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Abstract: 

As states increasingly turn to involuntary substance use treatment as a response to homelessness and public drug use, does the evidence support this policy shift? Drawing on three decades of research and multiple systematic reviews, Susan E. Collins examines the effectiveness, risks, costs, and ethical implications of involuntary civil commitment for adults with substance use disorders. She finds little evidence that compulsory treatment produces better outcomes than voluntary care and highlights research linking involuntary treatment to higher risks of relapse, overdose, and death after release. The article also explores lower-cost, evidence-based alternatives—including Housing First, harm reduction, medications for opioid use disorder, and diversion programs—that have demonstrated greater success in promoting recovery while respecting patient autonomy. For policymakers, clinicians, and correctional professionals, this timely review offers an important evidence-based perspective on one of today's most contested public health strategies.

Keywords: Substance Use Disorder; Involuntary Treatment; Harm Reduction; Housing First; Civil Commitment; Homelessness

Affiliations:  1: University of Washington.