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... One of the major justifications for treatment under coercion is that it is an effective way of treating offenders' substance dependence that will reduce the likelihood of their re-offending (Gerstein & Harwood, 1990;Inciardi & McBride, 1991). This approach has historically been most often used in the treatment of offenders who are dependent on heroin (Leukefeld & Tims, 1988) although it has most recently been used with cocaine-dependent offenders in "drug courts" in the USA (National Research Council, 2001). One issue is whether there should be a higher standard of proven effectiveness for coerced rather than for voluntary treatment. ...
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Melatonin is a pleiotropic signalling molecule that regulates several physiological functions, and synchronises biological rhythms. Recent evidences are beginning to reveal that a dysregulation of endogenous melatonin rhythm or action may play a larger role in the aetiology and behavioural expression of drug addiction, than was previously considered. This review, using information garnered from extant literature, examines the roles played by melatonin and its receptors in addictive behaviours, addiction related changes in brain chemistry and brain plasticity; and its possible benefits in the management of drug associated withdrawal syndrome, relapse and behavioural sensitisation.
... 11 In light of the success of this policy, the U.K., China, and the majority of countries in the European Union have followed suit by implementing MMT in their own criminal justice systems. 12 However, despite its success in preventing recidivism, attempts to establish MMT as a mainstay intervention for drug offenders have been held back by political opposition, 13 preference for abstinence- based treatments in the criminal justice system, 14 and ethical protest from clinicians and philosophers. 15 In this paper, we examine whether there is any sound ethical objec- tion to the use of MMT in criminal justice systems on the model employed in Australia, among other countries. ...
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Heroin use poses a significant health and economic burden to society, and individuals with heroin dependence are responsible for a significant amount of crime. Owing to its efficacy and cost‐effectiveness, methadone maintenance therapy (MMT) is offered as an optional alternative to imprisonment for drug offenders in several jurisdictions. Some object to such ‘MMT offers’ on the basis that they involve coercion and thus invalidate the offender's consent to MMT. While we find these arguments unpersuasive, we do not attempt to build a case against them here. Instead, we explore whether administration of MMT following acceptance of an MMT offer might be permissible even on the assumption that MMT offers are coercive, and in such a way that the resulting MMT is non‐consensual. We argue that non‐consensual MMT following an MMT offer is typically permissible. We first offer empirical evidence to demonstrate the substantial benefits to the offender and society of implementing non‐consensual MMT in the criminal justice system. We then explore and respond to potential objections to such uses of MMT. These appeal respectively to harm, autonomy, bodily and mental interference, and penal theoretic considerations. Finally, we introduce and dismiss a potential response to our argument that takes a revisionist position, rejecting prevailing incarceration practices.
... Asia, however, remains a region which relies upon an overly-punitive response to drugs, for example it is still one of the few areas of the globe that continue to implement the death penalty for drug offenses, and 11 countries continue to use compulsory centres for people who use drugs as their primary approach to treatment [3]. These types of services have been shown to be both ineffective [6,7] and unethical [8], yet countries such as Cambodia, Thailand, and Vietnam have yet to amend laws relating to detention centres. ...
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Background There is an estimate of three to five million people who inject drugs living in Asia. Unsafe injecting drug use is a major driver of both the HIV and hepatitis C (HCV) epidemic in this region, and an increase in incidence among people who inject drugs continues. Although harm reduction is becoming increasingly accepted, a largely punitive policy remains firmly in place, undermining access to life-saving programmes. The aim of this study is to present an overview of key findings on harm reduction in Asia based on data collected for the Global State of Harm Reduction 2014. Methods A review of international scientific and grey literature was undertaken between May and September 2014, including reports from multilateral agencies and international non-governmental organisations. A qualitative survey comprising open-ended questions was also administered to civil society, harm reduction networks, and organisations of people who use drugs to obtain national and regional information on key developments in harm reduction. Expert consultation from academics and key thinkers on HIV, drug use, and harm reduction was used to verify findings. Results In 2014, 17 countries in Asia provide needle and syringe programmes (NSP) provision and 15 opioid substitution therapy (OST). It is estimated that between 60 and 90 % of people who use drugs in Asia have HCV; however, treatment still remains out of reach due to cost barriers. TB testing and treatment services are yet to be established for key populations, yet nearly 15 % of the global burden of new cases of HIV-TB co-infection are attributed to southeast Asia. Eighteen percent of the total number of people living with HIV eligible for antiretroviral treatment (ART) accessed treatment. Only Malaysia and Indonesia provide OST in prison, with no NSP provision in prisons in the region. Conclusion To reduce HIV and viral hepatitis risk among people who inject drugs, there is a necessity to significantly increase harm reduction service provision in Asia. Although there has been progress, work still needs to be done to ensure an appropriate and enabling environment. At present, people who inject drugs are extremely difficult to reach; structural and legal barriers to services must be reduced, integrated holistic services introduced, and further research undertaken. Electronic supplementary material The online version of this article (doi:10.1186/s12954-015-0066-x) contains supplementary material, which is available to authorized users.
... 51. Farabee et al. 1998, and Leukefeld and Tims 1988, 243 emphasize the unsurprisingly low treatment success rates when only external motivational measures are in place. This is particularly strong when an involuntary patient self-assesses as a recreational drug user, rather than someone with an addiction problem. ...
Article
In what sense is a person addicted to drugs or alcohol incompetent, and so a legitimate object of coercive treatment? The standard tests for competence do not pick out the capacity that is lost in addiction: the capacity to properly regulate consumption. This paper is an attempt to sketch a justificatory framework for understanding the conditions under which addicted persons may be treated against their will. These conditions rarely obtain, for they apply only when addiction is extremely severe and great harm threatens. It will be argued also that to widen the measures currently in place in some jurisdictions, though philosophically well-motivated, would require very strong evidence of a set of conditions disposing a person to an addictive future. It is doubtful that any such currently available evidence is strong enough to justify coercive treatment. Nevertheless, coercive treatment of addiction is already a reality, with the potential for more, and so some discussion will be presented regarding the extraordinary safeguards necessary to prevent misapplication of such treatment policies.
... A number of Australian [1] and US states [2] legislated for the involuntary treatment of 'inebriates' in the late 19th and early 20th centuries. US Federal courts sent heroin-addicted individuals for 6 months' compulsory treatment in Public Health Hospitals at Lexington, Kentucky and Fort Worth, Texas from 1934 to 1971 [3]. In these detention centres treatment (usually detoxification and 12-Step psychotherapy) was mandatory. ...
... Compulsory detention of addicted individuals has either been abandoned or fallen into disuse in most developed countries for two main reasons. First, it failed to treat addiction effectively, with most people detained returning to drug use after release [1,3,4]. Secondly, this approach has been criticized for violating the human rights of drug users (e.g. ...
... As expected, longer treatment stays, which are a consequence of workplace mandates, predicted better outcomes. Consistent with other research (35)(36)(37), length of stay was a critical predictor of all outcomes and remained so at five years. Treatment adherence (such as medication adherence) is a primary outcome examined in the psychiatric literature, and studies have examined the role of feared loss of housing, financial leverage, and threatened hospitalization in improving adherence (38)(39)(40). ...
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This study examined the role of workplace mandates to chemical dependency treatment in treatment adherence, alcohol and drug abstinence, severity of employment problems, and severity of psychiatric problems. The sample included 448 employed members of a private, nonprofit U.S. managed care health plan who entered chemical dependency treatment with a workplace mandate (N=75) or without one (N=373); 405 of these individuals were followed up at one year (N=70 and N=335, respectively), and 362 participated in a five-year follow up (N=60 and N=302, respectively). Propensity scores predicting receipt of a workplace mandate were calculated. Logistic regression and ordinary least-squares regression were used to predict length of stay in chemical dependency treatment, alcohol and drug abstinence, and psychiatric and employment problem severity at one and five years. Overall, participants with a workplace mandate had one- and five-year outcomes similar to those without such a mandate. Having a workplace mandate also predicted longer treatment stays and improvement in employment problems. When other factors related to outcomes were controlled for, having a workplace mandate predicted abstinence at one year, with length of stay as a mediating variable. Workplace mandates can be an effective mechanism for improving work performance and other outcomes. Study participants who had a workplace mandate were more likely than those who did not have a workplace mandate to be abstinent at follow-up, and they did as well in treatment, both short and long term. Pressure from the workplace likely gets people to treatment earlier and provides incentives for treatment adherence.
... In the field of substance use disorders, it is generally accepted that compulsory treatment is more effective than voluntary for treatment retention and short-term abstinence (Leukefeld & Tims, 1988). Research indicates some support for improved outcomes with mandated substance abuse treatment (Kelly, Finney, & Moos, 2005;Miller & Flaherty, 2000;Nishimoto & Roberts, 2001). ...
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Although there is much momentum for behavioral health policies supporting mandated treatment, there is little evidence supporting its safety and effectiveness for individuals with complex issues. The authors used a national study of women with co-occurring psychiatric, substance use disorders and histories of trauma to compare mandated and voluntary treatment by examining psychiatric, substance use, and trauma-related outcomes following treatment. This quasi-experimental study included 2,726 women, with measures completed at baseline, 6-month, and 12-month follow-up. Two-way analyses of covariance examined the main and interactive effects of coercive status (mandated vs. voluntary) and condition (integrated treatment vs. services as usual) on psychiatric distress, trauma-related symptoms, and substance use outcomes. Women did better with integrated treatment and with mandated treatment regardless of treatment condition for psychiatric, trauma, and substance use outcomes at both follow-ups. Further research clarifying unintended side effects and change mechanisms of mandated treatment is needed to inform policy decisions.
... in the external pressure category of the non-treatment related client factors that may contribute to recovery from drug abuse (Leukefeld & Tims, 1988). A study of 2194 patients in long-term residential programs found that, independent of motivation for treatment, those under legal pressure remained in treatment longer (Knight, Hiller, Broome, & Simpson, 2000). ...
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The authors investigated the relationship between patients' self-rated satisfaction with treatment services during and shortly after treatment with their drug use outcomes at one year follow-up, using a US national panel survey of patients in 62 methadone, outpatient, short-term residential, and long-term residential programs. A favorable evaluation of treatment near the time of discharge had a significant positive relationship with drug use improvement outcomes approximately one year later, independent of the separately measured effects of treatment duration, counseling intensity, patient adherence to treatment protocols, pre-treatment drug use patterns, and other characteristics of patients and treatment programs.
... Coerced treatment is not a new concept but has been employed by the American legal system over more than eight decades, beginning with the morphine maintenance clinics in the early 1920s, and continuing with the opening of the first public health services hospital in 1935 that treated incarcerated and self-referred substance users ( Leukefeld and Tims, 1988;Prendergast et al., 2002;Terry and Pellens, 1928). In other countries, the history of coerced treatment is, by comparison to the United States, shorter. ...
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Drug and alcohol use presents a serious social problem for most countries in the world. Of particular concern is the well-documented relationship between substance use and crime, which has contributed to an increased popularity and willingness to utilize more forceful means to pressure substance users into treatment. Although compulsory/legally mandated treatment is appealing, it has been one of the most fiercely debated topics in the addiction field, raising a number of issues including ethical concerns and motivational considerations. In this context, the most important question to be answered is whether or not compulsory treatment is effective in the rehabilitation of addicted offenders. Regrettably, three decades of research into the effectiveness of compulsory treatment have yielded a mixed, inconsistent, and inconclusive pattern of results, calling into question the evidence-based claims made by numerous researchers that compulsory treatment is effective in the rehabilitation of substance users. The present paper provides an overview of the key issues concerning the use and efficacy of legal coercion in the rehabilitation of substance users, including a critique of the research base and recommendations for future research.
... Offenders who successfully complete a treatment program are theoretical good risks to reenter society. The extant knowledge base suggests that prison-based programs, vested in the ideas of classification and prediction, significantly reduce both recidivism and relapse rates (Anglin et al., 1996; Farabee, Prendergast, & Anglin, 1998; Field, 1989; Gendreau, 1996; Inciardi, Martin, Butzin, Hooper, & Harrison, 1997; Knight, Simpson, Chatham, & Camacho, 1997; Leukfeld & Tims, 1988; Wexler, 1996). The modified prison therapeutic community (TC) approach to the treatment of substance abusing inmates has been touted as particularly successful in 0047-2352/$ – see front matter D 2003 Elsevier Ltd. ...
... Offenders who successfully complete a treatment program are theoretical good risks to reenter society. The extant knowledge base suggests that prison-based programs, vested in the ideas of classification and prediction, significantly reduce both recidivism and relapse rates ( Anglin et al., 1996;Farabee, Prendergast, & Anglin, 1998;Field, 1989;Gendreau, 1996;Inciardi, Martin, Butzin, Hooper, & Harrison, 1997;Knight, Simpson, Chatham, & Camacho, 1997;Leukfeld & Tims, 1988;Wexler, 1996). The modified prison therapeutic community (TC) approach to the treatment of substance abusing inmates has been touted as particularly successful in 0047-2352/$-see front matter D 2003 Elsevier Ltd. ...
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The delivery of substance abuse treatment within correctional settings marks one of the criminal justice system's primary opportunities to disrupt the drugs-crime nexus. Federally funded residential substance abuse treatment programs were rapidly introduced across the nation, although implementation problems increased their operational variability. This article examines how implementation barriers interrelate with other types of obstacles and multiply to hinder determinations of program effectiveness. Specific barriers were identified from a case study of process and outcome evaluations of the South Carolina Residential Substance Abuse Treatment (RSAT) program. A conceptual framework groups barriers by type into four interrelated domains wherein additive effects and reciprocal consequences that can undermine effective program assessment are illustrated.