Coerced Drug Treatment in The Criminal Justice System

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Criminology and Criminal
DOI: 10.1177/1748895807078867
2007; 7; 269 Criminology and Criminal Justice
Toby Seddon
ethical and criminological issues
Coerced drug treatment in the criminal justice system: Conceptual,
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ISSN 17488958; Vol: 7(3): 269286
DOI: 10.1177/1748895807078867
269
Coerced drug treatment in the criminal
justice system:
Conceptual, ethical and criminological issues
TOBY SEDDON
University of Manchester, UK
Abstract
A striking phenomenon in many western countries is the increasing
use of the criminal justice system as a means of channelling and
coercing drug users into treatment. Despite somewhat equivocal
research evidence about its effectiveness, this approach has
continued to expand, including in Britain. This article takes a step
back and explores some of the critical background issues that have
been largely overlooked to date. Some conceptual, ethical and
criminological aspects of coerced treatment in the criminal justice
system are considered. It is argued that coerced treatment is a
central issue for both contemporary criminology and criminal justice
policy.
Key Words
coerced treatment criminal justice drugs drug treatment
ethics
Introduction
One of the articles of faith of many drug workers in this country is that prob-
lem users cannot be coerced into treatment.
(Hough, 1996: 36)
In Britain, this was no doubt true in 1996 but there has been a sea change
in attitudes over the last decade. Starting with the introduction of the Drug
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Treatment and Testing Order (DTTO) pilots in 1998 (Turnbull et al., 2000)
and most recently with the Tough Choices initiative, coerced treatment has
become a key part of British drug policy and practice (Hunt and Stevens,
2004). This development has occurred in the context of a broader policy
shift which since 1998 has focused on a major expansion of services within
the criminal justice system using every opportunity from arrest, to court, to
sentence, to get drug-misusing offenders into treatment (Home Office,
2002: 4). Coercive approaches that utilize the leverage of the criminal just-
ice system are thus part of a wider programme of voluntary referral from
all stages of the system.
Although coerced treatment is a relatively new departure in Britain,
1
some
countries have a much longer experience of using criminal justice leverage in
this way. The most obvious example is the United States, where the idea can
be traced back to the narcotic farms of the 1920s right through to the
California Civil Addict Program in the 1960s (Anglin, 1988), but other coun-
tries have been following this route for several decades, notably Australia and
several European countries (Webster, 1986; Stevens, 2004).
The rationale for the policy of coerced treatment, certainly in its con-
temporary British form, is based on three foundational principles:
1. that there is a strong causal connection between drug addiction and acquisi-
tive crime;
2. that treatment is effective in reducing this drug-related crime;
3. that coerced treatment is effective.
The strength of the evidence base for these three principles varies. Principle
One has been the subject of a long-running and unresolved debate. While the
association between certain types of drug use and involvement in property
crime is indisputable, the causal nature of this relationship is far from clear
(see Seddon, 2000) and the concept of addiction on which it rests is prob-
lematic and contested (e.g. Grapendaal et al., 1995). Evidence for Principle
Two is much stronger. In the British context, the National Treatment Out-
come Research Study has indicated that treatment can contribute towards
substantial reductions in offending for some individuals (Gossop et al., 2001,
2005, 2006). On the other hand, there is limited British evidence in support
of Principle Three, the main substantive contribution currently being the
recent report by McSweeney and colleagues (2006). Reviews of the inter-
national research reveal a wide range of outcomes for coerced treatment, with
some studies suggesting coerced clients do no worse than those entering treat-
ment voluntarily and that legal pressure can aid treatment retention but with
others showing negative effects (Klag et al., 2005; Stevens et al., 2005b).
The aim of this article, however, is not to revisit the evidence base for
these three principles. Rather, it seeks to consider some of the critical con-
ceptual and theoretical issues underpinning coerced treatment. The first sec-
tion examines some of the basic conceptual building blocks in this area,
looking specifically at the idea of coercion itself and the related concept of
motivation, as well as the notion of treatment as it is used in this context.
In the second section, some of the ethical issues posed by coerced treatment
270 Criminology & Criminal Justice 7(3)
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are considered. The third section discusses some important criminological
aspects of the issue. Although the article has a particular focus on the
British context, it has a wider relevance. It not only draws on international
research but also concentrates on the analysis of general issues and prin-
ciples relating to coerced treatment that have a transnational applicability.
Conceptual issues
The idea of coerced treatment obviously involves two central concepts, coer-
cion and treatment, and these will both be examined here. Looking first at
coercion, a basic definition provides a useful starting point: Coerce (verb)
Persuade (an unwilling person) to do something by using force or threats
(source: Compact Oxford English Dictionary). Following this definition, the
idea of coercion breaks down into three component parts:
1. persuading someone to do something
2. which they are unwilling to do
3. by using force or threats.
The first component, persuasion, implies a process of convincing or encour-
aging someone to undertake a particular course of action by making what
might be termed a sales pitch, setting out the benefits of following that course
and/or the dangers of not doing so. Central to this, therefore, is the commu-
nication of information to targeted individuals about the options on offer and
their relative merits. In other words, we can say that coercion must include an
informative or communicative element. Reference to options is a reminder
that coerced individuals still retain a choice, however constrained. This marks
the distinction between coerced and compulsory treatment, as the latter does
not involve or require consent. The discussion in this article focuses on coerced
treatment, although it is worth noting that arrangements for compulsory
placement in drug treatment do exist in some countries (Stevens et al., 2005a:
207). The idea of (constrained) choice, which underpins coercion, has some
further significant implications and will be returned to later in this article.
The second component, that the person is unwilling, raises some import-
ant points. Research has found that not all those who are legally mandated
into treatment are unwilling entrants (Farabee et al., 2002; Longshore et al.,
2004: 11213). Nor do they all lack interest in treatment or feel that they do
not need it (Hiller et al., 2002). The mere fact that legal pressure is applied to
direct a person into treatment does not in itself necessarily mean that they
were actually coerced into it in the sense of being forced against their will. As
Longshore et al. (2004: 113) observe, a blanket assumption that individuals
referred through criminal justice routes are under greater coercion than those
who are not would be mistaken and unfounded. Willingness or desire to par-
ticipate in treatment cannot be simply or directly inferred from the referral
route (Stevens et al., 2006) and equating coercion with criminal justice referral
is misleading (Wild, 1999, 2006). This is a major conceptual weakness in
much of the research literature to date (Wild et al., 2002; Wild, 2006: 43).
SeddonCoerced drug treatment 271
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The third component, that of using force or threats, again raises a signifi-
cant issue. The alternative to entering treatment needs to be perceived, in
relative terms, to be less beneficial or less pleasant for there to be a threat.
To give a British example, the Drug Treatment and Testing Order (DTTO)
2
was intended as a community-based alternative to imprisonment, with the
expectation that those offenders who refused or failed to comply with the
order would end up in custody. This has been described by some critics of
coerced treatment as illustrating how the apparent requirement for offend-
ers to consent to this type of intervention is in fact a sham. What kind of
informed consent can offenders realistically give if the alternative is prison?
Yet the fact that within these kinds of initiatives, drug treatment typically
represents for many offenders an offer they cannot refuse, to use Mike
Houghs (1996: 36) phrase, is of course intrinsic to the whole concept of
coercion. It is not a regrettable indicator that coercion has gone too far,
rather it is its hallmark. The whole point is to try and shift the costbenefit
ratios of the different options so that treatment is clearly and obviously the
preferential choice for as many individuals as possible.
These three elements then are the core components of the idea of coer-
cion in this context. Typically coerced treatment is defined in contrast with
voluntary treatment, implying that there is a binary distinction between
the twoeither an individual freely enters into drug treatment or else they
are coerced into it. As already indicated, conceptually this is a rather crude
and simplistic way of describing the decision-making processes of drug
users about treatment entry. A number of studies have found that coercion
is most usefully conceptualized as a continuum rather than as a dichoto-
mous variable (Anglin et al., 1989; Anglin and Hser, 1990; Farabee et al.,
1998; Hiller et al., 1998; Longshore et al., 2004: 11112).
A key article by Marlowe and colleagues (1996) established two central
points. First, they demonstrated that coercive pressures at drug treatment
entry were operative in multiple life spheres (1996: 82). In other words,
coercion is a multi-dimensional concept, with coercive pressures emanating
from diverse sources, including family and financial concerns as well as the
criminal justice system (Polcin and Weisner, 1999; Marlowe et al., 2001;
Polcin, 2001: 5945; Longshore et al., 2004: 112). As Bean puts it:
In a different form [coercion] occurs also outside the criminal justice system,
for rarely do offenders enter treatment free of all forms of coercion, whether
from friends, relatives or others. To talk, therefore, of coercion and com-
pare this unfavourably with voluntary decisions to enter treatment is to be
too optimistic about the nature of many drug users lives.
(2004: 229)
Second, and most interestingly, Marlowe and colleagues went on to show
that legal pressures may exert substantially less influence over drug treatment
entry than do informal, extra-legal influences (1996: 81). Research subjects
perceived treatment-entry pressures as stemming predominantly from psy-
chological, financial, social, familial, and medical domains respectively
269-286 CRJ-078867.qxd 2/7/07 4:08 PM Page 272
(1996: 81). Again, for many people it may be false to assume that the appli-
cation of criminal justice leverage dramatically increases the level of coercion
they feel to enter treatment. This leads on to another important point.
Coercion is an inherently subjective concept because it is the perception of
persuasion by threat that influences behaviour and not the level of threat that
objectively exists (Wild et al., 1998; Polcin, 2001: 5945; Young, 2002;
Longshore et al., 2004: 11213). This has obvious research implications for
the measurement of coercion.
This subjective dimension to coercion (external pressure) suggests import-
antly a close link with the concept of motivation (internal pressure). In the
drugs field, there are a number of models of motivation for change, perhaps
the best known of which is Prochaska and DiClementes (1986) cycle of
change, which suggests that individuals progress through a series of stages as
they change their addictive behaviour. Despite its strong research and clinical
influence, the cycle of change has been heavily criticized in recent years
(Sutton, 2001; Davidson, 2002) and increasingly distinctions are drawn
between motivation to enter treatment and motivation to engage in treatment
(Drieschner et al., 2004; see also Longshore and Teruya, 2006). Nevertheless,
however it is conceptualized, motivation is widely viewed as a critical factor
in treatment participation, retention and success (Hiller et al., 2002).
It has been argued that coerced treatment is doomed to failure precisely
because individuals do not have this internal motivation. As we have already
seen though, the assumption that all individuals referred through criminal
justice routes lack any interest in or desire for treatment is a false one
(Farabee et al., 2002; Hiller et al., 2002) and, as Hough (2002: 991) sug-
gests, in reality many voluntary treatment entrants begin their treatment
engagement with a degree of ambivalence (Klag et al., 2005: 1781). The crit-
ical question then is how we can conceptualize and understand the relation-
ship between external pressure (coercion) and internal pressure (motivation).
It has been suggested that legal coercion may increase readiness for treat-
ment (Gregoire and Burke, 2004; cf. Stevens et al., 2006), while others have
argued the contrary. Both viewpoints imply that internal and external pres-
sures are not entirely separate or independent domains. Rather, there is an
interactive relationship between them. There is some evidence that this inter-
action may have a significant impact in some circumstances. Several studies
have found that the combination of strong external pressures and strong
internal motivation can lead to better treatment outcomes than those pro-
duced by either factor on their own (Simpson and Joe, 1993; de Leon et al.,
1994; Longshore et al., 2004: 11516). Longshore and colleagues hypothe-
size that: External and internal motives may jointly affect treatment success
when external pressure is internalised or transformed by the person into
an internal motive (2004: 11516). Some recent contributions to the litera-
ture (Longshore and Teruya, 2006; Stevens et al., 2006; Wild, 2006) argue
that unravelling these complex interactions between legal pressure, other
external pressures, perceptions of coercion and internal motivation is vital
for more conceptually robust research on coerced treatment.
269-286 CRJ-078867.qxd 2/7/07 4:08 PM Page 273
Turning from coercion to the second central concept, treatment, this is
on the face of it easier to define. In the British context, the National Treat-
ment Agency (NTA) has produced the following definition:
[Drug treatment] describes a range of interventions which are intended to
remedy an identified drug-related problem or condition relating to a persons
physical, psychological or social (including legal) well-being. Structured drug
treatment follows assessment and is delivered according to a care plan, with
clear goals, which is regularly reviewed with the client. It may comprise a
number of concurrent or sequential treatment interventions.
(NTA, 2002: 2)
Other definitions broadly speaking offer variations on this theme. The crit-
ical issue here concerns the objectives of treatment interventions. This is
important as there is a significant debate about whether viewing drug treat-
ment through a criminal justice lens has distorted service provision.
3
It is clear
from the NTAs definition, and other similar ones, that the social domain is
only one of three drug-related problem areas that treatment may seek to
address. Within that domain, criminal activity and coming into contact with
the criminal justice system represent only one set of problems. In this sense,
the level of priority given to crime reduction as an objective of coerced treat-
ment in its own right (as opposed to a useful by-product) may actually shift
in a fundamental way what is meant by the term treatment. This is not sim-
ply a semantic point. The prioritization of crime reduction might result in a
preference for particular treatment modalities that might differ from those
that would be suggested were physical or psychological well-being the pri-
mary treatment goals. It could be hypothesized, for example, that within
coerced treatment there might be a greater emphasis on methadone prescrib-
ing, given its perceived effectiveness as a tool for reducing offending by heroin
users (Gossop et al., 2001). Certainly, the recent British experience has been
that in some local areas rapid prescribing has been seen as a way of making
coerced treatment more attractive to users, a strategy which may be in some
tension with a more careful and clinically driven approach to prescribing.
Clearly, the concept of coerced treatment is more complex than it might
first appear. A failure to grasp this has significantly impeded the accurate
measurement of the effects of coercion into treatment on treatment process
and outcome variables (Klag et al., 2005: 1783). As a consequence the evi-
dence base is actually much weaker than might be suggested by the number
of studies in this area. A more conceptually sophisticated approach is essen-
tial both for future research and future policy development.
Ethical issues
The ethics of coerced drug treatment is a matter of much debate and raises
some fundamental questions. There are several inter-linked issues concerning
justice and human rights that will be explored here.
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In the previous section, it was suggested that the significance of legal coer-
cion tends to be over-stated, given that drug users generally make decisions
about treatment under the influence of pressures from a range of sources.
However, Stevens and colleagues make the point that the coercive pressure
exerted by the State on individuals has a distinctive character, as the State has
agencies to deal with those who try to avoid it (2005a: 207). The question
then is on what moral basis this pressure is placed on drug-using offenders.
Two answers are often given: first, on the grounds of benevolence (its good
for them); second, on the basis of the crime prevention benefits to commu-
nities that may result from effective treatment (its good for us).
4
Neither answer is persuasive. The first is difficult to sustain as people in
liberal societies are not usually under any obligation to do what is good for
them. Individuals generally have a right to pursue unhealthy lifestyles if
they so wish and are not obliged to seek help to alleviate any afflictions
from which they may suffer. Indeed, the right to refuse treatment has been
held to come within the ambit of Article 8 of the European Convention on
Human Rights (Havers and Neenan, 2002; cf. Caplan, 2006). The second
answer raises arguments that have some echoes of older debates about the
ethics of rehabilitation in the penal system. Norval Morris (1974) argued
over 30 years ago that the use of imprisonment for the sole or primary pur-
pose of rehabilitation was incompatible with justice. The core of the ethical
difficulty identified by Morris is the problem of treating individuals only as
means and not as ends, an argument that draws on Kantian moral philoso-
phy. If every individual is seen to have an intrinsic value, then his or her
rights should not be sacrificed solely in order to protect others. From this
perspective, the justification of coerced treatment on crime prevention
grounds is highly problematic in ethical terms.
A different moral basis for the use of coercion has been suggested by
Gostin (1991) who argues that it can be ethical provided that it, first,
restricts the liberty of the recipient no more than the alternative disposal
already justified by the offence, second, is consistent with due legal process
(see also Porter et al., 1986) and, third, is targeted at those most in need of
and susceptible to treatment. Against this yardstick, current practice in
Britain raises some difficulties. Individuals who refuse or fail to comply
with treatment may indeed end up with a harsher punishment than they
would have received on the basis of their original offence. For example,
under recent provisions in the Drugs Act 2005, a person who is arrested
and subsequently released without charge but who tested positive for opi-
ates or cocaine at the police station might receive up to three months in
prison should they fail to attend their required drug assessment. In other
words, an individual could be wrongly arrested and later released but still
end up facing charges and possible imprisonment simply for not turning up
for an assessment at a drugs service.
Concerns of this kind recall aspects of the critique of rehabilitation in the
1970s which argued that in practice it had often turned out to be harsh and
excessive, prolonging interventions beyond what a purely punitive system
269-286 CRJ-078867.qxd 2/7/07 4:08 PM Page 275
would have required (von Hirsch, 1976; Allen, 1981; Cohen, 1985). They
relate too, albeit less directly, to the more polemical arguments of Thomas
Szasz (1963) and others about the rise of the Therapeutic State in which the
medical role or label is used to cloak what is in fact a moral and political
enterprise of social control. In this vein, Fischer argues that Drug Treatment
Courts in North America, with their symbolism of health and treatment,
obscure the fact that punishment is the persistent and predominant mode
of addiction control (2003: 244).
However, some of these criticisms may be seen as misplaced or overblown.
Coerced drug treatment involves a constrained choice rather than actual com-
pulsion. The rights of individuals are therefore not subordinated to those of
others as they are able to choose whether or not to enter treatment. Indeed,
British policy-makers have been at pains to emphasize the idea of choice
rather than coercion. The latest initiative is called Tough Choices and the
language of coercion appears to have entirely disappeared from the most
recent guidance documents that have been issued.
The validity of this argument hinges on whether individuals targeted for
legal coercion are genuinely able to give proper informed consent to treat-
ment. Is the appearance of choice in fact an illusion? Is consent in effect
given under duress? These questions are ultimately only answerable empir-
ically. There is little research evidence directly on this point but Stevens and
colleagues (2005a: 208) suggest that in their experience coerced drug users
tend to view the offer made to them as a genuine choice and opportunity
rather than as an imposition. Nevertheless, attempting to get informed con-
sent from potentially vulnerable individuals in a highly stressful environment
(typically in the police station or at court) risks being ethically problematic.
5
The requirement for genuine and informed patient consent is firmly estab-
lished in medical law and ethics (Herring, 2006). The question of consent
thus raises issues of professional ethics for health workers. As Bateman
(2001) argues, nurses and other health professionals are bound by codes of
ethics which enshrine their duty to act in the interests of individual patients
at all times. If a drug user is coerced into treatment and their consent is not
genuine, should the health professional decline to treat them? A further
related issue is the question of patient confidentiality and the sharing of
information between drug agencies and the criminal justice system. In order
to monitor compliance with coerced treatment, criminal justice agencies
require information about whether offenders are attending and engaging
with treatment. Barton has explored this area in a series of articles (Barton,
1999a, 1999b; Barton and Quinn, 2002). He notes that the practice of con-
fidentiality within mainstream health care is complex and ambiguous. In the
criminal justice context, he suggests that for information sharing there is a
fundamental tension between practice driven by the needs of individuals and
practice guided by the demands of the risk management of groups con-
sidered to be high-risk offenders (Barton and Quinn, 2002). In other
words, for drug treatment provision, the crime reduction agenda may distort
the exercise of professional discretion concerning patient confidentiality.
269-286 CRJ-078867.qxd 2/7/07 4:08 PM Page 276
A final set of ethical issues concerns the equity of access to treatment ser-
vices. The core concern is whether coerced treatment involves offenders jump-
ing the treatment queue ahead of non-offenders and, if it does, how can this
be justified? Finch and colleagues (2003) describe how the provision of
DTTOs in one area created what they considered to be unacceptable inequal-
ities in access to treatment. This of course can only happen where there is a
local shortfall of capacity in the treatment system relative to demand. Yet, in
the British context at least, it is arguable that the criminal justice agenda has
actually levered in additional funding which has improved access to treat-
ment both for offenders and non-offenders. A slightly more nuanced argu-
ment is that coerced treatment distorts how priorities for treatment access are
determined. Barton (1999a), for example, reports how in one area women
came to be squeezed out of treatment because they were not high priorities
from a criminal justice perspective. Rush and Wild (2003), reporting on
Canadian research, suggest that the operation of a coerced treatment pro-
gramme in Ontario was disproportionately drawing young males into the
treatment system and that this raised the issue of equity of access. Again, it is
possible to see the potential distorting impact of drug treatment being viewed
through the criminal justice lens.
In summary, there are a number of ethical concerns about coerced drug
treatment. It is clear that there are some significant and serious issues of just-
ice and human rights at stake which merit further debate. A theme running
through the discussion here has been that many of the ethical questions relate
to the ways in which the use of coercion and the criminal justice agenda can
distort the principles and practice of drug treatment.
Criminological issues
Coerced treatment for drug users in contact with the criminal justice system
raises a number of significant criminological issues, which will be explored in
this section. The concept obviously resonates strongly with rational choice
theory (Cornish and Clarke, 1986), one of the new criminologies of every-
day life that have become so influential over the last 25 years in providing
a new way of thinking about crime and social order in late modernity
(Garland, 2001). It is an underpinning assumption that drug-using offenders
will weigh up the costs and benefits of accepting treatment and make a
rational decision. The coercion or leverage provided by the criminal justice
system is intended to alter the costbenefit ratio in favour of treatment. The
individual offender is thus conceived as a rational calculator making choices
in order to maximize benefits and minimize costs (Frisher and Beckett, 2006).
However, there is a real paradox in the reliance on rational choice the-
ory in relation to coerced drug treatment. The interventions are predicated
on the targeted individuals acting as rational calculators, yet at the same
time those individuals are viewed as addicted consumers who are con-
sidered to lack the capacity to exercise properly their freedom to choose
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(Reith, 2004). In empirical terms, this notion of addictive consumption,
which is a key part of the rationale for coerced treatment, has been chal-
lenged by several studies (e.g. Grapendaal et al., 1995). At a more theor-
etical level, recent work by Pat OMalley and others (OMalley, 1999,
2002, 2004: 15571; Gomart, 2002; OMalley and Valverde, 2004; Reith,
2004) has shown how these paradoxical problems of freedom are actually
quite central to understanding contemporary modes of governing the conduct
of drug users. It is this dialectic between addiction and freedom which
underpins changing representations of drug users and changing responses to
their behaviour.
The idea of freedom has become a central theme more broadly within
studies of contemporary politics and government (Rose, 1999; OMalley,
2004). Nikolas Rose (1999), for example, has argued that within neo-liberal
governmental strategies, we are increasingly governed through freedom. He
observes that: The programmatic and strategic deployment of coercion
has been reshaped upon the ground of freedom, so that particular kinds of
justification have to be provided for such practices (1999: 10). He goes on
to argue that these justifications include:
The argument that the constraint of the few is a condition for the freedom of
the many, that limited coercion is necessary to shape or reform pathological
individuals so that they are willing and able to accept the rights and respon-
sibilities of freedom, or that coercion is required to eliminate dependency and
enforce the autonomy of the will that is the necessary counterpart of freedom.
(1999: 10)
From this perspective, coerced drug treatment can clearly be seen as a strat-
egy that is constructed on the ground of freedom. This should not be mis-
taken as meaning that we have entered the sunny uplands of liberty and
human rights, as Rose (1999: 10) nicely puts it, but rather that certain values
and ideas given the name freedom have come to provide the grounds on
which governmental power is exercised. This leads to an important point.
Coerced treatment is based on a very particular formulation of freedom in
which the drug user is imagined as a choice-maker (OMalley, 2004:
1613) and furthermore one who is obliged to choose. It is here that the
apparent paradox of freedom described aboveaddicts with attenuated
free will are at the same time expected to act as rational calculatorsis
resolved. Within coerced treatment initiatives drug users are not required to
exercise their full and sovereign free will, they are simply obliged to make a
choice from a highly constrained set of options (typically, prison or treat-
ment). Hence, OMalley (2004: 169) argues that choice displaces free will
in this formulation of freedom. The idea of Tough Choices, the name for
the latest British drug-crime initiative, is particularly apt in this respect.
Another, and related, feature of neo-liberal government is its distinctive
focus on risk and risk management. Indeed, the concept of risk has become
a central motif across the social sciences over the last 15 years (Beck, 1992;
Douglas, 1992; Hope and Sparks, 2000; Garland, 2003; OMalley, 2004)
269-286 CRJ-078867.qxd 2/7/07 4:08 PM Page 278
and understanding the nature of risk management practices has been
described as one of the central theoretical problems for contemporary crim-
inological enquiry (Sparks, 1997: 432). Sparks notes that there is an intrin-
sic connection between the notions of rational choice and of risk (1997:
424), or, as OMalley puts it, they are compatible and complementary terms
(2004: 169). The costbenefit calculations undertaken by rational actors are
about maximizing benefits and minimizing risks. However, in respect of
drug-using offenders, the animating idea of coerced treatment is that they
themselves are particular sources of risk to others, a form of risk that has
been termed actuarial (Feeley and Simon, 1994; OMalley, 2004: 22). In this
sense, coerced treatment can be viewed as a technology for the identification
and management of the actuarial risk of drug-driven crime. Its rise to
prominence in recent years can therefore be understood as part of the wider
rise of risk (Garland, 2003) within neo-liberalism.
Within the risk management technology of coerced treatment, drug testing
serves a critical function and has been described as a necessary prerequisite
for criminal justice treatment (Carver, 2004). It is frequently used in the ini-
tial identification of high-risk offenders, the tests providing data in a flow
of information for assessing risk (Feeley and Simon, 1994: 179). For ex-
ample, in the British context, testing of arrestees takes place in police cus-
tody suites (Deaton, 2004), identifying individuals who may subsequently
be targeted for drug treatment as they progress through the criminal justice
process.
6
Once individuals have been channelled into treatment, testing can
also provide a means of monitoring and enforcing compliance, providing
the material basis for surveillance (Simon, 1993: 187) which, as Ericson
notes, is a key component of the administration of risk:
Surveillance is the production of knowledge about (monitoring), and super-
vision of (compliance), subject populations. Knowledge production and
supervision are mutually reinforcing, and together they create surveillance as
a system of rule Surveillance is THE vehicle of risk management.
(1994: 161, capitals in original)
In contrast to Becks (1992) influential thesis, David Garland (2003) has
suggested that the core issue in todays risk society is not about modern
technology and its unwanted side-effects but rather concerns choices about
life-style and consumption. He argues that these kinds of choices and some
of their associated risk technologies have a particular resonance within con-
temporary consumer capitalism: [Criminological] accounts that highlight
rational choice and the responsiveness of offenders to rewards and disincen-
tives chime with the individualistic culture of our consumer culture
(Garland, 2001: 198). In these terms, the management of the risks associated
with the consumption of illegal drugs and involvement in drug subcultures
obviously goes to the heart of the matter. Coerced treatment, in particular, is
archetypal of contemporary risk management practices in three senses. First,
it involves managing the risks posed by a particular form of disordered con-
sumption (Reith, 2004) and its related life-style. Second, it utilizes the notion
269-286 CRJ-078867.qxd 2/7/07 4:08 PM Page 279
of choice and the responsiveness of drug-using offenders to rewards and dis-
incentives in order to manage risks. Third, it deploys surveillance, typically
via the use of drug testing, as a key tool for this risk management.
The attempted coercion or channelling of drug-using offenders into drug
treatment is a form of what Nikolas Rose describes as the government of
conduct within circuits of inclusion (2000: 187). These circuits are associ-
ated with a criminology of the self, that characterizes offenders as normal,
rational consumers, just like us (Garland, 2001: 137, emphasis in original).
For those individuals who cannot be accommodated in this way, they are
governed within circuits of exclusion (Rose, 2000: 187) linked to a crim-
inology of the other, of the threatening outcast, the fearsome stranger, the
excluded and the embittered (Garland, 2001: 137, emphasis in original).
For coerced drug treatment in the criminal justice system, these exclusionary
circuits predominantly involve the use of imprisonment. Those individuals
who reject the offer of treatment will often face prison. Similarly, and in
practice much more commonly, those who accept treatment but subse-
quently find themselves unwilling or unable to comply with its requirements
may be incarcerated. Coerced treatment thus fits with the more general pat-
tern of control practices within neo-liberal government.
Summarizing, the area of coerced treatment intersects with some major
themes in criminology today. In particular, it feeds into important debates
about the distinctive place of risk in late modern society. It is also closely
linked with the new styles of criminological thinking that have emerged
over the last couple of decades and which are associated with contemporary
strategies for crime control. It thus represents an important site for the
engagement with these highly significant areas of criminological debate.
Conclusions
This article has suggested that to frame the debate about coerced drug treat-
ment simply in terms of whether it works is premature and misleading.
The conceptual confusions that have characterized much of the research to
date rule out any possibility of definitive declarations about effectiveness.
One contribution of the article is to indicate some of the conceptual build-
ing blocks that might underpin the future development of a much more
coherent and useful evidence base.
Entering into the effectiveness debate is arguably premature in another
sense too. There are profound ethical issues raised by coerced treatment that
do not appear to have been fully examined yet. Some commentators have
directly linked the question of ethics with that of effectiveness, arguing that
coerced treatment is only ethically justifiable if it achieves positive outcomes
(Gostin, 1991). However, this begs some questions. The whole moral basis
for the approach is far from clear and there are concerns about potential
conflicts with principles of justice in its practical application. Perhaps even
269-286 CRJ-078867.qxd 2/7/07 4:08 PM Page 280
more significant are the issues of consent and confidentiality. It is the case,
in the British context at least, that much of the drug treatment provision into
which individuals are coerced is part of the National Health Service. It
should be a matter of disquiet at the very least that the principles of patient
consent and confidentiality may operate to a different standard when patients
are coerced into health services by the criminal justice system.
Finally, it has been argued that the issue of coerced treatment throws some
interesting light on some of the big questions of criminological thought and
should therefore be seen as a central issue for contemporary criminology.
Notably, it goes to the heart of debates about the distinctive place of notions
of risk and freedom within crime control practices at the beginning of the
21st century, debates which are at the forefront of criminological enquiry
today (Loader and Sparks, 2002). Coerced drug treatment in the criminal
justice system should be of interest to a much broader set of constituencies
than the drug specialists who have occupied the area up to now.
Notes
An earlier version of this article was presented at a seminar at the University
of Leeds in March 2005. Thanks to participants for their feedback. Thanks
also to Christiane Allard, Phil Hodgson, Douglas Marlowe, Alex Stevens
and anonymous reviewers for this journal for helpful comments on an earl-
ier version. The usual disclaimer applies.
1 As Berridge (1996: 303) notes, there had in fact been discussions in Britain
at the turn of the 20th century about the possibility of compulsory treat-
ment for drug addicts under the inebriates legislation. While this did not
materialize, it illustrates that in the British context the idea of coerced
treatment is not completely new, even if the practice is relatively novel.
2 The DTTO was replaced in April 2005 by the Drug Rehabilitation Re-
quirement (DRR) which involves a similar programme of drug testing and
treatment.
3 There is a parallel here with the wider community safety literature in which it
has been argued that the pre-eminence of the law and order agenda may be
distorting the provision of mainstream public services (Crawford, 2002: 233).
4 Thanks to Alex Stevens for suggesting this way of summarizing the two
positions.
5 In a recent research project in which the author was involved, a court-
based drugs worker gave an example of the type of situation sometimes
presented in practice: Youre assessing somebody whos literally holding
the wastepaper basket in front of them, heaving into it [] And then you
say Id just like you to sign these forms [] and they will sign anything.
6 Empirical studies cast doubt on the idea that the risks of offending associ-
ated with drug use constitute an objective or fixed risk that can be measured
and managed by drug testing and treatment (e.g. Grapendaal et al., 1995;
on testing, see Seddon, 2005: 16).
269-286 CRJ-078867.qxd 2/7/07 4:08 PM Page 281
References
Allen, F. (1981) The Decline of the Rehabilitative Ideal. New Haven, CT: Yale
University Press.
Anglin, M.D. (1988) The Efficacy of Civil Commitment in Treating Narcotic
Addiction, in C.G. Leukefeld and F.M. Tims (eds) Compulsory Treatment of
Drug Abuse: Research and Clinical Practice, pp. 834. NIDA Research
Monograph No. 86. Rockville, MD: National Institute on Drug Abuse.
Anglin, M.D. and Y. Hser (1990) Treatment of Drug Abuse, in M. Tonry and
J.Q. Wilson (eds) Crime and Justice: Annual Review of Research, vol. 13,
pp. 393460. Chicago, IL: University of Chicago Press.
Anglin, M.D., M. Brecht and E. Maddahian (1989) Pretreatment Characteristics
and Treatment Performance of Legally Coerced Versus Voluntary Methadone
Maintenance Admissions, Criminology 27(3): 53757.
Barton, A. (1999a) Sentenced to Treatment? Criminal Justice Orders and the
Health Service, Critical Social Policy 19(4): 46383.
Barton, A. (1999b) Breaking the Crime/Drugs Cycle: The Birth of a New Ap-
proach?, Howard Journal 38(2): 14457.
Barton, A. and C. Quinn (2002) Risk Management of Groups or Respect for
the Individual? Issues for Information Sharing and Confidentiality in Drug
Treatment and Testing Orders, Drugs: Education, Prevention and Policy
9(1): 3543.
Bateman, M. (2001) Conflict in Court?, Nursing Times 97(44): 345.
Bean, P. (2004) Drugs and Crime, 2nd edn. Cullumpton: Willan.
Beck, U. (1992) The Risk Society: Towards a New Modernity. London: Sage
Publications.
Berridge, V. (1996) Drug Policy: Should the Law Take a Back Seat?, The Lancet
347(8997): 3015.
Caplan, A. (2006) Ethical Issues Surrounding Forced, Mandated or Coerced
Treatment, Journal of Substance Abuse Treatment 31(2): 11720.
Carver, J. (2004) Drug Testing: A Necessary Prerequisite for Treatment and for
Crime Control, in P. Bean and T. Nemitz (eds) Drug Treatment: What Works?,
pp. 14277. London: Routledge.
Cohen, S. (1985) Visions of Social Control. Cambridge: Polity Press.
Cornish, D. and R. Clarke (eds) (1986) The Reasoning Criminal: Rational Choice
Perspectives on Offending. New York: Springer-Verlag.
Crawford, A. (2002) The Growth of Crime Prevention in France as Contrasted
with the English Experience, in G. Hughes, E. McLaughlin and J. Muncie
(eds) Crime Prevention and Community Safety: New Directions, pp. 21439.
London: Sage Publications.
Davidson, R. (2002) Cycle of Change: Ideas, Issues and Implications, Drugs:
Education, Prevention and Policy 9(1): 714.
Deaton, S. (2004) On Charge Drug Testing: Evaluation of Drug Testing in the
Criminal Justice System. Development and Practice Report No. 16. London:
Home Office.
De Leon, G., G. Melnick, D. Kressel and N. Jainchill (1994) Circumstances,
Motivation, Readiness, and Suitability (the CMRS Scales): Predicting Retention
in Therapeutic Community Treatment, American Journal of Drug and Alcohol
Abuse 20(4): 495515.
269-286 CRJ-078867.qxd 2/7/07 4:08 PM Page 282
Douglas, M. (1992) Risk and Blame: Essays in Cultural Theory. London:
Routledge.
Drieschner, K., S. Lammers and C. van der Staak (2004) Treatment Motivation:
An Attempt for Clarification of an Ambiguous Concept, Clinical Psychology
Review 23(8): 111537.
Ericson, R. (1994) The Division of Expert Knowledge in Policing and Security,
British Journal of Sociology 45(2): 14975.
Farabee, D., M. Prendergast and M. Anglin (1998) The Effectiveness of Coerced
Treatment for Drug-Abusing Offenders, Federal Probation 62(1): 310.
Farabee, D., H. Shen and S. Sanchez (2002) Perceived Coercion and Treatment
Need among Mentally Ill Parolees, Criminal Justice and Behavior 29(1):
7686.
Feeley, M. and J. Simon (1994) Actuarial Justice: The Emerging New Criminal
Law, in D. Nelken (ed.) The Futures of Criminology, pp. 173201. London:
Sage Publications.
Finch, E., J. Brotchie, K. Williams, S. Ruben, L. Felix and J. Strang (2003)
Sentenced to Treatment: Early Experience of Drug Treatment and Testing
Orders in England, European Addiction Research 9(3): 1317.
Fischer, B. (2003) Doing Good with a Vengeance: A Critical Assessment of
the Practices, Effects and Implications of Drug Treatment Courts in North
America, Criminal Justice 3(3): 22748.
Frisher, M. and H. Beckett (2006) Drug Use Desistance, Criminology & Criminal
Justice 6(1): 12745.
Garland, D. (2001) The Culture of Control: Crime and Social Order in Con-
temporary Society. Oxford: Oxford University Press.
Garland, D. (2003) The Rise of Risk, in R. Ericson and A. Doyle (eds) Risk
and Morality, pp. 4886. Toronto: University of Toronto Press.
Gomart, E. (2002) Towards Generous Constraint: Freedom and Coercion in a
French Addiction Treatment, Sociology of Health & Illness 24(5): 51749.
Gossop, M., J. Marsden and D. Stewart (2001) NTORS after Five Years: The
National Treatment Outcome Research Study: Changes in Substance Use,
Health and Criminal Behaviour during the Five Years after Intake. London:
National Addiction Centre.
Gossop, M., K. Trakada, D. Stewart and J. Witton (2005) Reductions in
Criminal Convictions after Addiction Treatment: 5-Year Follow-Up, Drug
and Alcohol Dependence 79(3): 295302.
Gossop, M., K. Trakada, D. Stewart and J. Witton (2006) Levels of Conviction
Following Drug Treatment: Linking Data from the National Treatment
Outcomes Research Study and the Offenders Index. Research Findings
No. 275. London: Home Office.
Gostin, L. (1991) Compulsory Treatment for Drug-Dependent Persons: Justi-
fications for a Public Health Approach to Drug Dependency, The Milbank
Quarterly 69(4): 56193.
Grapendaal, M., E. Leuw and H. Nelen (1995) A World of Opportunities:
Lifestyle and Economic Behaviour of Heroin Addicts in Amsterdam. Albany,
NY: State University of New York Press.
Gregoire, T.K. and A.C. Burke (2004) The Relationship of Legal Coercion to
Readiness to Change among Adults with Alcohol and Other Drug Problems,
Journal of Substance Abuse Treatment 26(1): 3541.
269-286 CRJ-078867.qxd 2/7/07 4:08 PM Page 283
Havers, P. and C. Neenan (2002) Impact of the European Convention on Human
Rights on Medical Law, Postgraduate Medical Journal 78(924): 5734.
Herring, J. (2006) Medical Law and Ethics. Oxford: Oxford University Press.
Hiller, M.L., K. Knight, K.M. Broome and D.D. Simpson (1998) Legal Pressure
and Treatment Retention in a National Sample of Long-Term Residential
Programs, Criminal Justice and Behavior 25(4): 46381.
Hiller, M.L., K. Knight, C. Leukefeld and D.D. Simpson (2002) Motivation as
a Predictor of Therapeutic Engagement in Mandated Residential Substance
Abuse Treatment, Criminal Justice and Behavior 29(1): 5675.
Home Office (2002) Updated Drug Strategy 2002. London: Home Office.
Hope, T. and R. Sparks (eds) (2000) Crime, Risk and Insecurity: Law and
Order in Everyday Life and Political Discourse. London: Routledge.
Hough, M. (1996) Drug Misuse and the Criminal Justice System: A Review of
the Literature. DPI Paper 15. London: Home Office.
Hough, M. (2002) Drug User Treatment within a Criminal Justice Context,
Substance Use & Misuse 37(810): 98596.
Hunt, N. and A. Stevens (2004) Whose Harm? Harm Reduction and the Shift
to Coercion in UK Drug Policy, Social Policy & Society 3(4): 33342.
Klag, S., F. OCallaghan and P. Creed (2005) The Use of Legal Coercion in the
Treatment of Substance Abusers: An Overview and Critical Analysis of
Thirty Years of Research, Substance Use & Misuse 40(12): 177795.
Loader, I. and R. Sparks (2002) Contemporary Landscapes of Crime, Order and
Control: Governance, Risk and Globalization, in M. Maguire, R. Morgan and
R. Reiner (eds) The Oxford Handbook of Criminology, 3rd edn, pp. 11022.
Oxford: Oxford University Press.
Longshore, D. and C. Teruya (2006) Treatment Motivation in Drug Users:
A Theory-Based Analysis, Drug and Alcohol Dependence 81(2): 17988.
Longshore, D., M. Prendergast and D. Farabee (2004) Coerced Treatment for
Drug-Using Criminal Offenders, in P. Bean and T. Nemitz (eds) Drug
Treatment: What Works?, pp. 11022. London: Routledge.
McSweeney, T., A. Stevens and N. Hunt (2006) The Quasi-Compulsory Treatment
of Drug Dependent Offenders in EuropeUK Findings: Summary. London/
Canterbury: Kings College London/University of Kent.
Marlowe, D.B., E.P. Merikle, K.C. Kirby, D. Festinger and A.T. McLellean
(2001) Multidimensional Assessment of Perceived Treatment-Entry Pressures
among Substance Abusers, Psychology of Addictive Behavior 15(2): 97108.
Marlowe, D.B., K. Kirby, L. Bonieskie, D. Glass, L. Dodds, S. Husband et al.
(1996) Assessment of Coercive and Noncoercive Pressures to Enter Drug
Abuse Treatment, Drug and Alcohol Dependence 42(2): 7784.
Morris, N. (1974) The Future of Imprisonment. Chicago, IL: University of
Chicago Press.
National Treatment Agency (NTA) (2002) Models of Care for the Treatment of
Adult Drug Misusers. London: NTA.
OMalley, P. (1999) Consuming Risks: Harm Minimization and the Government
of Drug-Users, in R. Smandych (ed.) Governable Places: Readings in
Governmentality and Crime Control, pp. 191214. Aldershot: Dartmouth.
OMalley, P. (2002) Drugs, Risks and Freedoms: Illicit Drug Use and
Misuse under Neo-Liberal Governance, in G. Hughes, E. McLaughlin and
269-286 CRJ-078867.qxd 2/7/07 4:08 PM Page 284
J. Muncie (eds) Crime Prevention and Community Safety: New Directions,
pp. 27996. London: Sage Publications.
OMalley, P. (2004) Risk, Uncertainty and Government. London: GlassHouse
Press.
OMalley, P. and M. Valverde (2004) Pleasure, Freedom and Drugs: The Uses
of Pleasure in Liberal Governance of Drug and Alcohol Consumption,
Sociology 38(1): 2542.
Polcin, D. (2001) Drug and Alcohol Offenders Coerced into Treatment:
A Review of Modalities and Suggestions for Research on Social Model
Programs, Substance Use & Misuse 36(5): 589608.
Polcin, D. and C. Weisner (1999) Factors Associated with Coercion in Entering
Treatment for Alcohol Problems, Drug and Alcohol Dependence 54(1): 638.
Porter, L., A. Arif and W. Curran (1986) The Law and Treatment of Drug and
Alcohol Dependent Persons: A Comparative Study of Existing Legislation.
Geneva: World Health Organization.
Prochaska, J. and C. DiClemente (1986) Towards a Comprehensive Model of
Change, in W. Miller and N. Heather (eds) Treating Addictive Behaviours,
pp. 327. New York: Plenum.
Reith, G. (2004) Consumption and Its Discontents: Addiction, Identity and the
Problems of Freedom, British Journal of Sociology 55(2): 283300.
Rose, N. (1999) Powers of Freedom: Reframing Political Thought. Cambridge:
Cambridge University Press.
Rose, N. (2000) Government and Control, in D. Garland and R. Sparks (eds)
Criminology and Social Theory, pp. 183208. Oxford: Oxford University
Press.
Rush, B. and T.C. Wild (2003) Substance Abuse Treatment and Pressures from
the Criminal Justice System: Data from a Provincial Client Monitoring System,
Addiction 98(8): 111928.
Seddon, T. (2000) Explaining the DrugCrime Link: Theoretical, Policy and
Research Issues, Journal of Social Policy 29(1): 95107.
Seddon, T. (2005) Searching for the Next Techno-Fix: Drug Testing in the
Criminal Justice System, Criminal Justice Matters 58(Winter): 1617.
Simon, J. (1993) Poor Discipline. Chicago, IL: University of Chicago Press.
Simpson, D.D. and G.W. Joe (1993) Motivation as a Predictor of Early Dropout
from Drug Abuse Treatment, Psychotherapy 30(2): 35768.
Sparks, R. (1997) Recent Social Theory and the Study of Crime and Punishment,
in M. Maguire, R. Morgan and R. Reiner (eds) The Oxford Handbook of
Criminology, 2nd edn, pp. 40935. Oxford: Clarendon Press.
Stevens, A. (2004) The Treatment/Punishment Hybrid: Selection and Experi-
mentation, paper presented at the 4th Annual Conference of the European
Society of Criminology, Amsterdam, August.
Stevens, A., T. McSweeney, M. van Ooyen and A. Uchtenhagen (2005a) On
Coercion, International Journal of Drug Policy 16(4): 2079.
Stevens, A., D. Berto, W. Heckmann, V. Kerschl, K. Oeuvray, M. van Ooyen et al.
(2005b) Quasi-Compulsory Treatment of Drug Dependent Offenders: An
International Literature Review, Substance Use & Misuse 40(3): 26983.
Stevens, A., D. Berto, U. Frick, N. Hunt, V. Kerschl, T. McSweeney et al. (2006)
The Relationship between Legal Status, Perceived Pressure and Motivation
269-286 CRJ-078867.qxd 2/7/07 4:08 PM Page 285
in Treatment for Drug Dependence: Results from a European Study of Quasi-
Compulsory Treatment, European Addiction Research 12(4): 197209.
Sutton, S. (2001) Back to the Drawing Board? A Review of Applications of the
Transtheoretical Model to Substance Misuse, Addiction 96(1): 17586.
Szasz, T. (1963) Law, Liberty and Psychiatry: An Inquiry into the Social Uses
of Mental Health Practices. New York: Macmillan.
Turnbull, P., T. McSweeney, R. Webster, M. Edmunds and M. Hough (2000)
Drug Testing and Treatment Orders: Final Evaluation Report. Home Office
Research Study No. 212. London: Home Office.
Von Hirsch, A. (1976) Doing Justice: The Choice of Punishments. Boston, MA:
Northeastern University Press.
Webster, C. (1986) Compulsory Treatment of Narcotic Addiction, International
Journal of Law and Psychiatry 8(2): 13359.
Wild, T.C. (1999) Compulsory Substance-User Treatment and Harm Reduction:
A Critical Analysis, Substance Use and Misuse 34(1): 83102.
Wild, T.C. (2006) Social Control and Coercion in Addiction Treatment:
Towards Evidence-Based Policy and Practice, Addiction 101(1): 409.
Wild, T.C., B. Newton-Taylor and R. Alletto (1998) Perceived Coercion among
Clients Entering Substance Abuse Treatment: Structural and Psychological
Determinants, Addictive Behaviors 23(1): 8195.
Wild, T.C., A.B. Roberts and E.L. Cooper (2002) Compulsory Substance Abuse
Treatment: An Overview of Recent Findings and Issues, European
Addiction Research 8(2): 8493.
Young, D. (2002) Impacts of Perceived Legal Pressure on Retention in Drug
Treatment, Criminal Justice and Behavior 29(1): 2755.
TOBY SEDDON is Senior Research Fellow in the Centre for Criminology &
Socio-Legal Studies in the School of Law at the University of Manchester.
Previously he held a research position in the Centre for Criminal Justice
Studies at the University of Leeds. He is author of Punishment and Madness
(2007, Routledge-Cavendish).
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