Should We Force People Into Treatment to Save Their Lives?
Ethical Dilemmas Of The Toxic Drug Crisis
What's This All About?
Imagine your loved one is drowning, but they keep pushing away the life preserver you're throwing them. That's how many families feel when someone they care about is struggling with severe drug addiction. Should the Government, through physicians, be allowed to force them into treatment to save their lives? It's one of the most heartbreaking and controversial questions we face today, especially as drugs on the street have become deadlier than ever.
I’ve had the privilege of hearing families tell their stories. Some of them believe that forced treatment is the only thing that saves their child’s life, even if they’re adults. Then there are the other stories, the horrific torn-apart families and broken trust. In some cases, it resulted in death.
This isn't just about personal choice anymore. We're dealing with a drug supply that's like playing Russian roulette every single time someone uses toxic street drugs. But forcing someone into treatment brings up huge questions about freedom, rights, and whether it actually helps or makes things worse (Jain et al., 2018). Are you ready to hear both sides? We take a look at the pros and cons.
What Does "Forced Treatment" Actually Mean?
When we talk about involuntary treatment for substance disorders, we're talking about a legal process where the government sets out policies that allow physicians or courts to order someone into drug treatment against their will. Think of it like an intervention, but with health authority or legal muscle behind it. Usually, doctors will start the process when they believe someone's substance use (addiction) has made them unable to make safe decisions for themselves (Jain et al., 2018).
It's different from being sent to treatment as part of a criminal sentence. This is more like what happens when someone is having a mental health crisis – the idea being that addiction has impaired their judgment so severely that they can't see they're in mortal danger. It’s also different in that they have committed no crime, but are about to be forcibly put through detox.
Some places try to make this less harsh through something called "negotiated coercion". Basically, a way of trying to give the person some say in their treatment, even though they're being forced into it (Owen & Floyd, 2010). It's like being told you have to go to the dentist, but you get to pick which dentist.
Why the Drug Crisis Has Changed Everything
Here's where things get really scary. The drugs on the street today aren't like the drugs of 20 or 30 years ago. It's like the difference between a BB gun and a machine gun. Fentanyl – a synthetic opioid that's incredibly potent. It is everywhere now, often mixed into other drugs without people knowing it. And there's other stuff like xylazine (a veterinary tranquillizer) that makes overdoses even harder to reverse (Enkh-Amgalan, 2019).
Picture this: you think you're buying one thing, but you're actually getting something 50 times stronger mixed with chemicals meant for horses. Every time someone uses street drugs now, they're essentially playing a deadly lottery. This reality has made some people say, "We can't wait for people to choose treatment – we need to save them from the likelihood of immediate death first."
The unpredictable nature of these contaminated drugs creates scenarios where people face immediate, life-threatening danger with every use (Brodziak, 2016). This constant invisible threat has intensified arguments for interventions that can remove individuals from this immediate danger, even if they have to be forced.
A Look Back: How We Got Here
To understand today's debate, we need to look at how society has treated addiction over time. For most of the past century, we've swung back and forth like a pendulum between two approaches: treating addiction as a moral failing that deserves punishment, or treating it as a medical condition that needs care (Adinoff & Cooper, 2019).
The "War on Drugs" was the ultimate example of the punishment approach – it was like trying to cure a fever by arresting the thermometer. Instead of helping people get better, we locked up millions of people, often making their problems worse (Adinoff & Cooper, 2019).
Forced treatment has existed in various forms throughout this history, sometimes tied to the criminal justice system, sometimes to mental health services. The legal justification usually comes from the idea that the government can step in to protect people who can't protect themselves. Kind of like how we don't let someone with severe dementia make certain decisions (Jain et al., 2018).
The challenge is that different places have different rules about when and how this can happen, leading to inconsistencies in who can access these services and under what conditions (Jain et al., 2018).
The Case FOR Forced Treatment: "Sometimes Love Means Horrible Choices"
When Families Feel They Have No Choice Left
Talk to parents who've asked for involuntary commitment for their adult children, and you'll hear stories that would break your heart. Often they were sideline spectators watching a system that did nothing. They've watched their child disappear bit by bit – losing jobs, relationships, health, and hope. They've tried everything: pleading, bribing, threatening, staging interventions, offering to pay for treatment. Nothing works.
For these families, forced treatment isn't about control or punishment – it's about desperation. It's like watching someone you love standing on train tracks with a locomotive bearing down, refusing to move. When someone you love is facing death from addiction, and they can't or won't save themselves, forcing them into treatment can feel like the only loving thing left to do (Jain et al., 2018).
The Medical Argument: Creating a Window of Opportunity
From a medical standpoint, supporters argue that forced treatment is like emergency surgery – sometimes you have to act quickly to save a life, even if the person can't consent. The immediate goal isn't to cure addiction (which takes time and willingness), but to create a safe space for detox and medical stabilization.
Think of it as pulling someone back from the edge of a cliff. Once they're safe, then you can work on helping them understand why they were so close to falling in the first place. Some research suggests that for people with both severe mental illness and addiction, physician or court-ordered treatment can help them stay on medication and reduce harmful behaviours like violence (Swanson et al., 2000).
The Case AGAINST Forced Treatment: "The Road to Hell..."
Despite good intentions, forced treatment has serious critics who raise important concerns about both its ethics and effectiveness.
The Deadly Rebound Effect
Here's one of the scariest unintended consequences: when someone is forced into treatment and gets clean, their body loses its tolerance to drugs. It's like a regular drinker who stops for months and then tries to drink like they used to – except with drugs, the consequences are likely to be fatal.
When someone leaves forced treatment and relapses (which happens often), they might use the same amount they used before going in. But now their body can't handle it, especially with today's super-potent street drugs. What was supposed to save their life might actually make them more likely to die from an overdose. It's a cruel irony that an intervention meant to prevent death could increase the risk of it.
The Freedom Question: Where Do We Draw the Line?
The biggest ethical concern is about basic human rights and freedom. In a free society, don't adults have the right to make their own choices, even bad ones? Where do we draw the line between protecting someone and controlling them (Jain et al., 2018)?
Think about it this way: we don't force people to exercise, eat healthy, or quit smoking, even though these choices affect their health. Why should addiction be different? Critics argue that once we start deciding that certain conditions make people incapable of making their own decisions, we're on a slippery slope that could lead to all sorts of government overreach (Cripps, 2011).
Breaking Trust and Burning Bridges
Imagine being forced into treatment against your will. How would you feel about the people who did that to you? How would you feel about the treatment system itself? Many people who go through forced treatment describe it as traumatic and punitive rather than helpful.
This matters because addiction recovery usually requires ongoing engagement with treatment providers and support systems. If someone's first experience with treatment is being forced into it, they might never trust the system enough to come back voluntarily when they're ready. It's like forcing someone to go on a blind date and then wondering why they never want to date again.
The Bigger Picture: It's Not Just About Individual Choices
Here's where the conversation gets really complex. Focusing only on whether to force individuals into treatment misses the bigger picture of why people develop addiction in the first place and what keeps them stuck.
The Mental Health Connection
Most people with severe addiction also struggle with other mental health issues – depression, anxiety, PTSD, bipolar disorder, and schizophrenia (Korte et al., 2017; Basedow et al., 2020; Faridhosseini et al., 2019). Often, people start using drugs to cope with these untreated mental health problems. It's like trying to fix a broken arm with pain medication – it might help temporarily, but you haven't addressed the actual break.
Our treatment systems are often like separate islands that don't communicate with each other. Someone might get help for their addiction in one place and their depression somewhere else, but nobody's looking at the whole picture. Despite the strong connection between mental health and addiction, these treatment systems often work in isolation from each other (Patel et al., 2016).
Poverty and Homelessness: The Foundation Cracks
You can't understand addiction without understanding the life circumstances that often go with it. Poverty, homelessness, unemployment, trauma – these aren't just side effects of addiction, they're often root causes too.
Imagine trying to recover from addiction while you're sleeping on the street, don't know where your next meal is coming from, and can't find work. It's like trying to build a house on quicksand. People experiencing homelessness, for example, often face high rates of alcohol problems with limited access to appropriate support services (Carver et al., 2020). Even if forced treatment gets someone clean temporarily, if they go back to the same impossible circumstances, relapse becomes almost inevitable. So to be absolutely clear, involuntary treatment should never be implemented unless there are resources in place when the person is discharged
What Forced Treatment Can't Fix
Here's the hard truth: forced treatment might stop someone from using drugs for a while, but it can't fix trauma, provide housing, create job opportunities, or heal broken relationships. It's like putting a band-aid on a wound that needs surgery.
Real recovery from addiction usually requires addressing all these underlying issues – unresolved trauma, chronic pain, lack of social support, discrimination, or deep-seated mental health conditions. That takes time, resources, and most importantly, the person's willing participation (Salina et al., 2016). You can force someone to stop using drugs temporarily, but you can't force them to heal from the pain that led them to drugs in the first place.
A Deadly Guessing Game
Street drugs today are contaminated with substances so potent and unpredictable that every use is potentially fatal. Fentanyl can be 50-100 times stronger than morphine, and it's showing up in everything, not just opioids, but also in cocaine, methamphetamine, and even fake prescription pills. These substances are frequently distributed as contaminants in other drugs or pressed into counterfeit pills, meaning people may consume them unknowingly (Brodziak, 2016).
It's like if someone was selling bottles labelled "beer" but some of them contained pure grain alcohol mixed with poison. People think they're buying one thing and getting something completely different and far more dangerous (Enkh-Amgalan, 2019). This unpredictability means that even experienced drug users can't gauge what's safe anymore.
The Tolerance Trap Gets Deadlier
Remember that deadly rebound effect we talked about? The toxic drug supply makes it even worse. Someone might leave treatment with reduced tolerance and then encounter street drugs that are exponentially more potent than what they used before going in. It's a perfect storm for fatal overdose.
This reality intensifies arguments on both sides. Supporters say the danger is so immediate and severe that we can't wait for people to choose treatment voluntarily. Critics argue that forced treatment followed by release into this toxic environment will actually increase someone's risk of death.
Finding Balance: What Does Good Policy Look Like?
So how do we navigate this minefield of competing values and unintended consequences?
Rights vs. Safety: The Eternal Tension
At its core, this debate is about balancing individual freedom with protecting people from harm (Jain et al., 2018). It's like the age-old question of whether you should be required to wear a seatbelt – except the stakes are much higher and the answers much less clear.
The challenge is defining when someone's judgment is so impaired by addiction that they can't make informed decisions about their own safety. Unlike other medical conditions where incapacity is more obvious, addiction exists on a spectrum, and the dividing line isn't always clear.
Beyond Quick Fixes: Building a Real Safety Net
The most promising path forward isn't choosing between forced treatment or doing nothing. What we need is to build a comprehensive system that gives people real alternatives before they reach a crisis point.
Think of it like preventing house fires instead of just having better fire trucks. We need a full continuum of care that includes prevention, early intervention, a wide array of voluntary treatment options (including medications like methadone and buprenorphine), robust harm reduction services, and sustained recovery supports (Enkh-Amgalan, 2019; Scheibe et al., 2020; Douaihy et al., 2013).
Evidence-based therapies like Acceptance and Commitment Therapy (ACT) also form part of this continuum, aiming to build resilience and coping skills (Osaji et al., 2020; Najafi & Arab, 2020).
A Comprehensive Approach: More Than Just Treatment
Real solutions require thinking beyond just medical treatment. It's like addressing a flood by not just building better boats, but also fixing the dam, improving drainage, and helping people move to higher ground.
This means massively increasing investment in and accessibility of voluntary, evidence-based addiction treatment and comprehensive harm reduction services (Patel et al., 2016; Enkh-Amgalan, 2019). We need to:
Make treatment accessible: So people don't have to wait weeks or months to get help when they're ready
Ensure cultural appropriateness: Services that are trauma-informed and culturally sensitive
Remove financial barriers: Making care affordable for everyone who needs it
Address social determinants: Tackling poverty, homelessness, and lack of educational and employment opportunities
Reduce stigma: So people feel safe asking for help before they're in crisis
The Path Forward: No Easy Answers, But Reasons for Hope
What We Still Need to Learn
The truth is that we don't have enough good research on whether forced treatment actually works in the long run, especially in the context of today's toxic drug supply (Jain et al., 2018). Most studies look at short-term outcomes, but addiction recovery is a long-term process. It's like judging the success of a diet based on the first week instead of the first year.
We especially need research on how forced treatment affects people in the context of today's toxic drug supply. The risks and benefits may be different now than they were when most of the existing research was done.
Room for Both Compassion and Caution
Maybe the answer isn't choosing sides, but finding ways to honour both the desperate love of families and the fundamental rights of individuals. This might mean:
Improving the process: Making sure forced treatment, when it happens, includes robust safeguards, due process, and genuine efforts to engage the person in their own care
Time-limiting commitments: Avoiding indefinite holds and focusing on crisis stabilization rather than long-term coercion
Intensive follow-up: Recognizing that the period right after release is extremely dangerous and providing intensive support
Family education: Helping families understand both the potential benefits and serious risks of forced treatment
A Call for Innovation and Dialogue
This issue demands our best thinking, not our most polarized positions. We need rigorous research on the long-term efficacy and potential harms of involuntary treatment for substance use disorders, especially considering the current drug toxicity context (Jain et al., 2018). We also need:
Nuanced ethical guidelines and evidence-based policies
Innovative approaches that balance safety with respect for individual rights
Honest conversations about the limits of what any intervention can accomplish
Sustained investment in the full range of services people need
Policy solutions that address root causes, not just symptoms
Conclusion: Love, Rights, and the Messy Reality of Addiction
The question of forced treatment for addiction doesn't have simple answers because addiction itself isn't simple. It's tangled up with mental health, poverty, trauma, family dynamics, and now an unpredictably dangerous drug supply.
What we do know is this: the desperate love that drives families to consider forced treatment is real and valid. The fundamental right to make your own choices, even bad ones, is also real and important. The immediate danger posed by today's toxic drug supply is unprecedented. And the complex, long-term nature of addiction recovery means there are no quick fixes, no matter how well-intentioned.
While coercion might serve in acute crises, expanding accessible voluntary, trauma-informed care, harm reduction, and tackling systemic inequities presents a more sustainable, rights-affirming approach to this public health challenge (Jain et al., 2018). Moving forward, we need responses that are both compassionate and evidence-based, that protect immediate safety while respecting long-term autonomy, and that address not just the symptoms of addiction but its underlying causes.
Most importantly, we need to remember that behind every statistic and policy debate is a real person – someone's child, parent, sibling, or friend – who deserves both our protection and our respect. Finding the right balance won't be easy, but the stakes are too high not to keep trying.
The conversation continues, and it should. Because in that ongoing dialogue lies our best hope for finding solutions that honour both our deepest values and our most urgent needs. Continued dialogue and innovation are essential to mitigate harms and support recovery. In the end, this isn't just about addiction policy – it's about what kind of society we want to be when our most vulnerable members are in crisis.
References (for the best experience, copy and paste links to research into your browser)
Jain, A., Christopher, P., & Appelbaum, P. S. (2018). Civil Commitment for Opioid and Other Substance Use Disorders: Does It Work? In Psychiatric Services (Vol. 69, Issue 4, pp. 374–376). American Psychiatric Association Publishing. https://doi.org/10.1176/appi.ps.201800066
Owen, J. L., & Floyd, M. (2010). Negotiated Coercion: Thoughts about Involuntary Treatment in Mental Health. In Ethics and Social Welfare (Vol. 4, Issue 3, pp. 297–299). Informa UK Limited. https://doi.org/10.1080/17496535.2010.516131
Enkh-Amgalan, S. (2019). Visualization of Global Opioid Use Disorder Rates Based on Harm Reduction Availability. In Journal of Purdue Undergraduate Research (Vol. 9, Issue 1). Purdue University Press. https://doi.org/10.5703/1288284316958
Adinoff, B., & Cooper, Z. D. (2019). Cannabis legalization: progress in harm reduction approaches for substance use and misuse. In The American Journal of Drug and Alcohol Abuse (Vol. 45, Issue 6, pp. 707–712). Informa UK Limited. https://doi.org/10.1080/00952990.2019.1680683
Brodziak, A. (2016). The harm caused by marihuana use disorders is interrelated in some european countries to the harm caused by new psychoactive substances. 1, 27–27. https://doi.org/10.15761/.1000106
Swanson, J. W., Swartz, M. S., Wagner, H. R., Burns, B. J., Borum, R., & Hiday, V. A. (2000). Involuntary out-patient commitment and reduction of violent behaviour in persons with severe mental illness. In British Journal of Psychiatry (Vol. 176, Issue 4, pp. 324–331). Royal College of Psychiatrists. https://doi.org/10.1192/bjp.176.4.324
Korte, K., Bountress, K., Tomko, R., Killeen, T., Moran-Santa Maria, M., & Back, S. (2017). Integrated Treatment of PTSD and Substance Use Disorders: The Mediating Role of PTSD Improvement in the Reduction of Depression. In Journal of Clinical Medicine (Vol. 6, Issue 1, p. 9). MDPI AG. https://doi.org/10.3390/jcm6010009
Basedow, L. A., Kuitunen-Paul, S., Roessner, V., & Golub, Y. (2020). Traumatic Events and Substance Use Disorders in Adolescents. In Frontiers in Psychiatry (Vol. 11). Frontiers Media SA. https://doi.org/10.3389/fpsyt.2020.00559
Faridhosseini, F., Saghebi, A., & Mirzadeh, M. (2019). Personality disorders and substance use disorders: a narrative review. In Electronic physician (Vol. 11, Issue 2, pp. 7558–7563). Knowledge Kingdom Publishing. https://doi.org/10.19082/7558
Patel, V., Chisholm, D., Dua, T., Laxminarayan, R., & Medina-Mora, M. E. (2016). Disease Control Priorities, Third Edition (Volume 4): Mental, Neurological, and Substance Use Disorders. Washington, DC: World Bank. https://doi.org/10.1596/978-1-4648-0426-7
Carver, H., Parkes, T., Browne, T., Matheson, C., & Pauly, B. (2020). Investigating the need for alcohol harm reduction and managed alcohol programs for people experiencing homelessness and alcohol use disorders in Scotland. In Drug and Alcohol Review (Vol. 40, Issue 2, pp. 220–230). Wiley. https://doi.org/10.1111/dar.13178
Salina, D. D., Ram, D., & Jason, L. A. (2016). Sexual Coercion, Trauma, and Sex Work in Justice-Involved Women with Substance Use Disorders. In Journal of Aggression, Maltreatment & Trauma (Vol. 25, Issue 3, pp. 254–268). Informa UK Limited. https://doi.org/10.1080/10926771.2015.1121189
Douaihy, A. B., Kelly, T. M., & Sullivan, C. (2013). Medications for Substance Use Disorders. In Social Work in Public Health (Vol. 28, Issues 3–4, pp. 264–278). Informa UK Limited. https://doi.org/10.1080/19371918.2013.759031
Scheibe, A., Shelly, S., Hugo, J., Mohale, M., Lalla, S., Renkin, W., Gloeck, N., Khambule, S., Kroucamp, L., Bhoora, U., & Marcus, T. S. (2020). Harm reduction in practice – The Community Oriented Substance Use Programme in Tshwane. In African Journal of Primary Health Care & Family Medicine (Vol. 12, Issue 1). AOSIS. https://doi.org/10.4102/phcfm.v12i1.2285
Osaji, J., Ojimba, C., & Ahmed, S. (2020). The Use of Acceptance and Commitment Therapy in Substance Use Disorders: A Review of Literature. In Journal of Clinical Medicine Research (Vol. 12, Issue 10, pp. 629–633). Elmer Press, Inc. https://pmc.ncbi.nlm.nih.gov/articles/PMC7524566/
Najafi, L., & Arab, A. (2020). The Efficacy of Acceptance and Commitment Therapy on Psychological Resilience in Women with Substance Use Disorder. In International Journal of High Risk Behaviors and Addiction (Vol. 9, Issue 2). Brieflands. https://doi.org/10.5812/ijhrba.92102