Nonvoluntary Treatment for Substance Use Disorders Take III

This article just came across my social media this morning.  It is discouraging to say the least, especially given the scope of the problem we are facing.  As I have said before, the ethics of nonvolutnary treatment only hold up if we are able to provide the solicitous care people with sever substance use disorders need; treatment that could be reasonably expected to help an individual into recovery.  Based on this article it is clear that there is both a policy and implementation problem. It is hard to say that it’s treatment not prison when it looks like this:

The men stay for 30 to 90 days in small rooms, which are former cells with metal mesh on the widows, bunk beds and wooden foot locker like benches. (Robin Lubbock/WBUR)

Sadly, I am not surprised.  Despite our understanding of the “disease model” of addiction we still do not treat persons with substance use disorders the same way we treat people with other chronic illnesses.  Can you imagine opening a facility to treat other illnesses like heart disease or diabetes but then telling patients “sorry, we can’t administer lisinopril or insulin?”  This fits with our overly moralistic view of addiction and the lingering prejudice that places a focus not on treating an illness but rather on punishment, stigmatization, and the enforcement of some sort of moral conversion.

I am wholly sympathetic to the families of these men: “He’s treated like prisoner, he eats awful food like the prisoners, but it’s worth it because he’s alive,” Vehmeyer said. “I wish there was another option but there no other option.”  How terrible it is that all we can offer families is the false dichotomy of death or ineffective treatment in a prison setting. Under these conditions it is difficult to justify the abridgement of civil liberties when it is very unlikely that that temporary abrogation of rights will ultimately result in the return of the capacity for autonomous choice.  


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