ABSTRACT
What is at stake in mandatory treatment for those with substance addictions? We will answer this by addressing several related tasks. The first is conceptual: what exactly is mandatory treatment, and what are the forms that it takes? The second is factual: what is the current legal and policy situation for mandatory treatment across some representative jurisdictions? The third is normative: what is its justification and how does this articulate with the law? A fourth task is to identify a difficulty that arises in its justification: addiction impairments are conative, cyclical and diachronic, and so the standard cognitively flavoured synchronic criteria for judging competence do not readily apply. So in what sense are addicted persons lacking in the competence required to refuse treatment? A final task is to consider whether there are utilitarian grounds for accepting a limited system of mandated treatment. If, on balance, it demonstrably reduces harm could a case be made for it on the grounds of its effectiveness? Public health studies in this area reveal mixed results, with some positive outcomes in reducing recidivism in criminal justice contexts, but the data for cases of civil commitment is less clear.
