Civil commitment for alcohol and other drug dependence: perspectives from people with lived or living experience
Background: When someone is experiencing significant harm due to their substance use, and has refused voluntary treatment, when, if ever, is it appropriate to intervene and force them into treatment involuntarily? In many countries globally (including two Australian states), civil commitment programs are available where individuals can be forced into treatment for their substance use under specific circumstances. Whilst generally a legally mandated intervention, civil commitment is not in response to criminal behaviour and is instead considered a health intervention aimed at preventing death or other serious harm. Despite this aim of protecting individual’s safety, many have opposed the use of civil commitment, with concerns over the efficacy, potential human rights violations, and the potential trauma caused by such a restrictive intervention. Whilst scholars from many different fields have long been debating the use of civil commitment, there has been little research conducted exploring the perspectives of those most affected by this policy: people with lived and living experience of alcohol and other drug (AOD) dependence. As the first study of its kind in Australia, the aim of our research was to explore understandings, experiences and perspectives of civil commitment by people with lived and living experience of AOD dependence, including family members and significant others.
Methods: Three focus groups (n = 11) were held with people with lived and living experience of AOD dependence in Melbourne, Australia in 2023 with two facilitators from the research team. The focus groups were partially structured with questions and prompts from the facilitators; however, the discussion was left largely open-ended to allow participants to discuss and work through points of disagreement and difficulty. Transcripts of discussions were analysed thematically.
Results: Participant’s perspectives of civil commitment were tied to their experience of AOD dependence and treatment. Participants were cautious about the efficacy of civil commitment given they felt choice, and autonomy were important requisites for treatment success. Yet, they also saw value in protecting people from harm in certain circumstances. Participants worried civil commitment causes traumatisation/re-traumatisation, and proposed policy ideas for reducing this risk and introducing agency where possible.
Conclusions: Attending to opportunities for patients to exercise and experience choice and agency within civil commitment treatment (or any involuntary intervention) is perceived as important for treatment success.
