A disturbing sight is becoming all too common in our cities: individuals openly using drugs, sometimes menacing passersby and leaving behind a trail of needles and drug paraphernalia in public spaces. In response, President Trump has put forward a direct solution: compelling these individuals off the streets and into rehabilitation programs.
While this might sound like a drastic measure, the framework for such action already exists. At least 34 states and the District of Columbia have laws permitting the involuntary commitment of individuals with severe substance use disorders to rehabilitation facilities. A recent executive order from Mr. Trump aims to intensify the enforcement of these existing statutes, many of which are currently underutilized.
Similar to compulsory treatment for mental health conditions, these laws are typically considered a last resort, often initiated by family members desperate to help a loved one. However, law enforcement officials and medical professionals also have the authority to petition the courts for such commitments.
However, significantly expanding the application of these laws faces considerable challenges. Even if it were possible to remove a large number of people from public spaces, states would struggle to secure adequate rehabilitation beds and funding. Currently, even those actively seeking help often face a shortage of available treatment options.
Here are some things to know:
How Do Involuntary Commitment Cases Start?
Typically, a family member, spouse, or close friend initiates the process by petitioning a court. However, most states also permit police officers, doctors, social workers, and sometimes even government officials (like the mayor in the District of Columbia) to open a case.
These hearings can take place in various court settings, including municipal, county, family, or probate courts. Some areas have even established specialized dockets specifically for behavioral health cases.
A common requirement in most states is the submission of affidavits from two medical doctors to support the petition.
What Rights Do Individuals Have if They Resist Treatment?
Yes, significant legal protections are in place. These include the right to legal representation. While most states have judges decide these cases, Texas mandates a jury trial unless the individual (referred to as the “proposed patient”) waives this right.
Generally, the person initiating the petition must demonstrate with “clear and convincing” evidence that the individual poses an ongoing threat to themselves or others. Kentucky, notably, sets an even higher bar, requiring proof “beyond a reasonable doubt.”
Some states, like Delaware, explicitly state that simply refusing treatment is not enough to prove an individual lacks the judgment to decide whether involuntary rehabilitation is necessary.
However, critics of civil commitment frequently argue that in reality, these protections can be weak, and the “risk of harm” standard is often interpreted too broadly.
How Frequently Is Involuntary Commitment Utilized for Addiction?
There isn’t a centralized federal database to track these cases. State-level data collection is often inconsistent, with some jurisdictions even combining commitments for mental illness with those for substance use disorders.
Massachusetts, however, maintains more detailed records than most states. In 2025 alone, over 6,000 petitions were filed, leading to 2,758 involuntary commitments, as reported by the state’s Department of Public Health.
Florida’s law has been in place for over three decades, yet the state only mandated annual reporting in 2024. The first such analysis, released by the University of South Florida in December, covered only court-initiated cases (excluding those handled by police or hospitals). From June 2022 to July 2023, 10,236 cases went to court, with nearly half being dismissed before a formal hearing.
Is Compulsory Addiction Treatment Effective?
There’s limited research to definitively say whether treatment mandated through involuntary civil commitment leads to long-term recovery from addiction. Some recent findings suggest a discouraging trend.
For instance, a 2024 study examining California’s systems described them as “shrouded in obscurity” and criticized the “lacking” data available for evaluation.
Similarly, Massachusetts’ 2024 analysis of civil commitment cases from 2015 to 2021 showed concerning results. Researchers found that individuals who completed mandatory rehab had a “significantly greater odds of experiencing a nonfatal opioid overdose” within 30 and 90 days compared to those who completed voluntary treatment.
Another 2024 study, which investigated the link between civil commitment laws and opioid overdose deaths from 2010 to 2021, couldn’t establish a significant difference between states with and without these laws, largely due to numerous confounding factors.
It’s important to distinguish drug courts, a component of the criminal justice system, which don’t directly order individuals to rehab. Instead, defendants are given a choice: undergo treatment or face jail time. Some researchers suggest that drug courts offer a more favorable path to recovery than incarceration or no treatment, particularly for individuals whose severe substance use impairs their decision-making. However, rigorous studies comparing voluntary rehabilitation with drug-court-mandated rehab have yielded mixed results.
What Kind of Treatment Can Judges Mandate?
Judges in some states can order a combination of residential and outpatient programs. Yet, a 2024 report by the Legislative Analysis and Public Policy Association indicates that at least five states restrict judicial orders to inpatient treatment only. The duration of involuntary commitment varies widely, from two weeks to a full year, with 90 days being the most common.
Notably, Rhode Island’s involuntary commitment law exclusively addresses alcohol use, while Vermont’s statute covers drug addiction but omits alcohol.
The laws themselves rarely specify the type or quality of treatment required. Many private treatment centers are reluctant to accept mandated patients, believing that effective rehabilitation relies on voluntary participation and preferring not to work with individuals who are unwilling.
Massachusetts is one of the few states that actively funds its involuntary commitment law, known as Section 35, which was enacted in 1970 and has undergone frequent amendments. The state has agreements with eight facilities to treat individuals committed under Section 35, including a secure center for adult men managed by the state’s Department of Correction. Following a formal commission’s investigation into Section 35 procedures in 2019, the Legislature announced in 2023 that this practice would be phased out by the end of 2026, contingent on the availability of sufficient alternative treatment beds.
Who Bears the Cost?
Residential rehabilitation is notoriously expensive. To prevent families from using civil commitment as a loophole for free treatment, many states stipulate that the petitioner or the patient themselves must cover the costs. Without private insurance, Medicaid typically becomes the primary payer.
Given the Trump administration’s proposed Medicaid cuts, which are expected to significantly raise the eligibility criteria for drug treatment, funding involuntary commitment placements could become an overwhelming financial burden.
The Historical Roots of Involuntary Substance Abuse Laws
The origins of these laws trace back over two centuries. Dr. Paul S. Appelbaum, a psychiatrist and expert on civil commitment, notes that in 19th-century America, alcohol consumption was high and pervasive. Debates between temperance movements and medical societies over whether alcoholism was a disease or a moral failing laid the groundwork for today’s discussions on substance use disorders.
Initially, the medical perspective held sway. By the late 1800s, states began establishing commitment procedures for institutions like New York State’s “inebriate asylums.” However, the temperance movement eventually gained momentum, culminating in the Prohibition era.
A significant development occurred in 1935 with the establishment of the Narcotic Farm in Lexington, Kentucky. This facility served as both a treatment and research center for individuals frequently sent there under federal criminal and civil statutes.
The 1970s saw a rise in the use of heroin, marijuana, and psychedelics, coinciding with the launch of the federal “War on Drugs.” During this period, states began introducing civil commitment laws, which were further expanded in the 1990s and continue to be updated amid the ongoing overdose crisis.
Currently, New York State does not have such laws, though New York City’s Mayor Eric Adams recently urged the state to enact similar legislation.
The Deep-Rooted Controversies Surrounding These Laws
Civil commitment laws are inherently contentious. They essentially allow the state to take custody of individuals who haven’t committed a crime, sometimes involving physical restraint, and force them into rehabilitation. Should these individuals leave the facility, arrest warrants can be issued.
Critics consistently question the fundamental purpose of these laws. Are they truly beneficial for individuals unwilling or unable to stop substance use? Or do they primarily serve to offer relief to families struggling with a loved one’s unstable condition and restore public order?
Theoretically, the answer is both. The state is seen as having a “parent-like” obligation to care for those unable to care for themselves, while also holding a duty to protect the broader public.
However, a societal split emerges when comparing mental illness, widely accepted as a medical issue, with addiction. There’s an ongoing debate: is addiction also a disease, or primarily a matter of personal choice?
This ambivalence is reflected in the laws themselves. According to the 2024 LAPPA compilation, fifteen states will not involuntarily commit an individual for substance addiction unless they also have a co-occurring mental illness.
Dr. Appelbaum emphasizes that addiction, encompassing both biological and behavioral components, defies simple classification. While involuntary commitment can indeed halt a self-destructive cycle, he points out that current laws aren’t designed to effectively manage a chronic, relapsing disease.
“Simply passing a law doesn’t automatically establish a functional system,” states Dr. Appelbaum. “Addiction treatment is complex and requires sustained effort. It’s not an issue that can be resolved in a mere 30 days.”