The UK government is about to enact a range of compulsory drug treatment programmes in its latest efforts to ‘win’ the ‘war on drugs’.
This is despite the fact that the best evidence available indicates that compulsory substance misuse programmes do not work.
In this article we will look at the government’s policy document, reflecting on a 2016 systematic review of such programmes to show the viability of these proposals in the eyes of research already done.
In early December 2021, the UK government published a new approach to tackling drug misuse.
Including over £700 million of new investment in services, the policy document called “From Harm to Hope: A 10-year drugs plan to cut crime and save lives” stated (p47): “We want to see greater use of tough and effective community sentences with drug rehabilitation requirements, which require offenders to commit to treatment and regular drug testing”.
Essentially, the government is rightly stating that drug misuse has not fallen and crime – considering everything from dealing and buying drugs to crimes attributed to their effects – has not changed due to previous policies.
Given that other countries such as Portugal have had some success with a treatment-first approach, it seems that the current government is taking a coercive approach to treatment.
But what is the evidence for this policy’s success?
Studies have been completed looking at individual treatment programmes around the world.
In 2016 a paper was published that reviewed the evidence available for the success of compulsory treatment programmes, looking at nine research papers.
Systematic reviews are at the apex of research as they look at individual research papers and try to see if there are any trends evident from a body of research.
The paper, “The Effectiveness of Compulsory Drug Treatment: A Systematic Review” concluded that in most cases where compulsory treatment programmes were assessed, they failed.
The research papers looked at two broad measures – substance misuse relapse rates and the likelihood of those who were enrolled committing crime again (recidivism).
It only looked at drug programmes that included illicit drug use. Those that were purely alcohol-related were excluded.
The authors also chose to exclude regimes where the choice was given to the substance misuser of legal punishment or to undertake treatment.
Many of the regimes they did look at were coercive at some level and there is a question of the human rights of those undertaking them.
In the next sections, we will look at seven of the papers reviewed in this research and summarise the conclusions of each.
In Chongqing, China, police can force those who use illicit drugs to undertake a residential rehabilitation programme that can range from 28 days to several months, without going to court.
Huang et al reported that the regime involves, “physical exercise, moral and legal education, drug and health education and skills training”. They did not specify what this regime actually meant on a daily basis to those undergoing the programme.
Huang et al found that of the 177 people tracked in the research, 46% of those enrolled relapsed between one to six months after completion.
A further 10% would relapse within a year of doing the programme.
This would leave 44% who did not go on to misuse drugs after being forcibly enrolled on the programme.
Chinese authorities can sometimes force substance misusers to detox from their drug of choice.
In this paper, three groups of people were followed, comprising a total of 615 people.
The first group were on a mandatory detox programme and the second group were on a voluntary detox programme, with a third group acting as a ‘control group’.
In this study, 98% of those followed would relapse within a year of the programme, 22% of whom would relapse within just three days. This calls into question the effectiveness of such a programme.
This paper looked at programme participants’ likelihood to commit crimes again.
Of 506 people, three groups were followed on a court-mandated rehabilitation programme where people were forced to live in a closely supervised non-custodial therapeutic community.
The first group were graduates of the programme, while the second were people who had dropped out of the programme.
A control group of people who had not been enrolled on the rehabilitation programme were also assessed.
The dropouts from the course were slightly more likely to commit crimes (around 30% of them).
However, close to 20% of the other two groups with no statistical significance between them went on to commit crimes.
Given that graduates and non-participants had similar outcomes, this also calls into question the viability of the programme.
Some 2,095 US veterans who misused drugs were divided into two groups who attended 12-step abstinence programmes.
After one year, 61% of those on mandatory abstinence programmes had not relapsed.
Meanwhile, 48% of those on similar, voluntary programmes remained abstinent.
Though apparently a good step forward, by the five-year follow-up, only 45% of those on voluntary programmes and 50% on mandatory programmes remained abstinent.
This represented minimal statistical significance, and again called into question the efficacy of compulsory treatment.
In Thailand, 422 people who inject drugs were followed and engaged in a government forcible detox and treatment programme.
Over the first 45 days of the programme, they were assessed in the community and then had to spend four months in a residential setting before doing two months of vocational training.
This showed a 50% abstinence rate in the first year after completing the course.
No follow-up was done after the year-long period.
Some 109 people who were sent to prison for drug offences were forced to do a three-month detox programme while serving a 12-month sentence.
Those that failed to remain abstinent would repeat the sentence until they achieved 12 months of abstinence, and would pay for their treatment on release.
These were compared to 99 people who were in prison already for similar offences but did not do the course.
The research showed that those on the course were significantly more likely to commit offences and use drugs upon release than those not on the course.
Consequently, the regime was reviewed by the Taiwanese authorities.
In the largest cohort of all in this systematic review, 1,494 people on a compulsory treatment programme as part of their probation were compared to 4,359 who were either on regular probation, sent to court services or sent to prison.
This research showed that those who were forced into treatment as part of their probation were significantly more likely to commit more crimes than those who had been sent to court services.
The review of the programmes, both residential and in the community, showed that 78% of the compulsory drug treatment programmes had similar results to control groups.
The control groups included those who were on voluntary treatment programmes and those who were on no treatment programmes at all.
It also showed that 22% of the programmes studied led to a higher chance of those enrolled committing crimes after they had completed the course, creating more problems than solved.
Compulsory treatment is as likely as control groups, which include voluntary treatment, to achieve abstinence on the part of the individuals.
As such, there seems to be a false hope on the part of the UK government in making such treatment programmes compulsory when without the expense incurred in the criminal justice system it is possible to achieve the same results.
Other research has questioned the human rights issue around compulsory treatment programmes.
In China and other countries where human rights are less of an issue to governments, such programmes won’t cause a problem.
A paper published in September 2021 concluded that up to half a million people currently detained for substance misuse around the world amounts to a ‘grave violation of human rights’ and that when it is tested as a ‘reasonable limitation to the right to liberty’, it fails.
This is not to say that drug misuse or being able to commit crimes are a human right, but that many of those in detention are not causing problems to society sufficiently to have their human rights affected.
The move by the UK government is considered by some to be a step towards the highly regarded drugs policy of Portugal.
However, in Portugal’s case drug misuse is considered a health problem and distinctly not a matter for criminal justice.
Under Portuguese law, authorities cannot force someone into treatment – they can only strongly advise them to do so.
The success, it seems, is as much due to the willingness of the participants to recover as it is in offering them support.
This might suggest that the compulsory element weakens the model as without the willing participation of those enrolled, ultimately, they will choose whether or not to relapse afterwards.
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Boris is our editor-in-chief at Rehab 4 Addiction. Boris is an addiction expert with more than 20 years in the field. His expertise covers a broad of topics relating to addiction, rehab and recovery. Boris is an addiction therapist and assists in the alcohol detox and rehab process. Boris has been featured on a variety of websites, including the BBC, Verywell Mind and Healthline. You can connect with Boris online at LinkedIn or X.com.
