Why forced treatment can’t fix substance use disorder

When a loved one is living with serious substance use disorder and refuses to get help, sometimes it seems like the only solution is to force them into it. In many states, people can be “arrescued” — that is, forced under penalty of law into a treatment program that is nearly identical to being incarcerated, down to orange jumpsuits. It’s an idea that David Sheff, who wrote “Beautiful Boy: A Father’s Journey Through His Son’s Addiction,” recently advocated for a guest essay in the New York Times. “Those who love people with substance use disorders have a difficult choice: Do something, even if it’s deeply unpleasant and may not ultimately work, or risk their loved one’s death,” he argued.

But Sarah Wakeman, an addiction medicine physician who serves as the medical director for substance use disorder at Mass General Brigham in the Office of the Chief Medical Officer, says that while she understands the love and sorrow that make people see involuntary treatment as a solution, it doesn’t actually work.

On this episode of the “First Opinion Podcast,” I spoke with Wakeman about the two very different reasons why people advocate for involuntary treatment; the evidence that suggests it simply does not work; and a more compassionate, effective approach to addressing opioid use disorder.

“One patient had been in multiple voluntary and involuntary settings, and had also been imprisoned. And he said to me that he actually preferred just being in prison, where he could mind his own business and do his own thing and wasn’t forced to go to eight hours a day of what he perceived to be not-very-helpful groups,” Wakeman said.

Our conversation stems from her recent First Opinion essay, “Why involuntary treatment for addiction is a dangerous idea.”

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