Broadening the Base of Treatment for Alcohol Problems (1990) / Chapter Skim
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D: Coercion in Alcohol Treatment
D: Coercion in Alcohol Treatment
Pages 579-610
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From page 579... ...
In the cases in which it refers to pressure by the family, coercion means those procedures in which there is an organized strategy involving some institutional contact. The types of coercion that are found in alcohol treatment today and that are discussed here are civil commitments, referrals to alcohol treatment from the criminal justice system, workplace referrals, and family and early intervention programs.
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From page 580... ...
treatment outcome related to these programs and populations; and (e) the general impact of the presence of a largely coerced population in the alcohol treatment system.
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From page 581... ...
Consequently, in recent years, the focus of civil commitment in most states has been on mental illness resulting in imminent danger to the self or others (Dunham, 1985~. There are several issues relevant to a discussion of involuntary commitment today and its application in the field of alcohol problems.
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From page 582... ...
Because of the variation across states and the lack of comprehensive reviews on the subject, it is difficult to gauge the place of alcohol in the overall civil commitment framework. Frequent of Akohol-K - d Involuntary Commitments Little is known about the frequency of such commitments, although some figures are available on the total number of admissions for alcohol problems.
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From page 583... ...
Some states (e.g., California) have proposed legislation that would implement a seriously deteriorating criterion; the presentation of the model law in 1983 reflects a general trend, supported by psychiatrists, to relax involuntary commitment criteria.
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From page 584... ...
In the absence of extensive and replicated research, professional and other interests appear to have dominated the literature in this area with rhetorical arguments for and against their positions. The historical tension between the individual's right to treatment and his or her civil rights remains visible and central to discussions of civil commitment criteria.
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From page 585... ...
In their review of state laws regarding compulsory outpatient treatment, Keilitz and Hall define IOC as "the dispositional options (lying between inpatient hospitalization and outright release) available to a civil court after an 'adjudication' of involuntary civil commitment" (1985:378~.
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From page 586... ...
229~. It is important to examine the area of civil commitment because, although alcohol treatment commitments are rare in comparison with alcohol treatment generally, the coercion issues raised by the commitment process are more clear-cut and easier to discern.
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From page 587... ...
. They commonly included panels of criminal justice representatives, treatment officials, and citizens who assessed cases for diversion from the criminal justice system to community alcohol treatment programs.7 Although federal funding of most such projects has ended, in some areas they were followed by state or locally funded formal diversion schemes.
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From page 588... ...
communities, the national attention given to a treatment approach for DWI individuals through the Alcohol Safety Action Projects has been important in establishing such interventions. Today alcohol treatment is an established sanction for DWI offenses, and in fact, many states have transferred much of the handling of DWI offenses to alcohol treatment programs.
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From page 589... ...
These questions will need to be resolved if the trend toward diagnostic-based referral continues. The Prevalence of Criminal Justice Referrals Referrals to alcohol treatment from the criminal justice system are numerous (Boscarino, 1980; Furst et al.,1981; Speiglman, 1984; Weisner, 1987a,b; Connecticut State Drug and Alcohol Abuse Criminal Justice Commission, 1988;)
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From page 590... ...
Their alcohol treatment utilization rates were also higher than their rates for general health services and mental health treatment utilization. The authors suggest that these statistics are a result of high arrest rates for Mexican Americans for offenses that the criminal justice system refers to alcohol treatment.
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From page 591... ...
Workplace Referrals Referrals from the workplace are another form of coerced entry into alcohol treatment, although they usually involve less explicit coercion than that attached to criminal justice referrals. This treatment sector has evolved partly through its own impetus but also through the direct and indirect encouragement of NIAAA (Roman, 1988~.
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From page 592... ...
The Prevalence of Workplace Referrals There are no accurate data on the numbers of individuals who have entered treatment through EAPs or other workplace programs. The NDATUS collects information on the number of programs that provide EAP services; however, it does not provide statistics on the number of EAP- or other workplace-referred clients.
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From page 593... ...
There are no statistics to indicate the number of individuals who have entered treatment as a result of these methods and no data on treatment outcome. The Distribution of Criminal Justice and Employee Assistance Program Referrals: Public Versus Private Programs There is some agreement that criminal justice referrals are more commonly found in public alcohol treatment programs whereas workplace referrals are more common in private treatment programs.
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From page 594... ...
Some studies have found that individuals involved in processing with the criminal justice system may present themselves to alcohol treatment agencies as self-referred in a strong effort to gain admittance and avoid harsh criminal justice sanctions (Speiglman and Weisner, 1982~. Researchers in the EAP field have also questioned whether informal or subtle coercion may exist in the workplace even for those whose intakes are recorded as self-referred (Heyman, 1976; Roman, 1988; Trice and Sonnenstuhl, 1988~.
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From page 595... ...
Epidemiological descriptions of DWI populations are especially important as first offenders with DWI problems increasingly enter alcohol treatment, but this new treatment group has only begun to be investigated epidemiologically (Ryan and Segars, 1983; Weisner, 1984; Reis and Davis, 1979; Hoffmann et al., 1987; Stewart et al., 1987~. In addition, there has been no significant investigation of the alcohol problem characteristics of other criminal justice referrals.
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From page 596... ...
found that, in the case of drug treatment, individuals diverted from criminal justice were often referred earlier than were voluntary clients as a result of their drug use and drug-related problems; similar study is needed of individuals diverted as a result of their alcohol problems. The Employee Assistance Program Population Despite the large number of individuals who come to alcohol treatment through workplace referrals, there is very little epidemiological information on these persons.
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From page 597... ...
Should it consist of those individuals with alcohol problems who are not referred from the criminal justice system or from the worksite? Or should it be alcohol treatment clients who are not coerced to enter treatment?
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From page 598... ...
they also touna that criminal ~us~ce-rererrea clients stays In treatment longer. Many contingencies operate in alcohol treatment.
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From page 599... ...
Because the number of these clients is very large, however, the courts have seen alcohol treatment referral as a way of reducing the court load, and they often respond by summarily referring the individual back again to treatment. Gallant (1968)
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From page 600... ...
If, for example, individuals in alcohol treatment increasingly have polydrug problems, the nature and prevalence of coercion are likely to be affected because coercion and diversion programs have much more of a footing in the drug treatment field. A second issue relates to overall access to treatment.
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From page 601... ...
Some of the larger questions relate directly to the functions of treatment (Speiglman, 1984~. How far is the alcohol treatment field willing to go in taking on a social control function?
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From page 602... ...
7. Unlike the alcohol treatment sector, the drug treatment sector has a tradition of compulsory programs.
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From page 603... ...
1987. State Resources and Services for Alcohol and Drug Abuse Problems, Fiscal Year 1986: An Analysis of State Alcohol and Drug Abuse Profile Data.
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From page 604... ...
(brochure for a training workshop for alcohol treatment professionals)
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From page 605... ...
1981. Utilization of Alcohol Treatment Services in California.
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From page 606... ...
1983. Intervention Skill Development Seminar (brochure for a training workshop for alcohol treatment professionals)
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From page 607... ...
1989. The American criminal justice system and mandates to alcohol treatment: The role of Alcoholics Anonymous.
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From page 608... ...
1984. Alcohol treatment and social control: Contradictions in strategies for California's skid rows.
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From page 609... ...
Presented at the Alcohol Treatment Service Systems Research panel at the Alcohol and Drug Problems Association National Conference, St. Louis, Missouri, September.
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