The term commonly used for compulsory treatment is civil commitment. Typically, civil commitment serves as an alternative to incarceration (prison) by providing compulsory, court-ordered treatment for chronic drug abusers, especially antisocial addicts responsible for committing a large number of criminal acts. It is generally believed that narcotic addicts must be brought into a supervised environment for an extended period of time for any treatment to be meaningful. Civil commitment is a useful strategy for diverting into treatment those who ordinarily would not seek assistance voluntarily, and it has been shown to suppress daily narcotic use and criminal involvement (Leukefeld & Tims, 1988).
The concept of compulsory treatment for drug abusers in the United States was proposed shortly after Congress passed the Harrison Act of 1914. By 1919, the Narcotics Unit of the U.S. Treasury Department had convinced Congress to establish a chain of federal "narcotics farms," where heroin users convicted of federal law violations could be incarcerated and treated for addiction (Inciardi, 1988). The first of such farms, established in 1935, was the U.S. Public Health Service Hospital in Lexington, Kentucky. Three years later, a sister hospital was established in Fort Worth, Texas. The goal of the facilities was to use vocational and psychiatric therapy to help free the addicts of their psychological dependence on drugs, to treat withdrawal illness, and to correct mental and social problems. Follow-up studies from Lexington in the 1940s indicated that addicts treated under legal coercion with posthospital supervision had better outcomes than voluntary patients, primarily because voluntary patients rarely completed the treatment program (Maddux, 1988). However, later studies failed to support these early positive findings. During the 1950s, hospital staff members recommended the enactment of a federal civil commitment law for narcotic addicts, but legal counsel in the Department of Health, Education, and Welfare considered such a law unconstitutional.
Then in 1962, President John F. Kennedy convened a White House Conference on Narcotic and Drug Abuse where nearly all members approved the civil commitment of narcotic addicts. Civil commitment was advocated as protection for society and rehabilitation for the individual. A compulsory treatment program aimed at the federal offender was enacted by the Narcotic Addict Rehabilitation Act (NARA) of 1966. By that time, about twenty-five states had laws permitting civil commitment, and a few major programs were enacted in response to public fears of growing drug-related street crime (Inciardi, 1988). California, in 1961, launched its Civil Addict Program (CAP), the first large-scale civil commitment program to be implemented in the United States. Because of its relative success, in 1966, New York's Narcotic Addiction Control Commission (NACC) established the largest and costliest civil commitment program in history—the New York State Civil Commitment Program.
CIVIL COMMITMENT PROGRAMS
The federal NARA and the California and New York compulsory treatment programs had a similar intent: They made it possible for the necessary legislation to be enacted and for commitment procedures to be carried out. They served to control and rehabilitate the compulsive drug abuser by providing secure treatment environments as an alternative to regular incarceration in correctional facilities (Leukefeld & Tims, 1988). Eligible addicts convicted of a crime could be committed by the court or could choose commitment over incarceration. Addicts not involved in criminal proceedings could commit themselves voluntarily or could be involuntarily institutionalized upon the petition of another individual (such as a peace officer) (Mc-Glothlin, Anglin, & Wilson, 1977). Integral to each of these programs was supervised aftercare with antinarcotics testing. Length of commitment terms ranged from three years in NARA to seven years in CAP.
Although nearly all of NARA's civil commitment programs were generally considered unsuccessful, the funding for community programs contained within the same legislation did provide seed money for the nationwide establishment of some of today's basic drug-treatment programs in the community (Maddux, 1988). It was also believed that the New York State Civil Commitment Program failed, and the process of dismantling it began in 1971 (Inciardi, 1988). The failure of this program is partly attributable to the fact that it was administered by the social welfare agency of New York State, which had little experience controlling addicts. In contrast, CAP, California's program, was deemed at least moderately effective in modifying behavior, because it was implemented through the California Department of Corrections, which had trained personnel who were familiar with treating substance abusers (Anglin, 1988).
Follow-up studies of the California program found that participants exhibited reductions in daily heroin use as well as in property crime and antisocial activities. Although many patients did become readdicted at some point, their relapses were typically of shorter duration and less frequent than those not involved in treatment (Anglin, 1988). The general conclusion drawn from these studies was that civil commitment, when adequately implemented, might be an effective means of reducing narcotic addiction and of minimizing adverse, addiction-related behavior. Repeated interventions are typically required, however, because drug dependence is a chronic condition marked by relapses (Leukefeld & Tims, 1988).
LIMITATIONS OF CIVIL COMMITMENT
Civil commitment helps get drug abusers into treatment and keeps the abusers in treatment for an extended length of time. Outcome studies have generally shown that the success of treatment is directly related to the amount of time spent in treatment and that long-term supervision upon return to the community, with objective monitoring (Drug Testing), is an essential component of a successful program. Furthermore, civil commitment often makes treatment available before a crime is committed, and it provides clear treatment goals rather than only providing punishment (Leukefeld & Tims, 1988). Still, such a program as civil commitment has serious limitations. It is costly and can overwhelm facilities unless adequate funding, facilities, and staff have been made available. Many addicts are considered unwilling or unsuitable for participation. External coercion can bring drug users into treatment, but it cannot assure that as patients they will participate in treatment. Even with the advent of intensive interventions designed to engage the patients, some patients simply participate passively (Maddux, 1988). Finally, the scope of civil commitment is restricted by constitutional guarantees of individual liberty. The question remains: Within a free society, to what extent should the government curtail the civil liberties of a compulsive drug user?
Today, there is an increasing tendency to see civil commitment as control rather than treatment and it serves only a limited number of addicts who are sufficiently problematic in their behavior to warrant commitment. The use of such measures as civil commitment in a better coordinated and expanded fashion, however, could produce significant individual and social benefits (Anglin, 1988). Civil commitment may also gain more popular support as a means for dealing with intravenous drug users who are at risk for contracting or transmitting AIDS.
(See also: Coerced Treatment for Substance Offenders ; Treatment Alternatives to Street Crime [TASC] )
Anglin, D. (1988). The efficacy of civil commitment in treating narcotic addiction. Compulsory treatment of drug abuse: Research and clinical practice (NIDA Research Monograph 86). Rockville, MD: U.S. Department of Health and Human Services.
Inciardi, J. A. (1988). Compulsory treatment in New York: A brief narrative history of misjudgment, mismanagement, and misrepresentation. The Journal of Drug Issues, 18 (4), 547-560.
Leukefeld, C.G., & Tims, F. M. (1988). An introduction to compulsory treatment for drug abuse: Clinical practice and research. Compulsory treatment of drug abuse: Research and clinical practice (NIDA Research Monograph 86). Rockville, MD: U.S. Department of Health and Human Services.
Leukefeld, C.G., & Tims, F. M. (1988). Compulsory treatment: A review of findings. Compulsory treatment of drug abuse: Research and clinical practice (NIDA Research Monograph 86). Rockville, MD: U.S. Department of Health and Human Services.
Maddux, J. F. (1988). Clinical experience with civil commitment. Compulsory treatment of drug abuse: Research and clinical practice (NIDA Research Monograph 86). Rockville, MD: U.S. Department of Health and Human Services.
Mc Glothlin, W. H., Anglin, M.D., & Wilson, B.D. (1977). An evaluation of the California Civil Addict Program (Services Research Monograph Series). Rockville, MD: U.S. Department of Health, Education, and Welfare.
Harry K. Wexler