Overview

Civil commitment for substance use disorders (SUD) involves the mandatory enrollment of people in abstinence-focused treatment. In the United States, 35 states and the District of Columbia have such commitment laws for people with SUD. This fact sheet focuses on the effects of civil commitment on people with SUD.

Civil Commitment is not an Evidence-Based Intervention for people with SUD

• A systematic review included four high quality, US-based studies and found:
  • No consistent effects on short-term or long-term recidivism (i.e. committing a crime again)
  • Potential short-term decreases in substance use, but no long-term differences in substance use.
• There are no currently identified studies that show improved mental or physical health outcomes for mandatory treatment
• Ethical concerns
  • Concerns over human rights violations and ethics, impacting individual autonomy and dignity, plague this treatment modality.
    • Several lawsuits describe patients under armed correctional officers, in solitary confinement, being segregated and strip-searched, and dealing with abusive treatment and assault from officers.
  • Civil commitment is not endorsed by the patients, stakeholders, or clinicians in these treatments

Improve the quality of voluntary treatment to address disparities in SUD outcomes

• Studies indicate that the perception of feeling overlooked and feeling disconnected from healthcare providers can act as barriers treatment, particularly in minoritized communities.
  • Such disconnect has been seen in studies with racial/ethnic minorities generally, Black and Latino youth, or Hawaiian youth identifying as Native Hawaiian (NH), Micronesian, or as sexual or gender minorities, Asian American communities, and sexual minority women.
  • These groups are disproportionately subject to criminalization, increased risk of incarceration, and worsened health outcomes.
  • Mandatory treatments can exacerbate alienation, foster distrust, and reduce future healthcare utilization.
• Focus needs to be on addressing the shortcomings of voluntary care by increasing access to empirically supported, culturally sensitive care, such as peer recovery support services, patient centered care, and harm reduction.

Policies that impose decisions and penalize individuals for their illnesses are ineffective and can be harmful.

• Encouraging investment in voluntary, community-based treatment programs such as supervised injection facilities, open-access medication assisted treatments, and peer support systems may be more effective
• Given the ethical considerations and the rise of for-profit substance use rehabilitation facilities, enhanced oversight of treatment facilities is required. This includes ensuring the use of evidence-based care, proper training for providers, and the protection of patients’ rights and values.
• Supporting the inclusion of people who have experienced SUD, particularly those from groups experiencing SUD health disparities, in policy making conversations.
• Addressing the economic root causes of SUD including poverty, unemployment, and housing instability