Table 1 Coercive Treatment vs Involuntary Treatment Characteristics

Definition

Treatment provided to individuals as an alternative to a less desirous outcome.

Short term civil commitment using specifically drafted legislation to treat people with substance dependence against their will in cases where there is imminent risk as a result of substance use.

Examples

Drug Court to avoid incarceration; engagement with AOD services to avoid removal of children by Child Protection Services.

Short term, hospital based treatment for people at imminent risk in the short term as a result of their substance use.

Patient’s consent required?

Yes, patients must choose to engage in treatment and must have the capacity to do so.

No, patients are detained and admitted involuntarily and must be determined to have their capacity to consent undermined by substance use.

Is a substance dependence required?

No

Yes

Treatment setting

Community or residential

Inpatient

Program target outcomes

Reduced drug related harm to the individual, but also the community, family and/or employer

Reduce the immediate harm to the individual, usually by reducing risk of imminent physical risk.

Referring agency

Variable: justice, employer or industrial regulatory authorities, child protection, licencing boards

Health professionals

Australian States and Territories with current programs

All

VIC, NSW, TAS

Level of evidence

2A^a

4^a

Summary of Evidence available

Variable result depending on characteristics of the treatment program, with most evidence coming from programs associated with criminal justice system. Some reduced use and better treatment engagement while in the program. Outcomes best with longer periods of engagement, particularly if combined with social supports. Cost effective interventions [13].

Evidence limited, particularly relating to long term outcomes. Models from Australia and internationally have been unable to show they achieved their aims in reducing long term harm, while being costly to provide [13].

Level of evidence for methamphetamine

3B^a

none