RESIDENT: Involuntary Treatment for Adult Non-Offenders with Substance Use Disorders?

Evaluate the session

Presenting Author(s): Dr. Emily Cooley, MD

Co-Author(s): Dr. Anees Bahji, MD, FRCPC & Dr. David Crockford, MD, FRCPC

Date and time: 25 Mar 2023 from 14:45 to 15:00

Location: Hawthorn B  

Learning Objectives

1. Review the evidence for and against involuntary addiction treatment in adults;
2. Consider applicability of international data to the Canadian context;
3. Explore relevant ethical and medicolegal issues related to involuntary addiction treatment.

Abstract

Background

Involuntary treatment for adults outside the criminal justice system with substance use disorders (SUD) is controversial. Canadian governments have recently proposed involuntary treatment for adult non-offenders with SUD based on their morbidity, mortality, and impacts on public safety and health care utilization. However, the effectiveness of involuntary treatment using the mental health act or separate legislation for this purpose has not been reviewed based on existing treatment studies. This study aims to provide a narrative review of that literature, and discuss the potential pros and cons of involuntary treatment in adult non-offenders with SUD.

Methods

A literature review was conducted using MEDLINE augmented by the references of relevant found studies and reviews. Only treatment studies were included. Results: There are very few studies of involuntary treatment of adult non-offenders with SUD and no Canadian studies. Most studies came from jurisdictions with special legislation for the involuntary treatment of SUD. Patients entering treatment voluntarily did better overall than those admitted involuntarily, however, some improvements were seen in those involuntarily treated, with benefits extending beyond acute therapy in some studies.

Conclusions

Evidence for the involuntary treatment of adult non-offenders with SUD suggests limited benefits, with voluntary treatment consistently outperforming involuntary treatment. The use of involuntary treatment for SUD would likely require special legislation, the development of designated treatment sites, and extensive aftercare programming that may not justify the costs and potential ethical and legal issues. Resources likely would be better directed towards expanding voluntary treatment options.

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