In the United States today, people most often enter alcohol treatment and Alcoholics Anonymous because they are compelled to do so. There are a number of avenues for such coercion. First and foremost are the courts, which regularly sentence DWIs to 12-step programs. According to Constance Weisner (1990, p. 588) of the Alcohol Research Group in Berkeley, "In fact, many states have transferred much of the handling of DWI offenses to alcohol treatment programs." Not only DWI, but many other crimes are dealt with by referrals to the treatment system, which regularly includes participation in AA (or NA Narcotics Anonymous) groups.
Inside of prisons, inmates are forced into AA groups and programs based on them. Sometimes the treatment is required as a part of sentencing. Often, it is made clear to the inmate that AA attendance is required in order to gain parole. In addition, other state-run programs for example, social support programs frequently require clients to undergo such treatment. The costs of refusal here are expulsion from the program and termination of benefits. Likewise, in family court cases, when alcohol problems are alleged, the court will mandate assessment and typically will also mandate treatment, often under threat of loss of child custody.
The same holds true for drugs and drug use as well, with the added problem that, since use of many drugs is illegal, any use at all of such substances, no matter how moderate, is automatically labeled "abuse," "addiction," or "chemical dependence." Anyone arrested for possession of such drugs is automatically labeled an abuser or addict; and a great many such people are forced into 12-step groups and 12-step treatment.
The trend in U.S. courts is ever more in this direction. The creation of drug courts as alternatives to ordinary court proceedings and the substitution of treatment for criminal sentencing are becoming the norm. In part, this development is an improvement over repressive sentencing of drug users. Nonetheless, such coerced treatment carries many of the negative consequences of jail sentences, and it has additional drawbacks in terms of personal freedoms and the right to define one's inner life.
Meanwhile, employee assistance programs and a wide variety of private and public employers likewise funnel people reported to have drug or alcohol problems into treatment virtually always of the 12- step variety. Employees are told that they can either enter treatment "voluntarily" or lose their jobs. While this is not the same type of coercion as state-ordered treatment under threat of imprisonment, it is clearly not a free choice.
The disease model of alcoholism that underlies AA and 12-step treatment programs has an explanation of the need for such coercion: alcoholics are in "denial." This denial then becomes an all- purpose pretext for forcing people to do things that they don't want to do. Professional organizations such as the American Society of Addiction Medicine provide official medical sanction for this authoritarian tendency.
At the same time, all alcohol problems from drunk driving, to drinking at work, to periodic excesses at parties are labeled alcoholism or alcohol dependence, which is the basis on which individuals are coerced into alcoholism treatment programs and AA. Yet, many people in such situations need simply to be careful where they drink and how they consume alcohol they are not clinically alcohol dependent or, in some cases, even alcohol abusers. Most in this group can resume drinking with appropriate safeguards.
Furthermore, many people, especially young people, display sometimes severe substance abuse problems, but then outgrow them. This process is so ordinary that it has been given the commonplace name, "maturing out." Maturing out will occur far more often than not unless drug/alcohol treatment and education persuade many individuals who would otherwise do so that they cannot escape youthful drinking and drug excesses.
Since, as noted above, all illegal drug use is regarded as drug abuse, an employee found to have consumed marijuana will be forced to undergo treatment. A similar predicament holds for drivers found to have consumed marijuana, since there is no legal threshold for marijuana in the blood, as there is for alcohol. For people treated in these circumstances, the question immediately raised is, "treated for what?" Cannot people be moderate consumers of marijuana (or, for that matter, of cocaine or any other drug)? Once again, such treatment will almost invariably be 12-step treatment.
Much of the pressure for expanding coercive drug treatment is due, oddly enough, to the failure of current drug policies. Since there is a pervasive sense that we as a society are barking up the wrong tree with punitive laws that punish simple possession or use of drugs with imprisonment, treatment becomes an attractive alternative. Since many career felons use drugs and alcohol regularly as a part of devi ant lives, the idea has taken hold that treating them for substance abuse in prison will improve their prospects of avoiding reimprisonment.
Not only is the imposition of treatment within the court system a popular plank in the drug policy reform movement's platform, but it is widely endorsed by the perpetrators of our current repressive drug policy. Thus, some radical drug reformers react favorably to the comment of drug czar Barry McCaffrey, "Treating offenders for drug addiction instead of just locking them up will reduce crime as well as prison costs" (Wren, 1999). Here is a policy everyone can agree with! Since supporters of this reform believe treatment helps people, and may in fact do so in some cases (although many fewer than claimed), forcing people into 12-step drug and alcohol treatment programs is thought to be benign, even a great humanitarian improvement over penal solutions. But what if this is not the case, as is made clear in the following examples:
Virtually any interaction between the individual and the state, or an employer, school, or anyone with power over a person's future, can involve compulsory treatment, especially since it is claimed to benefit the individual, to be an alternative to even harsher punishment, or to give people options they may not previously have had.
This book, in contrast, considers the range of drawbacks to an increasingly intrusive therapeutic state. What are these drawbacks?
This book is a response to the accelerating trend of coercing people into substance abuse treatment in the United States. It offers the potential victim of this massive system sound information with which to resist this pressure. It provides support for those who sense that something is amiss in their diagnosis, in the treatment they are ordered to undergo, and/or in their prognosis. If they find that the treatment they have been mandated to enter is offensive to them, and/or they question its likely efficacy, this book offers ample evidence that their suspicions are sound, and that these form legitimate reasons for resisting the ordered treatment. In particular, this book deals with the legal aspects of this problem, and the legal options available to the individual confronted with such a problem.
Readers will find that the news in this area is not entirely good. Legal strategies for resisting intrusions against the right of individuals to decide for themselves what is wrong with them and what to do about it are not always well mapped. Furthermore, the cost of avoiding treatment can be facing legal penalties for having committed a crime and/or for having endangered the safety of others (for instance, by drunk driving). In no way is this book meant to excuse people from the operation of normal judicial sanctions for actions that endanger or harm others. Indeed, in part we want to strengthen the norms of social disapproval; we are not inclined, for example, to excuse drug- and alcohol-related violence as a therapeutic problem in which perpetrators are blameless because they are supposedly powerless over their addiction.
Furthermore, in some areas, there is little or no legal protection against state and employer coercion of individuals. This is largely the case with compulsory drug testing, combined with a requirement of treatment, in private employment relationships. Even in areas where the courts have ruled clearly such as the illegality of state-required 12-step treatment the ability of individuals (such as those in prison or those from whom the state has taken children) to actually make use of these rulings is limited. In another area for which there is legal support the requirement of informed consent about the nature of treatment, its outcomes, and potential alternatives the principle is more often observed in the breach than in the practice.
Nonetheless, our view in writing this book is that compulsory treatment is wrong and ineffective. Our goal is to support even to encourage individuals to resist the therapeutic state. In no area is its emergence once a science fiction topic, as in A Clockwork Orange more real than in present-day substance abuse treatment.