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NEUROSCIENCE OF PSYCHOACTIVE SUBSTANCE USE AND DEPENDENCE

oversight and thus is open to abuse. Coercion into treatment may also occur
after an offender has been charged and before being processed by the court.
This is the case in USA drug courts, where adjudication may be postponed
until treatment has been completed (General Accounting Office, 1995).
An offender may be coerced into treatment after conviction. If this is done
before sentencing, the court may make completion of treatment a condition
of a suspended sentence. Alternatively, an offender may be encouraged to
enter drug treatment to help him or her to remain abstinent while a sentence
is suspended. Drug treatment may also be required after part of a sentence
has been served: enrolment in drug treatment may be made a condition of
release on parole. Alternatively, enrolment in drug treatment may be
encouraged as a way of remaining free of illicit drugs while on parole.

Ethical issues in coerced treatment
Coerced treatment involves the use of state power to force people to receive
treatment and so unavoidably raises ethical and human rights issues (Mann,
1999). Evidence from the USA suggests that treatment for heroin dependence,
such as methadone maintenance, therapeutic communities and drug free
counselling, is of benefit to those who receive it (Gerstein & Harwood, 1990).
However, the benefits for any individual are still uncertain since treatment
assists only about 50% of those who receive it (Gerstein & Harwood, 1990),
and relapse to heroin use after treatment is high. The treatment of cocaine
dependence is much less effective than treatment for opioid dependence
(Platt, 1997). This weakens the ethical justification for “civil commitment”
for cocaine dependence but it may not rule out less coercive forms of
treatment.
A consensus view on drug treatment under coercion prepared for WHO
(Porter, Arif & Curran, 1986) concluded that such treatment was legally and
ethically justified only if the rights of the individuals were protected by “due
process” (in accordance with human rights principles) (Mora, 2000), and if
effective and humane treatment was provided (Stahl, 1996).
The uncertain benefits of coerced treatment have led some proponents to
argue that offenders should be allowed two “constrained choices” (Fox, 1992).
The first constrained choice would be whether they participate in drug
treatment or not. If they declined to be treated, they would be dealt with by
the criminal justice system in the same way as anyone charged with the same
offence. The second constrained choice would be given to those who agreed
to participate in drug treatment: they would be given the choice of the type
of treatment that they received. There is some empirical support for these
recommendations in that there is better evidence for the effectiveness of
coerced treatment that requires some “voluntary interest” by the offender
(Gerstein & Harwood, 1990).
The most ethically defensible form of legally coerced treatment for drug
dependent offenders is the use of imprisonment as an incentive for treatment

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