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Pilarinos A, Barker B, Nosova E, Milloy MJ, Hayashi K, Wood E, Kerr T, DeBeck K. Coercion into addiction treatment and subsequent substance use patterns among people who use illicit drugs in Vancouver, Canada. Addiction 2020; 115:97-106. [PMID: 31379008 PMCID: PMC6933075 DOI: 10.1111/add.14769] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 11/26/2018] [Accepted: 07/26/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS Many people who use drugs (PWUD) are coerced into receiving treatment. This study aimed to assess changes in substance use and related outcomes before versus after treatment in people coerced into treatment, voluntarily attending treatment or not attending treatment. DESIGN Data from three linked prospective cohort studies of PWUD were used. McNemar's test and non-linear growth curve modeling were employed to: (a) assess changes in substance use patterns before and after coerced addiction treatment and (b) compare these changes with changes in PWUD who (1) voluntarily accessed and (2) did not access treatment. SETTING Vancouver, Canada. PARTICIPANTS A total of 3196 community-recruited PWUD. MEASUREMENTS The outcome variables were substance use and related outcomes assessed by self-reported questionnaire. The input variable was self-reported coerced addiction treatment (defined as being forced into addiction treatment by a doctor or the criminal justice system), voluntary treatment versus no treatment. FINDINGS Between September 2005 and June 2015, 399 (12.5%) participants reported being coerced into addiction treatment. In McNemar's test, there were no statistically significant reductions in within-group substance use outcomes for people coerced into treatment, voluntarily attending treatment or not attending treatment. In non-linear growth curve analyses, there were no statistically significant differences in the before and after substance use patterns between those coerced into treatment versus either of the two control groups (all P > 0.05). In subanalyses, we found no statistically significant differences in substance use patterns between people who reported formal coerced treatment through the criminal justice system and people who reported informal coerced treatment through a physician. CONCLUSIONS Among PWUD in Vancouver, Canada, there appear to be no statistically significant improvements in substance use outcomes among those reporting coerced addiction treatment, those voluntarily accessing treatment, and those not attending treatment.
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Affiliation(s)
- Andreas Pilarinos
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
- Interdisciplinary Studies Graduate Program, University of British Columbia, 270-2357 Main Mall, Vancouver, B.C., Canada V6T 1Z4
| | - Brittany Barker
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
- First Nations Health Authority, 100 Park Royal S, West Vancouver, B.C., Canada, V7T 1A2
| | - Ekaterina Nosova
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
| | - M-J Milloy
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Tenth Floor, Vancouver, B.C., Canada, V5Z 1M9
| | - Kanna Hayashi
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Room 11300, Blusson Hall, Burnaby, B.C., Canada, V5A 1S6
| | - Evan Wood
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Tenth Floor, Vancouver, B.C., Canada, V5Z 1M9
| | - Thomas Kerr
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
- Department of Medicine, University of British Columbia, 2775 Laurel Street, Tenth Floor, Vancouver, B.C., Canada, V5Z 1M9
| | - Kora DeBeck
- British Columbia Centre on Substance Use, 1045 Howe Street, Fourth Floor, Vancouver, B.C., Canada, V6Z 2A9
- School of Public Policy, Simon Fraser University, 3277-515 West Hastings Street, Vancouver, B.C., Canada, V6B 5K3
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Abstract
A central tenet of medical ethics holds that it is permissible to perform a medical intervention on a competent individual only if that individual has given informed consent to the intervention. Yet it occasionally seems morally permissible to carry out non-consensual medical interventions on competent individuals for the purpose of infectious disease control (IDC). We describe two different moral frameworks that have been invoked in support of non-consensual IDC interventions and identify five desiderata that might be used to guide assessments of the moral permissibility of such interventions on either kind of fundamental justification. We then consider what these desiderata imply for the justifiability of carrying out non-consensual medical interventions that are designed to facilitate rehabilitation amongst serious criminal offenders. We argue that these desiderata suggest that a plausible case can be made in favor of such interventions.
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Affiliation(s)
| | - Thomas Douglas
- Thomas Douglas is a Senior Research Fellow at the Uehiro Centre for Practical Ethics and the Faculty of Philosophy, University of Oxford, U.K.
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Abstract
This study evaluated a community-based correctional program in California, in which parolees tested positive on illicit drugs were given the option of going into a treatment program or having their parole revoked and returned to prison in California. Two comparison groups were constructed to assess the treatment effect-a propensity-based comparison group extracted from the general parolee population and program dropouts. Although implicitly coercive, some parolees who finished the program were less likely to be reincarcerated 12 months following release than both comparison groups. However, the observed treatment advantage quickly eroded in the second observation year. Savings realized from the incarcerations avoided were more than enough to pay for the program. Findings from this study suggest that boosting participation in reentry services through coercive measures may yield currently unrealized individual and societal benefits. However, systemic efforts are needed to extend the short-term treatment effects. Design and data limitations in the study weaken the persuasiveness of these findings. Methodological implications and policy issues about coerced treatment are discussed.
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Affiliation(s)
- Sheldon X Zhang
- Department of Sociology, San Diego State University, CA 92182-4423, USA.
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Hampton AS, Conner BT, Albert D, Anglin MD, Urada D, Longshore D. Pathways to treatment retention for individuals legally coerced to substance use treatment: the interaction of hope and treatment motivation. Drug Alcohol Depend 2011; 118:400-7. [PMID: 21632188 PMCID: PMC3189264 DOI: 10.1016/j.drugalcdep.2011.04.022] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 04/25/2011] [Accepted: 04/29/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although several states have adopted policies diverting individuals convicted of non-violent drug offenses to substance use treatment, in lieu of incarceration or as a condition of probation, previous research has produced inconsistent findings on the effectiveness of such programs when comparing outcomes for legally coerced individuals to more voluntary entrants. Less studied in these populations is within group variation in treatment expectations and motivation influences, which have been shown to affect retention as well. METHODS As motivation has traditionally been viewed as contributing to treatment retention and higher levels of hope (the perception that goals can be met) are viewed as an asset in treatment, the role of these factors in predicting better retention between legally coerced and more voluntary clients were examined in a sample of 289 treatment admissions in California. RESULTS Results found that motivation mediates the relationship between hope and retention for participants in general. Although the differences in mediation between the legally coerced and the non-legally coerced were not significant, when examining the groups separately, there was a significant mediation of the relationship between hope and retention by motivation only for those individuals who were not legally coerced into treatment (p<.05). CONCLUSION The findings imply that while being legally coerced may lead to different pathways to treatment retention, for individuals who were not legally coerced, higher levels of hope may play an important role in determining treatment retention.
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Affiliation(s)
- Ashley S. Hampton
- Temple University, Department of Psychology, Weiss Hall, 1701 N. 13thSt., Philadelphia, PA 19122, United States,Corresponding author at: Temple University, Department of Psychology, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA 19122, United States. Tel.: +1 215 804 9806; fax: +1 215 204 5539. (A.S. Hampton)
| | - Bradley T. Conner
- Temple University, Department of Psychology, Weiss Hall, 1701 N. 13thSt., Philadelphia, PA 19122, United States
| | - Dustin Albert
- Temple University, Department of Psychology, Weiss Hall, 1701 N. 13thSt., Philadelphia, PA 19122, United States
| | - M. Douglas Anglin
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, UCLA, 1640 S. Sepulveda Blvd., Ste. 200, Los Angeles, CA 90025, USA
| | - Darren Urada
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, UCLA, 1640 S. Sepulveda Blvd., Ste. 200, Los Angeles, CA 90025, USA
| | - Douglas Longshore
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, UCLA, 1640 S. Sepulveda Blvd., Ste. 200, Los Angeles, CA 90025, USA
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