Should Addiction Treatment be Compulsory?

I have not personally suffered an addiction and I have no expertise in addiction medicine.  But I have treated large numbers of individuals with gastrointestinal issues who also are in the midst of an addiction or are recovering from this illness.  I have tremendous admiration for a person who has – with the help of professionals – unshackled himself from the suffocating tentacles of addiction.  As I have not faced this challenge,  I cannot begin to contemplate the journey.

This nation has not settled on a coherent strategy to battle this plague.  Is it a medical issue?  Is it a law enforcement issue?  Which treatments are evidence based?   Should insurance coverage for treatment be required as are other benefits such as preventive care?  Can treatment be compelled on an unwilling addict? 

I read a poignant opinion piece recently in The New York Times by David Sheff whose son ultimately prevailed against his addiction.  The article refers to a study that concluded that compulsory addiction therapy was as or more effective than treatment submitted to voluntarily.  The author points out that many experts dispute this conclusion.  The author’s son chose treatment over jail.

A century ago, heroin was sold legally in the U.S.

While I think we need to open and flexible with regard to new thinking in addiction treatment, I do not think that a study or two should upend established treatment protocols and expert opinion.

We don’t want to lurch in the wrong direction consuming resources and time that could have been better used differently.  If there is a critical mass of experts recommending a new pathway, then let’s test it in small pilot studies to determine if further study is warranted. 

Keep in mind that we can always find a study or two to support any point of view.  I wouldn’t be shocked if there are studies lurking in the cyberuniverse suggesting that cigarette smoking confers health benefits. 

Gastroenterologists go with our gut.  Mine informs me that that the probability of success of coerced addiction treatment is less than it would be if the individual sought treatment.  Let’s submit the issue to the scientific method. 

The financial costs of treating addiction are very high.  The risks of failure and recidivism are also high.  Even when successful, the journey is likely to be long and jagged.   

And we all know that the costs are very high and the prospects for sustained success are very low.  Who is going to pay for the treatment?  What is the success rate of different treatments and how is success defined?  How much are we all willing to pay to treat each afflicted individual?  What other use for the money could be considered?

How can we assure that the available treatment programs are high quality and are subject to rigorous oversight?

And, of course, we have to consider the societal and human costs of not treating these individuals.

Obviously, the ideal strategy is to reduce drug demand overall and to intervene on folks before the addiction has firmly set in.  Easier said than done.

Addiction is a disease that most of us have avoided by luck.  It’s a scourge that effects all of us.

I don’t have a proven battle plan, But I do believe that the fight is worthy.