Drug Users Are Being Sentenced to Forced Rehab. But Does It Work?

Yolo County, in California’s agricultural Central Valley, where tract homes and auto-body shops spring up across the street from pastures and orchards, has some of the same homelessness and substance-abuse problems fueling the ghastly street theater seen on skid rows in San Francisco and Los Angeles. 

But if Gov. Gavin Newsom signs into law a bill that unanimously passed the state Legislature earlier this month, Yolo County will also become the latest laboratory in an ongoing and widening nationwide experiment: Instead of sentencing drug users to jail, what if you sentenced them to rehab?

Described as an alternative to incarceration for people charged with certain “drug-motivated felonies,” the “secured drug treatment facility” that would open under what the local district attorney’s office is calling “Hope Yolo” is one of the latest examples of “involuntary commitment," in which the courts mandate substance-abuse treatment.

Laws depriving individuals of certain rights for mental health problems have existed for decades. (Such “conservatorship” laws were used, now infamously, by Britney Spears’s father to control the singer’s fortune and freedom.) But as the opioid-overdose crisis has worsened, the use of both criminal and civil procedures to compel recalcitrant drug users to get help, with the threat of “real” imprisonment if they do not comply, has become more popular across the United States.

Thirty-five states now allow individuals to petition a civil judge to order a family member or loved one into treatment via a conservatorship, up from 28 states that had similar laws on the books in 2011, according to researchers at Northeastern University School of Law’s Health in Justice Action Lab. And in states without civil conservatorships, criminal judges can sentence drug users to rehab either in regular courts or in “drug courts,” a model favored by President Joe Biden. 

Though there are slight differences between the civil and criminal involuntary commitment processes, both “control behavior that somebody doesn’t like, that society has deemed problematic,” says sociologist Alex V. Barnard, a professor at New York University who has studied the issue. “In the big-picture sense, these are both systems of care and control.”

Advocates for involuntary treatment point out that the status quo has clearly not worked—more than 90,000 Americans died after overdosing on drugs last year, another record—and some action is needed. “One of the things we know, and what people in opposition don’t want to hear, is what we are currently doing isn’t working,” said Jonathan Raven, the Yolo County chief deputy district attorney. “This is trying something new.”

Think of them as an intervention, with judges and police in the picture instead of just concerned family—which summons authorities as a last resort, so as to avoid a later call from the coroner. 

“We’re not trying to violate their civil liberties; we’re just trying to save their lives,” said Joan Arlinghaus. Arlinghaus lives in Kentucky, where she helps parents and family members navigate “Casey’s Law.” Passed in 2004, the statute allows family members of drug users to petition courts to grant conservatorships to commit them to treatment, provided they arrange a treatment bed ahead of time.

“They just need to be forced into treatment long enough to get their heads clear, fully detox from drugs, and go, ‘Oh, wow.’ Usually once they do that, they realize they’re in a good place,” she told VICE News. “At least, that’s the hope.”

Jay Davis is convinced Casey’s Law saved the life of his son, Jeff. A drug user since he was in his early teens, Jeff, now 31, spent most of a decade bouncing in and out of treatment programs, apartments, and jobs, with bouts of homelessness, and one suicide attempt foiled by police in Cincinnati. 

After hesitating to use Casey’s Law against his son—“I was a coward,” Jay Davis said—the sight of his zonked-out son dripping snot into his meal at a diner finally compelled Davis to file a petition to have his son committed in August 2020. 

After a court-mandated evaluation, he entered short-term residential treatment within days, before a transfer to a yearlong, Christian faith–centered treatment program, from which a transformed Jeff Davis is due to graduate Sept. 27. He plans to stay on longer, as a paid staffer offering peer mentorship to newcomers, his relieved father said. 

“When I first filed, Jeff sent me a very, very nasty text message, but since then he has thanked me over and over,” Jay Davis said. “He has told people there that we saved his life.”

“As far as forced? Absolutely it’s forced upon them. There’s no other way to say it,” he said. 

But research shows that Jeff Davis’ case is an outlier. Most often, involuntary treatment doesn’t work. Forcing someone into treatment against their will routinely fails; someone will get clean only when they want to get clean (and, oftentimes, not even then).

More problematic is that involuntary treatment is just jail in a different guise, according to critics, who say that using the state to commit someone to a “secured, locked” facility like the future treatment facility in Yolo County from which they can’t leave, is still incarceration. (Early proposals for Hope Yolo involved using an old juvenile detention hall, located right next door to the county jail, as the “secure treatment facility”; at the moment, the location is undecided.)

While the “Hope Yolo” proposal passed the state Legislature with rare bipartisan support as well as praise from former Gov. Jerry Brown, opposition poured in from civil liberties and drug-reform advocates, including Human Rights Watch, which called it “simply a plan for more incarceration under the guise of treatment.”

While civil commitments and criminal-justice system “alternatives” like Hope Yolo are different mechanisms, the overall effect is the same, according to Kellen Russoniello, a staff attorney with the Drug Policy Alliance, which opposed the Hope Yolo bill and also opposes civil commitments.

“You are forcing this person into treatment and punishing them if they do not comply,” he said. “I think a lot of people may view civil commitments as a less harsh version, but again, you’re still taking people’s freedoms away from them, and making their health care decisions for them.”

Researchers agree that involuntary commitment to drug treatment is understudied, but as a 2016 review published in the International Journal of Drug Policy found, available “[e]vidence does not, on the whole, suggest improved outcomes related to compulsory treatment approaches, with some studies suggesting potential harms,” including high potential for abuse within treatment centers. Instead, lawmakers should fund “non-compulsory” and evidence-based treatment. 

But rather than funding evidence-based techniques like medication-assisted treatment, lawmakers and judges are just throwing more and more opioid users into “jail lite,” according to critics. 

Owing to poor data collection, outcomes of U.S. involuntary commitment laws are murky. But what numbers are available indicate that use of involuntary commitments has steadily risen over the past decade.

In Massachusetts, use of civil commitments under a law called Section 35 nearly doubled from 2010 to 2018, with more than 10,000 people committed in 2017 and 2018, the most recent data available. And in Kentucky, use of Casey’s Law increased tenfold over the past decade, from 100 petitions in 2009 to 1,360 in 2019, according to data provided by the state Administrative Office of the Courts, with more than 500 filings in Kenton County alone, where Jay Davis filed against his son. (A dip in 2020, caused by courts’ closure during a stretch of the COVID-19 pandemic, is considered an aberration.) 

But observers say the available results aren’t encouraging.

Alex Woodruff, a health science specialist at the Boston VA Healthcare System, investigated Section 35 and described what he saw as “chaotic and messy.” 

A person in withdrawal might be dragged into court and declared a drug addict and a threat to themselves or others based only on visible track marks seen by a court psychologist on an arm. In some cases, Woodruff said, a person already in an outpatient treatment program that was generally working despite a recent relapse could be the subject of a Section 35 petition filed by fed-up family members—and then find themselves thrown into a different inpatient program run by the state Department of Corrections. “That was basically jail,” he said. 

Better treatment, run by the state health department rather than the prison system, was available, but whether the individual would end up there or in the de facto jail seemed a game of chance. “It was a mystery,” Woodruff said. “The way that I saw it implemented, I believe absolutely deprives civil liberties on a routine basis.”

But while the laws are on the books, not every state with involuntary commitment statutes uses them. And even in Kentucky, implementation of Casey’s Law varies widely from county to county, and mostly “sucks,” according to Jay Davis, who only managed to navigate the system with help from Arlinghaus and other advocates, he said. 

In Indiana, lawmakers passed a limited, trial-run version of Casey’s Law in 2017 that allowed people in three counties, including Marion County, where Indianapolis is located, to file conservatorship petitions. (Notably, the fact that the law allows “commitment proceedings” against an opioid user wasn’t mentioned in press releases.) Four years on, only one county, Tippecanoe, has launched a pilot program, and it’s unclear how well it’s going. The state Division of Addiction and Mental Health will not receive a progress report until next year, a spokesperson said. 

“Marion County frowned upon it,” said state Sen. Jeff Raatz, a former pastor and the bill’s chief sponsor. But in Indianapolis, the reluctance wasn’t because of civil liberties concerns; it was because Marion County didn’t have the treatment capacity, he said (and the bill did not provide any funding).

Undaunted, Raatz says he’ll continue to advocate for forced treatment. “I wouldn’t give up,” he said. “It may be that the powers that be in the counties need to be reminded of it.”

Whether the state is willing to pay for effective treatment is an open question, but the political popularity of forced drug treatment seems immune to its rate of failure. Lawmakers are swamped with constituent calls complaining about street scenes. Relatives of drug users are desperate, helpless, and afraid. And lingering concerns over civil liberties can be trumped with a single success story. 

For some, the choice between forcibly committing someone to treatment and letting them die free is no choice at all.

“It may not work the first time,” said Arlinghaus, the Kentucky advocate. “It may not work the second time. So we always say, it’s not a silver bullet. It’s just a hopeful option for families who have tried so many other things.”