INVOLUNTARY COMMITMENT FOR SUBSTANCE USE
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THE ISSUE:
As opioid use and overdose continue to pose a mounting public policy challenge in the US, access to evidence-based, affordable, and respectful treatment remains sparse. Perversely, legislators and officials are increasingly turning to civil commitment statutes to force drug users to in-patient “treatment” facilities. Many of these resemble prisons. More than half of US states currently have the authorizing statutes on the books, though the extent of their utilization is unclear. What is clear is that care provided in such state custody often fails to meet basic international standards for substance use disorder treatment; other elements of health care services in these facilities are often dismal. Aside from the obvious civil liberty implications, patients committed under these systems—many for periods of 90 days or more—face dramatically higher risk of relapse and overdose than those re-entering the community from voluntary treatment.
Today, civil commitment mechanisms are playing an increasingly prominent role in opioid crisis response. The reasons for this are several. First, they provide desperate families of at-risk patients. police, and health care providers with a decisive and relatively immediate crisis response mechanism. Second, care provided under civil commitment statutes provides a work-around to the kind of waiting lists and navigation barriers that characterize efforts to access voluntary treatment in most jurisdictions. Third, involuntary treatment under state care is paid for through state funds (and to insurers, in some instances); the individual or the family does not bear responsibility for the costs. Fourth--and probably most importantly--involuntary treatment creates an outlet for our society’s carceral approach to substance use under the false veneer of a softer, gentler “public health” approach.
Despite increasing utilization of these treatment mechanisms, little is known about the extent to which these provisions are being employed, and inadequate attention has been paid to articulating approaches to counter these carceral structures and laws through litigation or other forms of advocacy. Our research identifies the current national legal landscape for civil commitment of substance users, and assesses states' implementation of these provisions as a means for substance use treatment.
There is little research assessing media coverage and public narratives surrounding involuntary commitment for substance use. The Action Lab is filling this gap by analyzing national media trends through a quantitative MediaCloud analysis. This project expands on our previous work tracking false narratives. In order to promote informed journalism on humane solutions to the overdose crisis, our goal is to garner an accurate representation of the current public health narrative in the media about involuntary commitment, and to better understand the use of stigmatizing language about those who use drugs.
CNN, July 16, 2018
Involuntary Commitment Case Study: Sec. 35 in Massachusetts
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MA Section 35 Facilities
*All Data and Graphs generated from MA Section 35 Commission Report (July 1, 2019)
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.
Involuntary commitment stories were tracked for their narrative through MediaCloud from 2015 and 2020 across a vast collection of media publications.
Involuntary commitment stories were tracked across Facebook shares from 2015 to 2020 to see what specific stories and narratives garnered the most attention. These stories and their shares shape the public narrative on involuntary commitment. While media articles that presented critical commentary on involuntary commitment were shared more times overall than those with neutral or supportive narratives, those advocating for or neutral on IC draw more attention in the moment.
When coding for speakers present in each media piece, we identified legislators, journalists, friends/relatives, and healthcare professionals as the voices most commonly mentioned. Of note, only 6.6% of stories quoted an individual who experienced involuntary commitment, showing that their voices are widely neglected in news coverage of involuntary commitment.
To analyze the themes presented in each media piece, we coded stories by three major topics for the story focus: policy change, individual case stories, and involuntary commitment in practice. Policy change is the most commonly discussed topic in involuntary commitment coverage, while individual cases are the least commonly discussed topic.
This graph displays the specific drugs mentioned by each news story. Most commonly, no specific drug was mentioned.
Some media stories cite involuntary commitment as a preferred alternative to incarceration. When incarceration was mentioned in the stories we analyzed, 81% of the media articles did not mention the relationship between incarceration and involuntary commitment. Of the articles that did mention incarceration, 87% of the articles described involuntary commitment as a preferred alternative to incarceration.
Some media stories cite involuntary commitment as a preferred alternative to incarceration. When incarceration was mentioned in the stories we analyzed, 81% of the media articles did not mention the relationship between incarceration and involuntary commitment. Of the articles that did mention incarceration, 87% of the articles described involuntary commitment as a preferred alternative to incarceration.
Results
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
Alex Stevens, PhD
University of Kent School of Social Policy, Sociology, and Social Research
Harvard Health Publishing
"There is much work yet to be done to bring scientific evidence on addiction to bear on the criminal justice system."