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Conservatorships and Involuntary Drug Treatment: Does it Work? 

Written by Alexandra Hicks

Are forced rehab programs effective? Or ethical? A new bill in California that expands conservatorship laws is raising these questions.

Many people had never heard of conservatorships until the whole “Free Britney” movement (which started in 2009) gained traction a few years ago. But a new law in California that would allow the state to force addicts to undergo treatment has brought this controversial practice back into the limelight. More than two-thirds of the states already have similar laws in place, but experts warn that such measures can do more harm than good. Let’s take a closer look. 

What are conservatorships? 

A conservatorship is a complex legal process during which a court can designate a third party to oversee an individual’s care. This third party can be a family member, close friend, a professional conservator, or a public guardian that’s been appointed by the court; and the care can include medical, financial, and even committing a person to mental health facilities.  

Conservatorships can be either general or limited, the former being more overriding with the conservatee having little to no-decision making powers, while the latter allows the conservatee to retain control over the majority of their life, with the exception of what the court decides the conservator needs to be in charge of. Each state has their own laws regarding conservatorships, but the general idea is overall the same.  

While conservatorships are completely necessary in some cases, they do strip away a person’s autonomy and ability to make many personal decisions, so they become vulnerable to many different types of abuse if the person governing them has ill intentions.  

The #freebritney movement

One of the more high-profile examples of a conservatorship that was reported to be exploitative, was the case of Britney Spears, as mentioned above. Her father James was her conservator for 13 years, during which he allegedly controlled every aspect of her life, including all her finances, public appearances, and personal matters, even forcing her to use birth control. Another example is former NFL star Michael Oher, whose story inspired the book and movie, “The Blind Side”. In August of this year, he filed a lawsuit against the couple who claimed to adopt him. He says they did not legally adopt him, but instead placed him in a conservatorship and used it to control his finances.  

California Senate Bill 43 

Last week, Governor Gavin Newsom signed Senate Bill 43 into law, shining the spotlight back on the often-disputed practice of conservatorships. The new bill expands the state’s current conservatorship regulations to allow “involuntary rehab for people who are unable to provide for their personal safety or necessary medical care, in addition to food, clothing, or shelter, due to either severe substance use disorder or serious mental health illnesses.” 

The old law required a person to also be diagnosed with some type of mental disorder to be eligible for conservatorship, but now, anyone who shows signs of being addicted to drugs or alcohol can be forced into a treatment program by the state. According to a representative from Newsom’s office, “conservatorship can help break the cycle of repeated crises including arrest and imprisonment, psychiatric hospitalization, homelessness, and even premature death — and instead provide the care that can restore mental health and end the conservatorship.” 

California is one of thirty-eight states that allow some type of involuntary rehab with conservatorships, but the difference here is California’s vast population. The golden state accounts for roughly one-third of unhoused people in the entire U.S, and a large percentage of them have substance use disorders. This means that even though most states already have laws like this in place, we’re likely to see it in practice much more now that California is doing it too.  

Intensifying the overdose crisis

Numerous drug policy experts have called coerced treatments ineffective, stating that they infringe on individual and civil rights, and could actually worsen overdose rates, rather than help them. According to Jeannette Zanipatin, director of California’s chapter of the Drug Policy Alliance, the laws clearly do not align with current evidence that involuntary rehab can have detrimental consequences.  

“There’s no science or evidence that demonstrates that coerced treatment for substance use is actually effective and in fact, it increases the chances that someone could die of an overdose either when they’re in the facility or when they are immediately released,” she said. This is because a person’s tolerance goes down during forced periods of sobriety, and if they aren’t willing to quit, they’ll start using again soon after release.  

Substance abuse continues when a person is not ready to quit

So, the real fact of the matter here is that people will not quit using substances until they’re ready to. They need to realize that there is a problem, and they need to really feel the negatives impacts of the drug use on their lives. You can make a person go to rehab all you want, but if they themselves don’t acknowledge the problem, then in their minds, there is nothing for them to fix so they get out and continue using.  

“There is definitely political pressure for policy makers to be able to point to things that they are doing because everybody is seeing and experiencing folks who are homeless, folks who have mental health issues and folks who have issues with substance use; and so there has been a shift in public attitude and having less patience for what everyone is seeing but not really understanding why we’re at the point where we’re at,” Zanipatin added, noting that homelessness and substance abuse have both increased in the last few years, starting with the COVID-19 pandemic and widespread economic hardship that followed.  

Her fears echo a report published in 2017 by the group Physicians for Human Rights, which found that drug courts and rehab programs “regularly set participants up for failure.” The report went on to say that “Drug courts in the United States routinely fail to provide adequate, medically-sound treatment for substance use disorders, with treatment plans that are at times designed and facilitated by individuals with little to no medical training… Few communities have adequate treatment facilities, insurance plans often won’t finance effective treatment programs, and the criminal justice objectives of drug courts often overrule the medical needs of the patient in ways that threaten the rights and health of participants.” 

Are there any better solutions?

Obviously, both drug use and homelessness are growing problems in the United States. Even as the instability from the COVID-19 lockdowns fades away, the US has seen a record rise in homelessness over the last year. It’s worst on the West Coast and Northeastern states, with an average of 40 homeless per 100,000 residents. California has by far the largest overall number of homeless individuals, with an estimated 172,000 as of June 2023. Whereas California makes up 12% of the total US population, the rate of unhoused individuals in the state accounts for 30% of the nation’s total.  

Drug abuse, addiction issues, and overdose deaths have also surged since the COVID-19 pandemic. And this is coming after more than a decade of increased alcohol and methamphetamine use, and an opioid crisis that started in the late 1990s and has grown to “epidemic” proportions, claiming over 700,000 lives and counting.  

While some believe the gold-standard for treating addiction is medication, that’s not a viable option for everyone. Some people don’t have transportation to go to and from a clinic regularly, others can’t get these treatments covered by their insurance, if they’re even insured, and some get addicted to the medication they’re using to treat the initial addiction. For example, abuse and overdose rates for methadone have increased sixfold over the last couple decades. And while the numbers are still dramatically lower than opiate deaths, it does highlight a still unresolved issue with medication-based treatments for addiction. 

Talk therapy, meditation, lifestyle changes, and even safe drugs like cannabis, psychedelics, and certain pharmaceuticals can help improve a person’s mental health

That being said, the root cause of these problems is poor mental health. Trauma, abuse, exposure to substance abuse in families, and untreated mental illness can all lead to addiction; and if these issues aren’t addressed, the problems will continue. How to address these issues? It’s difficult to say. I’m no mental health expert, so I have no tangible solutions to offer. But it’s something to consider when politicians sign policies like this into law, and we see them fail time and time again.  

Final thoughts

All in all, it’s disheartening that Newsom approved this bill to update conservatorships and allow more ways to force people into rehab, while recently vetoing a bill that would have decriminalized several plant-based hallucinogens (which have been proven to be beneficial in the treatment of numerous mental health disorders, including addiction), as well another bill that would have legalized safe-use sites. While he’s no stranger to disappointing the masses, he’s made it quite clear that his interest is not in actually solving drug and homelessness issues in California… just appearing like he’s doing so.

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About the author

Alexandra Hicks

Managing editor at Cannadelics and U.S based journalist, helping spread the word about the many benefits of using cannabis and psychedelics.