Involuntary Rehab: Should You Force Someone Into Rehab?

October 10, 2022

Table of Contents

Forcing someone into rehab is a complicated decision, and the evidence on how effective these forced rehab visits actually are is, at best, mixed. What’s clear is that, whenever possible, it is much better for a person to voluntarily enter a drug treatment program than be forced to go.

What Is Involuntary Rehab?

Involuntary rehab refers to the practice of sending a person to a drug addiction treatment center (rehab) without their willing consent. It is a controversial practice that opens up many questions about the best way to balance limits on a person’s own personal autonomy with a desire to keep them and those around them safe.

Whatever one’s views on involuntary rehab, it is generally difficult to get someone involuntarily committed to a rehabilitation facility, requiring significantly more than just a genuine concern for their health and proof they may struggle with substance use disorder (SUD) or mental health issues. Legally, it must be proven that the person poses an imminent harm to their own life or the life of someone else (suicidality or homicidality).

What is an “Intervention”?

Somewhat related to involuntary rehab is the practice of staging interventions, popularized by the reality TV series Intervention. The specifics of interventions vary, but they usually involve sitting a person struggling with substance use disorder down with their family and loved ones and trying to convince them into undergoing addiction treatment voluntarily.

Interventions are often overseen by mental health professionals who guide the process. They may involve certain ultimatums and boundaries being set, especially if the person struggling with SUD has been doing harm, intentionally or not, to those around them.

While different from involuntary commitment, interventions often frame rehabilitation as the easiest path forward for a person who is struggling with drug use. If they don’t go to rehab, they may face serious life consequences, such as divorce, being kicked out of their home, legal trouble, and more, depending on their circumstances.

The efficacy of this approach isn’t entirely clear, as there isn’t enough data on the practice.[1] It should be noted that interventions, much like involuntary rehab, are often only used as a last resort to try and help someone who is struggling with drug misuse.

Can You Legally Force Someone Into Rehab?

In the United States, forcing someone into rehab is often a legally complex process and won’t always be possible, even if a person is in serious need of addiction help. Under the law, a person usually has a significant degree of autonomy and personal freedoms and a right to due process before any of the freedoms they’re usually afforded can be taken away.

The exact process to involuntarily commit a person to rehab depends on the state. It usually requires demonstrating a significant and immediate need for rehabilitation beyond just proving a person has a substance use disorder. Usually, it must be proven that the individual is either unable to take care of themselves to the point that their health and life are threatened, or that their drug use is contributing to an imminent threat of suicide or homocide. This usually requires a formal medical evaluation by a licensed clinician.

If you are considering trying to get someone involuntarily committed to rehab or someone is trying to do so for you, always consult a legal professional for first steps. 

The Involuntary Commitment Process

At least 35 states and the District of Columbia have established procedures that allow a person to be involuntarily committed to an addiction treatment facility under the right circumstances.[2] Common criteria for committal include the following:

  • Demonstrable loss of control due to a substance use disorder
  • An inability to meet basic life needs such as taking care of themselves 
  • Significant impairment of one’s ability to make decisions
  • Representing a notable danger to oneself or others
  • A severe enough addiction that it could qualify as a “grave disability”

Generally, the person deciding if an individual meets these criteria must be a relevant (usually medical) professional.

During the commitment process, including before a person is committed, a person will usually have access to an attorney and be afforded the same or similar rights typical of other important legal processes that may end in a loss of liberty. 

Potential Differences Between States

It’s important to research the specifics of this process in the State where you reside. For example, the maximum amount of time a person can be committed varies significantly, ranging from a few days to a year. You’ll also want to understand how recommitment works, which is the process by which, if appropriate, a person can be sent to rehab again after leaving. [2] Any family member pursuing the route of involuntary commitment will likely need to start by obtaining legal counsel. 

Efficacy of Involuntary Rehab

How does involuntary commitment compare to voluntary commitment in terms of long time outcomes for patients with SUD? This is hard to study for several reasons. First, State laws vary widely, making it difficult to compare the efficacy of involuntary treatment across state lines. In addition, The quality of a facility and the treatments used can vary, even within the same state. This makes it very hard to study.

At least one review has said compulsory drug treatment is often ineffective and has been suggested by some studies to potentially cause harm.[3] This same review suggested policymakers should be prioritizing non-compulsory treatment modalities. It is hard to get someone to discontinue substance use long term against their will. The most effective treatment will be for someone who is personally willing to change, and is not being forced to do so. 

Alternatives to Involuntary Rehab

While it may be appropriate or necessary to pursue involuntary commitment in extreme circumstances, the evidence suggests a person is much more likely to experience a good outcome from their treatment if they go voluntarily.

For many people, a brief stay at a rehabilitation facility to undergo withdrawal and then regular counseling can help them recover from drug misuse and stay in recovery.

In contrast, some people in crisis may benefit from longer term inpatient care, where they may stay at a facility for several weeks and undergo more intensive addiction counseling and even start long term medications for stabilization. 

Convincing a Loved One to Go to Rehab Voluntarily

An honest, judgment-free conversation with a loved one about their drug use and your concerns can sometimes be the push they need to get help. Approach the conversation without any anger and after doing a significant amount of research about addiction and evidence-based treatments. Talk to them about your worries regarding their health and the changes you’ve noticed.

If they’re willing to listen, talk about the treatment options you’ve researched. If possible, give them actionable information, like pamphlets or phone numbers they can call to schedule treatment. Your conversation might be what prompts them to get help.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. Drug and Alcohol Interventions: Do They Work? Psychology Today. https://www.psychologytoday.com/us/blog/when-your-adult-child-breaks-your-heart/201408/drug-and-alcohol-interventions-do-they-work. August 2014. Accessed August 2022.
  2. Involuntary Commitment and Guardianship Laws for Persons with a Substance Use Disorder. National Judicial Opioid Task Force. https://www.ncsc.org/__data/assets/pdf_file/0028/18478/inv-comm-and-guard-laws-for-sud-final.pdf. Accessed August 2022.
  3. The Effectiveness of Compulsory Drug Treatment: A Systematic Review. International Journal of Drug Policy. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4752879/. February 2017. Accessed August 2022.
  4. How to Create Healthy Boundaries. The University of Kentucky. https://www.uky.edu/hr/sites/www.uky.edu.hr/files/wellness/images/Conf14_Boundaries.pdf. Accessed August 2022.

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