INVOLUNTARY COMMITMENT FOR SUBSTANCE USE
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The Issue:
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​As the overdose crisis continues to surge, access to evidence-based, affordable, and respectful substance use treatment remains limited.
Under the banner of expanding treatment, policymakers and government officials are increasingly turning to involuntary commitment. This legal mechanism has traditionally been used to place “temporary holds” on people in a mental health crisis. When applied to people with addiction, involuntary (or “civil”) commitment laws and practices are often more expansive and arbitrary than the severe mental illness analogues. In many places, involuntary treatment for substance use is basically incarceration, rebranded; some states operate civil commitment through their departments of corrections.
More than half of states in the U.S. have statutes on the books authorizing involuntary commitment for substance use. Legal protections afforded to people who come into contact with this system are few. The care provided in state custody often fails to meet basic international standards for substance use disorder treatment. Other health care services in these facilities are often dismal. There are obvious civil liberty and ethical implications of holding patients against their will and without informed consent. But involuntary commitment may also aggravate the very problem it is purported to solve: people committed under these systems face higher risk of relapse and overdose than those who sought voluntary treatment.
Involuntary commitment mechanisms play an increasingly prominent role in opioid crisis response, with continued support from federal, state, and local governments. But little is known about these programs. Our work focuses on better understanding how states are implementing civil commitment for substance use.
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CNN, July 16, 2018
FOIA Project:
Examining Involuntary Commitment Practice
To assess involuntary commitment (IC) for substance use in practice, the Lab requested 2015 to 2020 data on IC programs through state-specific Freedom of Information Acts (FOIAs) from 15 U.S. states with the broadest laws. The requests produced full and partial data concerning state-wide volume, demographics, and facility and financial information for only five states:
Data Topic Request (2015-2020) | Massachusetts | Minnesota | North Carolina | South Carolina | Florida |
|---|---|---|---|---|---|
IC Pregnant Population | No | No | No | No | No |
IC By Race | Yes | Yes | Yes | Yes | Yes |
IC By Gender | Yes | Yes | Yes | Yes | Yes |
Financial Information | Yes | Yes | No | No | No |
Overdose Post-Discharge | No | No | No | No | No |
Overdose in Facility | No | No | No | No | No |
Total IC Population | Yes | Yes | Yes | Yes | Yes |
See Full Tableau Public Links Here: Number of People Committed, Race, Gender
Key Findings
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No states provided data on overdose totals during or after IC in their facilities.​
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States’ deployment of IC varied in intake volume.
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Of the states analyzed, programs ranged from maintaining 1,000 to 15,000 people in IC each year.
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Women make up at least 40% of people experiencing IC in each of these states, despite women making up 18% of the total people incarcerated in the U.S.
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North Carolina had a higher total volume of people in IC than compared to others.
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From June 2018-19, the state had nearly 1,341 people within their state-run facilities.​
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Our findings support the underrepresentation of BIPOC people in IC.
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IC is considered a less-harsh alternative to standard sentencing and incarceration and BIPOC people are more found within the standard carceral system.
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IC data is not consistently collected by each state and is difficult to access.
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From October 2020 to May 2021, only one-third of the contacted states were able to provide full or partial IC data.
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Data collection was often hindered by legal and communication barriers and hesitancy from the state offices to release information.
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Significant time was spent aggregating the collected information, as each states’ organization and maintenance of their data varied greatly from another.
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Some states reported that they do not collect or record data regarding IC at all.
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Analyzing National Media Trends on Involuntary Commitment for Substance Use
Methods
From October 2020 to March 2021, we aggregated and analyzed U.S. media articles published from 2015 to 2020 that covered involuntary commitment for their themes, rhetoric, speakers, and context. These articles were aggregated using MediaCloud, a research platform that includes a database of online mainstream news media by publication dates, media sources, and key terms. In total, 505 articles were independently coded by trained analysts and discrepancies in redundant coding were reconciled.
In our media analysis, we assessed the content of media articles that mention involuntary commitment or its analogs, as well as the proliferation in shares of these articles on Facebook. We specifically coded for parameters including: the voices represented speaking about involuntary commitment, how COVID-19 factored into involuntary commitment decisions, the article’s context (i.e. policy-based, a commentary on involuntary commitment as a general practice, or case-specific), involuntary commitment as an alternative to incarceration, mentions of specific substances or drug classes, and whether stigmatizing themes were used.
See Full Tableau Public Links Here: Time Trends (Published), Time Trends (FB Shared), Perspectives/Contexts, Drug Type Used- Perspectives, Alternative Recommendations
Key Findings
We identified 3 major findings from this research:
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Only 6.6% of media articles included perspectives from someone who had personally experienced involuntary commitment. Legislators, family members, and healthcare professionals are the voices most commonly featured.
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Involuntary commitment is experienced more commonly through in-patient than out-patient settings. The in-patient setting is more similar to incarceration than the out-patient setting because it restricts patient autonomy.
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Between 2015 and 2020, stories containing critical narratives of involuntary commitment were more often shared on Facebook than stories with neutral or supportive narratives.
Resources
Access to Addiction Services Briefing: June 1, 2023
Sunyou Kang, Katie McCreedy, Leo Beletsky et al
Journal of Addiction Medicine, 2023
Leo Beletsky and Rafik Wahbi
Journal of Law, Medicine, & Ethics, March 4, 2022