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Uses of Coercion in Addiction Treatment: Clinical Aspects
Article first published online: 18 FEB 2010
2008 American Academy of Addiction Psychiatry
The American Journal on Addictions
Volume 17, Issue 1, pages 36–47, January-February 2008
How to Cite
Sullivan, M. A., Birkmayer, F., Boyarsky, B. K., Frances, R. J., Fromson, J. A., Galanter, M., Levin, F. R., Lewis, C., Nace, E. P., Suchinsky, R. T., Tamerin, J. S., Tolliver, B. and Westermeyer, J. (2008), Uses of Coercion in Addiction Treatment: Clinical Aspects. The American Journal on Addictions, 17: 36–47. doi: 10.1080/10550490701756369
- Issue published online: 18 FEB 2010
- Article first published online: 18 FEB 2010
- Received April 13, 2006; revised June 22, 2006; accepted April 12, 2007
Coerced or involuntary treatment comprises an integral, often positive component of treatment for addictive disorders. By the same token, coercion in health care raises numerous ethical, clinical, legal, political, cultural, and philosophical issues. In order to apply coerced care effectively, health care professionals should appreciate the indications, methods, advantages, and liabilities associated with this important clinical modality. An expert panel, consisting of the Addiction Committee of the Group for the Advancement of Psychiatry, listed the issues to be considered by clinicians in considering coerced treatment. In undertaking this task, they searched the literature using Pubmed from 1985 to 2005 using the following search terms: addiction, alcohol, coercion, compulsory, involuntary, substance, and treatment. In addition, they utilized relevant literature from published reports. In the treatment of addictions, coercive techniques can be effective and may be warranted in some circumstances. Various dimensions of coercive treatment are reviewed, including interventions to initiate treatment; contingency contracting and urine testing in the context of psychotherapy; and pharmacological methods of coercion such as disulfiram, naltrexone, and the use of a cocaine vaccine. The philosophical, historical, and societal aspects of coerced treatment are considered.