treatment that offers hope and abandoning vulnerable people to streets where lethal substances claim more lives daily. When framed this way, the path forward becomes clearer.

Source: New York Times