Watching a loved one self destruct is one of the hardest things that any human has to face. This is what happens when one individual falls into the hell of addiction – they will usually take their family with them. Those people around the addict may feel completely powerless to resolve the situation. The addict denies they have a problem and refuse to consider any suggestions that they get help. The family then have to choice of watching this person slowly kill themselves or they can try to disengage. They may even consider the possibility of having this loved one committed to treatment against their will. This drastic step will appear appealing when there appears to be no other option to save the addict.
To say that an individual has been subject to involuntary commitment means that they have been court ordered into treatment for a mental health problem. Before the individual is committed they may be first put into a psychiatric institution for assessment – this can last for as long as 72 hours. Involuntary commitment is usually only used as a last resort for addicts when they appear to be putting their own life in imminent danger or they are a risk to other people.
Autonomy is an ethical principle that most humans feel strongly about – particularly in western countries. It can be defined as a state of being self governed. In practice it means that the individual is given the right to manage their own affairs according to their own motives and affairs. Autonomy is particularly important in regards to any type of medical procedure. It is now expected that the individual needs to give their informed consent before commencing any type of medical treatment. Even taking a person’s blood pressure measurement could be considered assault if the person has not given their permission – in practice consent is often implied.
The importance of the individual’s autonomy runs counter to the idea of involuntary commitment. In previous centuries there was far less concern about the individual’s personal autonomy and anyone could be committed to an asylum on the say so o their family or a medical professional. In modern times interfering with a person’s autonomy is a step that is not taken lightly. This is why taking away a person’s autonomy only occurs if it is felt that the individual is incapable of making rational decisions, and they are a real danger to themselves or other people. The goal of involuntary commitment is to protect the individual and society. As soon as they are well enough to make rational choices their personal autonomy will be restored.
It was once quite common for those trapped in addiction to be committed involuntarily for treatment. Relatives could alert the family physician about what was happening, and this professional would arrange for the commitment to hospital. This happens far less these days because of a number of factors. Since the 1960s there has been a growing concern for civil liberties. It became obvious that people were being committed to psychiatric units far too easily – sometimes just on the say so of a relative. The fear of infringing on civil liberties means that that the professionals these days are far less willing to get involved with this type of action. A legal case involving Addington v. Texas led to changes in the interpretation of the law. The burden of proof now needs to be far higher before it is reasonable to interfere with the individual’s autonomy. Another reason for why enforced addiction treatment is rare is a lack of funding. There are just not enough financial resources available to manage all the requests for involuntary commitment.
There are a number of reasons for why involuntary commitment might seem like a good idea:
* Family members have tried every other option, and they feel powerless to help their loved one who is in decline. They may seek involuntary commitment because they feel there is no other option.
* The extent of the substance abuse means that the individual is putting their own life in danger.
* The addict is a danger to themselves or other people when they are intoxicated. Some people can get completely out of control when they are under the influence.
* The substance abuse is exacerbating another mental health problem, and this is putting that person (or those around them) in danger.
The laws for involuntary commitment vary between states in the US. In 1975 the Supreme Court ruled that involuntary hospitalization or treatment violates the individual’s civil liberties. This violation can only be justified in extreme conditions – usually because a person has become a danger to themselves or other people. It is considered unconstitutional to keep a person in hospital against their will if they are not an imminent threat to themselves or others. Different states will interrupt laws concerning involuntary commitment differently, but the individual will usually continue to have certain rights even after they have been hospitalized against their will. For example, in Florida the person who has been committed will have the right to contact people outside and to have their case reviewed every six months.
It can be terribly frustrating to watch a loved one slowly kill themselves with alcohol or drugs. It may not be possible to have that person committed, but there are still things that can be done including:
* An addiction therapist is trained to help addicts develop the motivation to quit. This professional can help the individual see beyond their denial into the reality of their situation.
* The substance abuser is likely to have times when they are more open to the idea of addiction help. This can be at times after they have behaved particularly badly or when they are feeling ill because of the substance abuse.
* The most common reason for why people are able to walk away from addiction is that they have hit rock bottom. It is not necessary for the individual to lose everything before they reach this point.
* It is common for relatives to try to protect the individual from the worst consequences of their behavior. This might not be such a good idea because it may be enabling the addict and preventing them from hitting rock bottom.
* The addict may resist any direct suggestions that they get help for their addiction. It can be a better idea to leave recovery literature lying around the home.
* Groups such as Al-anon and Alateen can help family members cope with the behavior of the addict. They will also be able to get advice and support in dealing with the situation.