Can We Force the Addict Into Treatment?

Can We Force the Addict Into Treatment?

sometimes, I’ll get the call where a family member asks if there is a course of action to forcibly send a person into treatment. Some families will ask if there is a way to simply restrain the addict, throw him in the back of a van, and haul him off to treatment. While I certainly understand the frustrations involved in living with an addict and the never- ending requests to get them help (that typically fall on deaf ears), generally speaking, the answer is no. You can’t kidnap an addict and force treatment upon him.

The best solution is an alcohol or drug intervention. However, any seasoned intervention specialist will tell you that there are no guarantees when it comes to interventions. The addict nevertheless has the right to reject treatment. In most situations, it is nevertheless advisable to go forward with the intervention. The family will at the minimum have had the opportunity to get together as a team, provide a solution (treatment), and, God forbid, if something bad does befall the addict (further health complications, loss of job, jail, etc.) the family can feel a small level of comfort by knowing they all got together, did the best job they could and offered the gift of treatment. Additionally, the seed will have been planted in the addict’s mind that a solution is obtainable with the family waiting in the wings to offer sustain throughout the recovery course of action.

The alcohol intervention or drug intervention offers however another way to strongly suggest accepting the gift of treatment. To the extent it is obtainable within the framework of family or friends, leverage can be used to persuade the addict to accept help. Addicts often view leverage as a method of forcing treatment upon them, but this is simply not true. With leverage, the addict nevertheless has the right to reject treatment. The consequence of such rejection, however, comes with consequences.

for example, an employer may attend the alcohol intervention of an addicted employee. If the employee resists treatment, as a last resort, the employer may create a border wherein if the addict continues to resist treatment he will lose his job. Notice that in this example the addict nevertheless has a choice. He can resist treatment and continue drinking. If he does, however, he will now have to confront the consequence of job termination. This kind of leverage can be a powerful tool in not only “persuading” the addict into treatment, but also in eliminating the enabling and, perhaps more importantly, creating healthy boundaries for those friends and family members of the addict.

California does allow for an involuntary psychiatric evaluation, commonly referred to as a 5150, with an eye toward obtaining some level of short term medical treatment during the mandatory keep up. The 5150 course of action does have specific criteria and is not an easy undertaking, especially if you are dealing with a reluctant participant to the treatment course of action.

The California Welfare and Institutions Code (WIC) 5150 is an application for involuntary admission for up to 72 hours from the time the declaration is written. WIC 5150 is not itself a direct admission form and does not of itself authorize the involuntary admission; it merely gets the individual to the door. Then, as described in WIC 5151: Prior to admitting a person to the facility, the specialized person responsible for the facility or his or her designee shall estimate the individual in person to determine the appropriateness of the involuntary detention. During the period of confinement, a confined individual is evaluated by a mental health specialized to determine if a psychiatric admission is warranted. Confinement and evaluation usually occurs in a county mental health hospital or in a designated emergency room facility. If the individual is then admitted to a psychiatric unit, only a psychiatrist may rescind the 5150 and allow the person to either keep voluntarily or be discharged.

On or past to the expiration of the 72 hours, the psychiatrist must estimate the person to see if they nevertheless meet criteria for hospitalization. If so, the person may be offered a voluntary admission. If it is refused, then another keep up for up to 14 days may be applied for.

The criteria for a 5150 keep up requires probable cause. This includes danger to self, danger to others together with some indication, prior to the administering of the keep up, of symptoms of a mental disorder, and/or grave disability. The conditions must exist under the context of a mental illness and the person must be refusing psychiatric treatment.

I can report from experience that a 5150 keep up is not an easy course of action and one that local authorities take very seriously. A family called me to help them ease an alcohol intervention. Their loved one, a 50ish year old female alcoholic, was resistant to treatment, lived alone in a large house and was a recluse. It was clear that her alcoholism was progressing to the point where her family feared that she would soon die (several days at best) from the disease. Though we tried for several hours to “reach” her by the intervention course of action, the intervention ended with a phone call to 911 requesting a 5150 on the basis of grave disability.

Police and the fire department arrived and preformed a fleeting assessment using the above-referenced criteria. After asking her a series of questions to determine mental state (name, where do you live, what day is it, etc.) and questioning her further regarding suicide and homicide, they determined that she did not meet the criteria for a 5150 keep up. Although she arguably was gravely disabled (she was drunk at the time, empty bottles all over the floor, empty food containers strewn about), her condition was nevertheless insufficient to satisfy the “gravely disabled” provision of the code and the authorities had no different but to leave the house.

While a 5150 keep up is obtainable where appropriate, it is not a guarantee. Specific statutory criteria must be met. In situations where a 5150 is requested resulting from addiction, there nevertheless remains the very serious question of drug/alcohol treatment. At best, the family hopes for three days (and perhaps an additional 14 if granted) to plant the seed of treatment to address the addiction issues.

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