Research: Involuntary Substance Treatment Ineffective

Experts say involuntary treatment for substance use disorder lacks evidence of effectiveness and raises serious concerns about patient safety.

Published on Mar. 2, 2026

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Since President Donald Trump issued a July 2025 executive order aimed at "ending crime and disorder on America's streets," national attention has increasingly focused on involuntary treatment as a response to visible homelessness and drug use. However, research by Professor Susan E. Collins at the University of Washington shows that involuntary treatment for adults with substance use disorders is necessary in extreme cases, but does not outperform voluntary care and raises serious concerns about patient safety.

Why it matters

As more states expand laws allowing for involuntary treatment for substance use disorder, experts warn that the practice lacks clear scientific evidence of effectiveness and may actually lead to higher risks of relapse, rearrest, and even death after release from treatment. This raises concerns about the ethics and efficacy of involuntary treatment approaches.

The details

Involuntary treatment, or "involuntary civil commitment," is the most restrictive means of formal coercion, authorizing a court to order the involuntary deprivation of liberty by confining a person to a locked treatment facility. While reserved for extreme cases where a person poses an imminent risk of serious harm, research reviews have found no measurable benefit and in some cases clear harm from involuntary treatment for substance use disorder, including higher risks of relapse, rearrest, and death. Limited data from state programs in Massachusetts and Washington echo these findings, showing increased overdose mortality and mixed short-term results.

  • In July 2025, President Donald Trump issued an executive order aimed at "ending crime and disorder on America's streets."
  • In September 2025, officials in Utah announced plans for a 16-acre facility on the edge of Salt Lake City that would hold up to 1,300 people experiencing homelessness, with 300-400 beds reserved for involuntary treatment.

The players

Susan E. Collins

A licensed clinical psychologist, substance-use treatment professional, and researcher at the University of Washington who has focused on what works in substance use treatment, including among people experiencing homelessness.

Ricky's law

Washington's version of involuntary treatment, implemented in 2018, which prompted Collins to start researching involuntary treatment.

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What they’re saying

“Involuntary treatment for adults with substance use disorders is necessary in extreme cases, but it does not outperform voluntary care and raises serious concerns about patient safety.”

— Susan E. Collins, Professor of Psychiatry and Behavioral Sciences, University of Washington (Mirage News)

The takeaway

While involuntary treatment may be necessary in extreme cases, the evidence consistently points to lower-barrier and voluntary approaches as more effective, less costly, and less risky than involuntary treatment for substance use disorder. Expanding involuntary treatment beyond acute, life-threatening crises is unwarranted, and policymakers should instead focus on investing in and delivering voluntary services that have been shown to save lives, reduce harm, and foster sustainable recovery.