Abstract
Various options for treatment entry, engagement and retention for substance abuse problems have been proposed but none is more controversial than the issue of coercing or pressuring substance abusers into treatment. Most people who need treatment won't get it, and most people who enter treatment will not complete it. The use of coercion to persuade reluctant substance abusers to enter and remain in treatment has a long history, especially in the criminal justice system. The use of coercion with other populations is also promising.
This paper provides an overview of some of the current arguments for and against the use of coercion in substance abuse treatment. The three types of legal, formal and informal coercion are discussed. Issues related to motivation and intervention techniques are also reviewed. Most people cycle through a wide range of motivational influences to enter treatment. Some argue that substance abusers must choose treatment on their own for it to be effective. Others argue that coercion is effective in getting people into treatment and keeping them there long enough for it to be effective. Both internal motivation and external pressures from various sources are independent and powerful influences to enter treatment.
The effectiveness of coercion in treatment retention and pervasiveness of coercion in treatment is also reviewed.