Compulsory substance-user treatment and harm reduction: A critical analysis

Compulsory treatment potentially offers a cost-effective and rehabilitative alternative to incarceration for substance-user offenders. However, the co mpatibility of harm-reduction principles and compulsory substance-user trea tment initiatives is unclear. First, the historical record suggests that po licy and legislative changes promoting diversion to treatment are typically not followed up by administrative, fiscal, and evaluative support. Moreove r, cost-saving arguments underlying past programs may be inadequate to cope with concerns about civil liberties raised by compulsory treatment practic es. Second, empirical evidence suggests that there may be a fundamental inc ompatibility between attitudes endorsing compulsory treatment and attitudes endorsing harm reduction. Finally, empirical claims about the relative eff icacy of mandated versus nonmandated substance-user treatment are plagued b y conceptual and methodological problems. These arguments suggest that comp ulsory substance-user treatment and harm reduction may not be as compatible as is commonly believed. Consequently, caution is warranted in moving towa rd a widespread adoption of compulsory treatment policies. [Translations ar e provided in the International Abstracts Section of this issue.].