Can we force the addict to undergo treatment?
Every now and then, I get the call where a family member asks if there is a process for forcibly sending a person to treatment. Some families will ask if there is a way to simply immobilize the addict, put him in the back of a truck, and take him to treatment. While I certainly understand the frustrations of living with an addict and the endless requests for help (which often fall on deaf ears), the answer is generally no. You cannot kidnap an addict and force him to treat you.
The best solution is an intervention for alcohol or drugs. However, any experienced interventionist will tell you that there are no guarantees when it comes to interventions. The addict still has the right to refuse treatment. In most cases, it is advisable to go ahead with the intervention. The family will at least have 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, etc.) the The family may feel a small level of comfort in knowing that everyone came together, did the best job they could, and offered the gift of treatment. In addition, the seed will have been planted in the mind of the addict that there is a solution available with the family waiting behind the scenes to offer support throughout the recovery process.
Drug or alcohol intervention offers another way of strongly suggesting that the gift of treatment be accepted. As long as 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 imposing treatment on them, but this is simply not true. With leverage, the addict still has the right to refuse treatment. The result of such rejection, however, has consequences.
For example, an employer may attend an addicted employee’s alcohol intervention. If the employee resists treatment, as a last resort, the employer can create a limit where if the addict continues to resist treatment, they will lose their job. Notice that in this example the addict still has a choice. You can resist treatment and keep drinking. If you do, however, you will now have to face the consequences of dismissal. This type of leverage can be a powerful tool not only to “persuade” the addict to receive treatment, but also to remove the enablement and, perhaps most importantly, create healthy boundaries for the addict’s friends and family.
California allows an involuntary psychiatric evaluation, commonly known as a 5150, with a view to obtaining some level of short-term medical treatment during the mandatory suspension. The 5150 process has specific criteria and is not an easy undertaking, especially if you are dealing with a participant reluctant to the treatment process.
California Welfare and Institutions Code (WIC) 5150 is a request for involuntary admission for up to 72 hours from the time the statement is written. WIC 5150 is not itself a direct admission form and does not itself authorize involuntary admission; just lead the individual to the door. Then, as described in WIC 5151: Before admitting a person to the facility, the professional person in charge of the facility or his / her designee will evaluate the person in person to determine the appropriateness of involuntary detention. During the period of confinement, a mental health professional evaluates an confined individual to determine if a psychiatric admission is warranted. Confinement and evaluation generally take place in a county mental health hospital or designated emergency room. If the individual is admitted to a psychiatric unit, only a psychiatrist can rescind the 5150 and allow the person to voluntarily remain or be discharged.
On or before the expiration of 72 hours, the psychiatrist must evaluate the person to see if they still meet the criteria for hospitalization. If so, the person may be offered voluntary admission. If rejected, another suspension of up to 14 days can be requested.
The criteria for a 5150 withholding require probable cause. This includes danger to self, danger to others along with some indication, prior to the administration of the hold, of symptoms of a mental disorder and / or serious disability. The conditions must exist in the context of mental illness and the person must be refusing psychiatric treatment.
I can report from experience that a 5150 withholding is not an easy process and local authorities take it very seriously. A family called me to help them facilitate an alcohol-related intervention. His lover, a 50-year-old alcoholic, resisted treatment, lived alone in a large house, and was a recluse. It was clear that his alcoholism was progressing to the point where his family feared that he would soon die (several days at best) from the disease. Although we tried for several hours to “communicate” with her through the intervention process, the intervention ended with a phone call to 911 requesting a 5150 due to a serious disability.
Police and fire department arrived and conducted a brief assessment using the criteria mentioned above. After asking her a series of questions to determine her mental state (name, where she lives, what day it is, etc.) and further questioning her about suicide and homicide, they determined that she did not meet the criteria for a 5150 withholding. Although she could It was said that she was severely disabled (she was drunk at the time, empty bottles all over the floor, empty food containers strewn about), her condition was, however, insufficient to satisfy the code provision on “severely disabled” and the authorities had no another alternative but to leave the house.
While a 5150 withholding is available when applicable, it is not a guarantee. Specific legal criteria must be met. In cases where a 5150 is requested for addiction, the very serious question of drug / alcohol treatment remains. At best, the family waits for three days (and perhaps an additional 14 if granted) to plant the seeds of treatment to address addiction problems.