Involuntary Treatment: When The Customer Isn’t Always Right

Friday, October 12th, 2012

In a recent New York Times column, Dr. Paul Christopher wrote about a particular patient who, despite acknowledging the ill effects of his drug addiction, refused to consider seeking treatment. And because Dr. Christopher works in Rhode Island, one of a dozen states where mandatory treatment is not an option, there was little he could do to help.

I’ve worked in the treatment field in Rhode Island for close to 25 years, and unfortunately we’ve never been legally permitted to admit someone to treatment involuntarily unless they clearly pose an immediate danger to themselves or others. Because of this, we continue to see a small group of “chronic recidivists” who go in and out of local emergency rooms and detox facilities for months or even years. It’s a revolving door process, with only a small number of people using most of the available resources; they come in, they complete detox, they don’t participate in a viable discharge plan because they don’t want treatment, and then they go right back to using again. So, remind me—why don’t we allow involuntary committals in this state?

Of course, the answer always seems to come down to a person’s rights. We at Phoenix House Rhode Island must adhere to a lengthy list of client rights, which is a good thing, but we rarely stop to ask: when do some of these rights—specifically,  the right to refuse treatment—hurt the client? When should someone be mandated to treatment because it’s the only thing that will save his or her life?

In his article, Dr. Christopher points out that if he had been merely a few miles away in the neighboring state of Massachusetts, he would have been able to suggest that his patient’s wife petition a judge to mandate treatment. But in Rhode Island, holding someone in a hospital for 24 hours—or until they’re no longer heavily influenced by drugs or alcohol—is as far as doctors can go. Even if you were found under the influence and passed out on the street, you’d be released from the ER as soon as you were stable and no longer deemed a danger to yourself or others—if you refused treatment.

Ideally, doctors in every state should be able to mandate treatment on a case-by-case basis. Involuntary treatment could have saved 23-year-old Jaclyn Kinkade’s life, and it could still save Dr. Christopher’s patient. After all, recovery rates in residential treatment are significantly higher than rates for those who just complete a three- to seven-day detox. Plus, studies show that folks who are committed to treatment involuntarily do just as well as those who check themselves in. Even a short-term treatment experience after detox can open doors for people and start them thinking differently about their quality of life, loved ones, and recovery.

But until we begin a serious dialogue on the benefits as well as the potential drawbacks of involuntary treatment, what can we do? From my clinical experience, I know that positive change only appears attainable when someone sits down and talks with a drug user or alcoholic about the treatment process. In many respects, it’s Harm Reduction 101: how can we convince this person to change just one aspect of his or her life for the better and move forward from there? At the start of my career, I spent many years on and around the streets of downtown Providence, getting to know people who were living under bridges, assisting first responders with people we found unconscious on the sidewalk, and talking to them about treatment. And guess what? Many of them have gotten better over the years. If Rhode Island laws had allowed us to mandate treatment, some of them would have gotten better a lot faster. Others might still be with us.

Most people just need somebody to not give up on them and open a door. So maybe we help get them off the streets and in touch with a recovery coach, even if they’ve just completed a detox and are not yet ready to commit to treatment. Maybe then, we could help them re-establish a family support network or get back on medication for a mental health issue. Maybe we’d convince them to see a social worker for ten minutes every week, and pretty soon, that ten minutes would become an hour, and that hour would become admission to a residential treatment program.

The bottom line is that treatment – mandated or otherwise – saves lives, and Rhode Island and other states should absolutely reconsider involuntary treatment under specific circumstances. Meanwhile, we must take advantage of every available option, from outreach to harm reduction strategies. What we’ve found is that if you give a person an opportunity – any opportunity – to start a new life, chances are they’ll take that opportunity and run with it. Before you know it, you’re helping that person move forward towards a new life of recovery.

Fred Trapassi
Vice President of Rhode Island Programs,
Insurance and New Marketing Initiatives,
Phoenix House Rhode Island Programs

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1 Comment

  • Kim Sumner-Mayer

    right on, Fred! Having worked with Drug Treatment Courts for several years now, I recognize the value of “raising the bottom” by mandating treatment for those who most need it. I think that what RI needs is a campaign similar to the one spearheaded by the National Associaiton of Drug Court Professionals: the All Rise campaign, wherein graduates of Drug Court and others stand up publicly to endorse the program. If people in recovery in RI were helped to organize and stand up to address the legislature, perhaps some shift would be possible. The emphasis on individual rights is important and fundamental, but if those who have benefitted from having those rights truncated in the interest of their safety and well-being speak up for changing the law, then legislators have a harder time ignoring the arguments. Addiction treatment professionals must join with other stakeholders to organize such an effort. Thanks for your dedication to our clients!