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Can We Force the Addict Into Treatment?
From time to time, I get the call that a family member asks if there is a process to forcibly send a person to treatment. Some families will ask if there is a way to simply detain the addict, throw them in the back of a van, and take them to treatment. While I certainly understand the frustrations of living with an addict and the endless pleas for help (which usually fall on deaf ears), by and large the answer is no. You can’t kidnap an addict and force treatment on him.
The best solution is an alcohol or drug intervention. However, any experienced intervention specialist will tell you that there are no guarantees when it comes to surgeries. The addict still has the right to refuse treatment. In most cases, however, it is advisable to proceed with the intervention. The family will have at least had the opportunity to come together as a team, provide a solution (treatment) and, god forbid, if something bad happens to the addict (further health complications, job loss, jail time, etc.) the family he can feel a small level of comfort knowing that they all came together, did the best job they could, and offered the gift of the treat. In addition, the seed will have been planted in the addict’s mind that a solution is available with family waiting in the wings to offer support throughout the recovery process.
Alcohol intervention or drug intervention offers yet another way to forcefully prompt acceptance of the gift of treatment. To the extent that leverage is available within family or friends, leverage can be used to persuade the addict to accept help. Addicts often see leverage as a means to force treatment on them, but this is simply not true. With the draft, the addict still has the right to refuse treatment. The result of such a refusal, however, has consequences.
For example, an employer may participate in a dependent employee’s alcohol intervention. If the employee resists treatment, as a last resort, the employer can create a boundary where if the addict continues to resist treatment she will lose her job. Note that in this example the addict still has a choice. He can resist the treatment and continue drinking. If she does, however, he will now face the consequences of leaving the job. This type of leverage can be a powerful tool in not only “persuading” the addict into treatment, but also in purging the enabler and, perhaps more importantly, creating healthy boundaries for those friends and family members of the addict.
California allows an involuntary psychiatric evaluation, commonly referred to as 5150, with the goal of obtaining some level of short-term medical care while on mandatory suspension. The 5150 process has specific criteria, and it’s no easy feat, especially if you’re dealing with a reluctant participant in the treatment process.
California Welfare and Institutions Code (WIC) 5150 is an involuntary admission application up to 72 hours from the time the statement is written. WIC 5150 is not by itself a direct admission form and does not by itself authorize involuntary admission; it simply brings the individual in the door. Thus, as described in WIC 5151: Before admitting an individual to the facility, the facility’s professional manager or designee must evaluate the individual in person to determine the appropriateness of involuntary detention. During the confinement period, a confined individual is evaluated by a mental health professional to determine if a psychiatric hospitalization is warranted. Confinement and evaluation usually take place in a county mental health hospital or designated emergency room facility. If the individual is later admitted to a psychiatric unit, only a psychiatrist can revoke 5150 and allow the person to voluntarily stay or be discharged.
On or before the 72-hour deadline, the psychiatrist should evaluate the person to see if they still meet the criteria for hospitalization. If so, the person may be offered voluntary admission. If it is rejected, another suspension may be requested for up to 14 days.
The criteria for a 5150 suspension requires probable cause. This includes danger to self, danger to others together with some indication, prior to administration of the suspension, of symptoms of mental disorder and/or severe disability. The conditions must exist in the context of a mental illness and the person must refuse psychiatric treatment.
I can report from experience that a 5150 suspension is not an easy process and one that local authorities take very seriously. A family called me to help them facilitate an alcohol intervention. Their beloved, a 50-year-old alcoholic woman, 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 that her family feared that she would soon die (several days at most) of the disease. Although we tried for several hours to “reach” her through the intervention process, the intervention ended with a 911 call requesting a 5150 based on severe disability.
Police and firefighters arrived and carried out a brief assessment using the above criteria. After asking her a series of questions to determine mental status (name, where you live, what day it is, etc.) and further questioning her about the suicide and homicide, they determined that she did not meet the criteria for a 5150 suspension. While she was probably severely disabled (she was intoxicated at the time, empty bottles all over the floor, empty food containers strewn about), her condition was still insufficient to meet the “severely disabled” code provision, and the authorities had no alternatives but to leave the house.
While a 5150 suspension is available where appropriate, that’s not a guarantee. Specific statutory criteria must be met. In cases where a 5150 resulting from addiction is requested, the very serious issue of drug/alcoholic treatment still remains. At best, the family is hoping for three days (and possibly another 14 if given) to plant the seed of treatment to address addiction issues.
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