Ordovícico Inferior Tremadociano Superior

Compulsory treatment is currently used in many countries, including Britain, the United States, China, the Netherlands, New Zealand, Italy, Sweden, Germany, Canada and Spain. Some legal systems have long been afforded the authority to coerce and/or force individ- uals into drug treatment; compulsory drug treatment in the form it operates today is largely considered to have had its origins in the United States in the 1920s with morphine maintenance clinics (Klag et al., 2005). There is much variability in the ways in which compulsory treatment of offenders is implemented internationally, with significant differences in levels of legal coercion, the point in proceedings at which it is imposed, and in the types of offenders targeted. In the United States, the focus of compulsory treatment is on offenders charged with drug use offences, while in Britain and the Nether- lands, persistent offenders who may have committed non-drug offences are also tar- geted. As in Australia, courts in Europe can impose sentences that include a requirement to enter AOD treatment. Most European countries require the offender’s consent to enter treatment, though exceptions include Austria, Germany and the Netherlands (Stevens et al., 2005).

By comparison, the approach to compulsory treatment taken by Asian countries, such as China, is much stricter. A drug abuser who has broken the law can be compelled to attend a compulsory rehabilitation centre. Those found to use drugs a second time are sent to drug-rehabilitation-through-labour institutions. According to the Ministry of Public Security, in 2004 China had 583 com- pulsory drug rehabilitation centres and 165 drug-rehabilitation-through-labour institu- tions (compared with 247 voluntary drug rehabilitation centres) (Xinhua, 2004).

Like Australia, both New Zealand and Swe- den have civil commitment legislation. New

Zealand’s Alcoholism and Drug Addiction

Act 1966 provides for compulsory deten- tion and treatment of non-offenders for up to two years and is used to commit approx- imately 200 people per year (New South Wales Standing Committee on Social Issues, 2004). Applications can be made for either voluntary or involuntary commitment. The New Zealand Ministry of Health is currently reviewing the Act (Huriwai, personal com- munication, 2006).

The Swedish Care of Alcoholics, Drug Abus-

ers and Abusers of Volatile Solvents (Special Provisions) Act 1988 (1988:870) provides for individuals to be placed in compulsory care in institutions (known as LVM homes) specially intended for the provision of care under the Act, for up to six months or as soon as the purpose of care has been achieved (ss. 20, 22). The objective of compulsory care in an LVM home is not to provide treatment, rather it is to motivate individuals to accept subse- quent voluntary treatment for their addiction (European Committee for the Prevention of Torture and Inhuman or Degrading Treat- ment or Punish ment, 2003). The Act is unique in that it imposes a duty on public authorities to notify the Municipal Social Welfare Committee of abusers who may require care, and a duty on the Committee to then investigate and, where appropriate, apply for a care order (ss. 6–12). Approxi- mately 1000 people per year are placed under compulsory care (New South Wales Standing Committee on Social Issues, 2004). A report by the European Committee for the Preven- tion of Torture and Inhuman or Degrading Treatment or Punish ment (2003) expressed ‘serious misgivings about the practice of subjecting residents to forcible detoxifica- tion without offering them alternatives, and, more particularly, without the possibility of taking a free and informed decision to dis- continue taking drugs’.

Compul

sory tr

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2.3 Goals

As discussed above, the current National Drug Strategy aims ‘to improve health, social and economic outcomes by preventing the uptake of harmful drug use and reducing the harmful effects of licit and illicit drugs in Australian society’ (Ministerial Council on Drug Strategy, 2004, p.1). Harm minimisation is the underlying principle, and encompasses three different types of strategies:

supply reduction strategies, which aim to

•

disrupt the production and supply of illicit drugs, and the control and regulation of licit substances

demand reduction strategies to prevent

•

the uptake of harmful drug use, includ- ing abstinence-orientated strategies and treatment to reduce drug use

harm reduction strategies to reduce

•

drug- related harm to individuals and communities.

Federal and State governments, as well as non-government organisations, each develop plans and programs, in their own way, to implement these strategies. Thus, the mechan- isms operating to achieve these intentions are many and varied.

Diversion enters AOD treatment under the banner of demand reduction and harm reduction strategies. It includes police and court diversion (the former being by far the most common form of compulsory treat- ment) and has two main goals in practice:

reduced substance use, resulting in

•

im proved health and overall quality of life, and

reduced criminal justice involvement in

•

the present and future.

Legislation at a State level, designed to achieve these goals, usually also outlines additional, equally broad missions. For exam-

ple, an objective of the Compulsory Drug

Treatment Correctional Centre Act 2004

(NSW) is to ‘promote reintegration into the

community’; the Queensland Drug Rehabili-

tation (Court Diversion) Act 2000 aims to ‘reduce health risks to the community asso- ciated with drug dependency’.

Re-integration of clients into the community, and improvement of health and social func- tioning, may however be secondary outcomes. Further, there are few data to consider the extent to which these goals have become oper- ational or have achieved outcomes capable of evaluation. This paper examines the evidence that these broader goals, and the more specific goals, relating to substance use and crimi- nal justice involvement may be achieved by compulsory treatment. Whatever the outcome, there appears to be a widespread assumption that treatment is a better option than prison, which is ‘expensive and ineffective in reducing drug use and crime’ (Hall, 1997, p.12). As the United States Institute of Medicine

report Treating Drug Problems has argued:

The most important reason to consider these and related schemes to compel more of the criminal justice system to seek treat- ment is not that coercion may improve the results of treatment, but that treatment may improve the rather dismal record of plain coercion — particularly imprison- ment — in reducing the level of intensity of criminal behaviour that ensues when the coercive grip is released. (Gerstein & Harwood, 1990, p.11)

Civil commitment legislation provides for inebriates and drug-dependent persons to be detained and treated, but generally does not define the aims and expected outcomes of this action. Possible goals include short-term harm reduction, rehabilitation and protecting the interests of others. As we discuss in sec- tion 4.3, clarity on this issue is required and necessitates careful consideration of human rights and treatment effectiveness.

Key factor

s associated with compul

sory AOD tr

eatment

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