Can We Force the Addict Into Treatment?

Occasionally, I’ll get the call where a family member asks if there is a process to forcibly send a person into treatment. Some families will ask if there is a way to simply restrain the addict, throw him in the back of a van, and haul him off to treatment. While I certainly understand the frustrations involved in living with an addict and the never- ending requests to get them help (that typically fall on deaf ears), generally speaking, the answer is no. You can’t kidnap an addict and force treatment upon him.

The best solution is an alcohol or drug intervention. However, any seasoned intervention specialist will tell you that there are no guarantees when it comes to interventions. The addict still has the right to reject treatment. In most cases, it is still advisable to go forward with the intervention. The family will at least have had the opportunity to get together as a team, provide a solution (treatment), and, God forbid, if something bad does befall the addict (further health complications, loss of job, jail, etc.) the family can feel a small level of comfort by knowing they all got together, did the best job they could and offered the gift of treatment. Additionally, the seed will have been planted in the addict’s mind that a solution is available with the family waiting in the wings to offer support throughout the recovery process.

The alcohol intervention or drug intervention offers yet another way to strongly suggest accepting the gift of treatment. To the extent it is available within the framework of family or friends, leverage can be used to persuade the addict to accept help. Addicts often view leverage as a means of forcing treatment upon them, but this is simply not true. With leverage, the addict still has the right to reject treatment. The result of such rejection, however, comes with consequences.

For instance, an employer may attend the alcohol intervention of an addicted employee. If the employee resists treatment, as a last resort, the employer may create a boundary wherein if the addict continues to resist treatment he will lose his job. Notice that in this example the addict still has a choice. He can resist treatment and continue drinking. If he does, however, he will now have to face the consequence of job termination. This type of leverage can be a powerful tool in not only “persuading” the addict into treatment, but also in eliminating the enabling and, perhaps more importantly, creating healthy boundaries for those friends and family members of the addict.

California does allow for an involuntary psychiatric evaluation, commonly referred to as a 5150, with an eye toward obtaining some level of short term medical treatment during the mandatory hold. The 5150 process does have specific criteria and is not an easy undertaking, especially if you are dealing with a reluctant participant to the treatment process.

The California Welfare and Institutions Code (WIC) 5150 is an application for involuntary admission for up to 72 hours from the time the declaration is written. WIC 5150 is not itself a direct admission form and does not of itself authorize the involuntary admission; it merely gets the individual to the door. Then, as described in WIC 5151: Prior to admitting a person to the facility, the professional person in charge of the facility or his or her designee shall assess the individual in person to determine the appropriateness of the involuntary detention. During the period of confinement, a confined individual is evaluated by a mental health professional to determine if a psychiatric admission is warranted. Confinement and evaluation usually occurs in a county mental health hospital or in a designated emergency room facility. If the individual is then admitted to a psychiatric unit, only a psychiatrist may rescind the 5150 and allow the person to either remain voluntarily or be discharged.

On or previous to the expiration of the 72 hours, the psychiatrist must assess the person to see if they still meet criteria for hospitalization. If so, the person may be offered a voluntary admission. If it is refused, then another hold for up to 14 days may be applied for.

The criteria for a 5150 hold requires probable cause. This includes danger to self, danger to others together with some indication, prior to the administering of the hold, of symptoms of a mental disorder, and/or grave disability. The conditions must exist under the context of a mental illness and the person must be refusing psychiatric treatment.

I can report from experience that a 5150 hold 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 loved one, a 50ish year old female alcoholic, 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 where her family feared that she would soon die (several days at best) from the disease. Though we tried for several hours to “reach” her through the intervention process, the intervention ended with a phone call to 911 requesting a 5150 on the basis of grave disability.

Police and the fire department arrived and preformed a brief assessment using the above-referenced criteria. After asking her a series of questions to determine mental state (name, where do you live, what day is it, etc.) and questioning her further regarding suicidality and homicidality, they determined that she did not meet the criteria for a 5150 hold. Although she arguably was gravely disabled (she was drunk at the time, empty bottles all over the floor, empty food containers strewn about), her condition was nevertheless insufficient to satisfy the “gravely disabled” provision of the code and the authorities had no alternative but to leave the house.

While a 5150 hold is available where appropriate, it is not a guarantee. Specific statutory criteria must be met. In cases where a 5150 is requested resulting from addiction, there still remains the very serious question of drug/alcohol treatment. At best, the family hopes for three days (and perhaps an additional 14 if granted) to plant the seed of treatment to address the addiction issues.