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Discussion of Mandated Treatment Ignores Group Dynamics

January 1, 2007
by root
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The apparent success of mandated treatment has led to some recent publicity, including the article “Mandated Clients Finding Their Way” (see November 2006 issue) and an article entitled “Court Mandated Treat-ment Works as Well as Voluntary” in the Summer 2006 issue of the National Institute on Drug Abuse's NIDA Notes. This comes as a result of a collaborative research project on the subject, completed this year by the Department of Veterans Affairs and NIDA. It also comes well after NIDA's 1999 publication Principles of Drug Addiction Treatment: A Research-Based Guide. In the recent AP article, John F. Kelly, PhD, lead investigator of the VA study, paraphrased Principle #10 well when he said that “treatment doesn’t have to be voluntary to be effective,” adding, “Once the [mandated] client is exposed to treatment, it has an effect.”

For years, addiction treatment professionals specifically, as well as group therapists in general, have known that the “effect” Kelly refers to is not so much “treatment” per se but a healthy group milieu mix within the patient's treatment. Why is this crucial condition barely noted in the recent articles? NIDA itself failed to discuss—in Principle #10—the clinical significance of a healthy patient milieu mix. (It did, however, mention it in a section on prison-based treatment programs by saying, “Those in [prison-based] treatment should be segregated from the general prison population so that the ‘prison culture’ does not overwhelm progress toward recovery.”)

Gary Enos's article in AP failed to include or discuss the significance of a healthy milieu mix, outside of referring to what Kelly himself noted (“The key, Kelly explains, wasn’t in the profile the client carried into treatment, but in the gains the [mandated] client was able to make through treatment exposure and interaction with peers in a treatment context”). In the NIDA Notes article, it is Kelly—not the author of the article—who gives the nod to the importance of a healthy milieu mix by saying, “The high level of camaraderie in VA residential treatment, where these individuals interacted with self-motivated peers, may have contributed to a shift in attitude.”

Bravo for Kelly, and bravo to the authors of both articles for at least providing some of the statistics from the actual research. That at least allowed me to do the math (93% of the VA patients were in treatment voluntarily; 7% were court-mandated) and draw my own conclusions. As such, I would have written the headline for the NIDA Notes article differently: Court-mandated treatment works as well as voluntary; that is, when the ratio of mandated patients to voluntary patients is one to nine!

In an age of political and organizational “spin,” it makes me suspicious when editors or organizations downplay certain information while emphasizing other information. Does NIDA or NAADAC need to promote the (perhaps outdated) slogan “treatment works” that bad?

Doug Moser, MA, LLP, Traverse City, Michigan

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