coerced drug treatment in the criminal justice system

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Criminology and Criminal

DOI: 10.1177/17488958070788672007; 7; 269Criminology and Criminal Justice

Toby Seddonethical and criminological issues

Coerced drug treatment in the criminal justice system: Conceptual,

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Criminology & Criminal Justice

2007 SAGE Publications

(Los Angeles, London, New Delhi and Singapore)

and the British Society of Criminology.

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ISSN 17488958; Vol: 7(3): 269286DOI: 10.1177/1748895807078867

269

Coerced drug treatment in the criminaljustice system:Conceptual, ethical and criminological issues

TOBY SEDDON

University of Manchester, UK

Abstract

A striking phenomenon in many western countries is the increasing

use of the criminal justice system as a means of channelling and

coercing drug users into treatment. Despite somewhat equivocal

research evidence about its effectiveness, this approach hascontinued to expand, including in Britain. This article takes a step

back and explores some of the critical background issues that have

been largely overlooked to date. Some conceptual, ethical and

criminological aspects of coerced treatment in the criminal justice

system are considered. It is argued that coerced treatment is a

central issue for both contemporary criminology and criminal justice

policy.

Key Wordscoerced treatment criminal justice drugs drug treatment

ethics

Introduction

One of the articles of faith of many drug workers in this country is that prob-

lem users cannot be coerced into treatment.

(Hough, 1996: 36)

In Britain, this was no doubt true in 1996 but there has been a sea changein attitudes over the last decade. Starting with the introduction of the Drug

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Treatment and Testing Order (DTTO) pilots in 1998 (Turnbull et al., 2000)and most recently with the Tough Choices initiative, coerced treatment hasbecome a key part of British drug policy and practice (Hunt and Stevens,2004). This development has occurred in the context of a broader policy

shift which since 1998 has focused on a major expansion of services withinthe criminal justice system using every opportunity from arrest, to court, tosentence, to get drug-misusing offenders into treatment (Home Office,2002: 4). Coercive approaches that utilize the leverage of the criminal just-ice system are thus part of a wider programme of voluntary referral fromall stages of the system.

Although coerced treatment is a relatively new departure in Britain,1 somecountries have a much longer experience of using criminal justice leverage inthis way. The most obvious example is the United States, where the idea canbe traced back to the narcotic farms of the 1920s right through to theCalifornia Civil Addict Program in the 1960s (Anglin, 1988), but other coun-tries have been following this route for several decades, notably Australia andseveral European countries (Webster, 1986; Stevens, 2004).

The rationale for the policy of coerced treatment, certainly in its con-temporary British form, is based on three foundational principles:

1. that there is a strong causal connection between drug addiction and acquisi-

tive crime;

2. that treatment is effective in reducing this drug-related crime;

3. that coerced treatment is effective.The strength of the evidence base for these three principles varies. PrincipleOne has been the subject of a long-running and unresolved debate. While theassociation between certain types of drug use and involvement in propertycrime is indisputable, the causal nature of this relationship is far from clear(see Seddon, 2000) and the concept of addiction on which it rests is prob-lematic and contested (e.g. Grapendaal et al., 1995). Evidence for PrincipleTwo is much stronger. In the British context, the National Treatment Out-come Research Study has indicated that treatment can contribute towards

substantial reductions in offending for some individuals (Gossop et al., 2001,2005, 2006). On the other hand, there is limited British evidence in supportof Principle Three, the main substantive contribution currently being therecent report by McSweeney and colleagues (2006). Reviews of the inter-national research reveal a wide range of outcomes for coerced treatment, withsome studies suggesting coerced clients do no worse than those entering treat-ment voluntarily and that legal pressure can aid treatment retention but withothers showing negative effects (Klag et al., 2005; Stevens et al., 2005b).

The aim of this article, however, is not to revisit the evidence base for

these three principles. Rather, it seeks to consider some of the critical con-ceptual and theoretical issues underpinning coerced treatment. The first sec-tion examines some of the basic conceptual building blocks in this area,looking specifically at the idea of coercion itself and the related concept ofmotivation, as well as the notion of treatment as it is used in this context.In the second section, some of the ethical issues posed by coerced treatment

270 Criminology & Criminal Justice 7(3)



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are considered. The third section discusses some important criminologicalaspects of the issue. Although the article has a particular focus on theBritish context, it has a wider relevance. It not only draws on internationalresearch but also concentrates on the analysis of general issues and prin-

ciples relating to coerced treatment that have a transnational applicability.

Conceptual issues

The idea of coerced treatment obviously involves two central concepts, coer-cion and treatment, and these will both be examined here. Looking first atcoercion, a basic definition provides a useful starting point: Coerce (verb)Persuade (an unwilling person) to do something by using force or threats(source: Compact Oxford English Dictionary). Following this definition, theidea of coercion breaks down into three component parts:

1. persuading someone to do something

2. which they are unwilling to do

3. by using force or threats.

The first component, persuasion, implies a process of convincing or encour-aging someone to undertake a particular course of action by making whatmight be termed a sales pitch, setting out the benefits of following that courseand/or the dangers of not doing so. Central to this, therefore, is the commu-

nication of information to targeted individuals about the options on offer andtheir relative merits. In other words, we can say that coercion must include aninformative or communicative element. Reference to options is a reminderthat coerced individuals still retain a choice, however constrained. This marksthe distinction between coerced and compulsory treatment, as the latter doesnot involve or require consent. The discussion in this article focuses on coercedtreatment, although it is worth noting that arrangements for compulsoryplacement in drug treatment do exist in some countries (Stevens et al., 2005a:207). The idea of (constrained) choice, which underpins coercion, has some

further significant implications and will be returned to later in this article.The second component, that the person is unwilling, raises some import-

ant points. Research has found that not all those who are legally mandatedinto treatment are unwilling entrants (Farabee et al., 2002; Longshore et al.,2004: 11213). Nor do they all lack interest in treatment or feel that they donot need it (Hiller et al., 2002). The mere fact that legal pressure is applied todirect a person into treatment does not in itself necessarily mean that theywere actually coerced into it in the sense of being forced against their will. AsLongshore et al. (2004: 113) observe, a blanket assumption that individuals

referred through criminal justice routes are under greater coercion than thosewho are not would be mistaken and unfounded. Willingness or desire to par-ticipate in treatment cannot be simply or directly inferred from the referralroute (Stevens et al., 2006) and equating coercion with criminal justice referralis misleading (Wild, 1999, 2006). This is a major conceptual weakness inmuch of the research literature to date (Wild et al., 2002; Wild, 2006: 43).

SeddonCoerced drug treatment 271



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The third component, that of using force or threats, again raises a signifi-cant issue. The alternative to entering treatment needs to be perceived, inrelative terms, to be less beneficial or less pleasant for there to be a threat.To give a British example, the Drug Treatment and Testing Order (DTTO)2

was intended as a community-based alternative to imprisonment, with theexpectation that those offenders who refused or failed to comply with theorder would end up in custody. This has been described by some critics ofcoerced treatment as illustrating how the apparent requirement for offend-ers to consent to this type of intervention is in fact a sham. What kind ofinformed consent can offenders realistically give if the alternative is prison?Yet the fact that within these kinds of initiatives, drug treatment typicallyrepresents for many offenders an offer they cannot refuse, to use MikeHoughs (1996: 36) phrase, is of course intrinsic to the whole concept ofcoercion. It is not a regrettable indicator that coercion has gone too far,rather it is its hallmark. The whole point is to try and shift the costbenefitratios of the different options so that treatment is clearly and obviously thepreferential choice for as many individuals as possible.

These three elements then are the core components of the idea of coer-cion in this context. Typically coerced treatment is defined in contrast withvoluntary treatment, implying that there is a binary distinction betweenthe twoeither an individual freely enters into drug treatment or else theyare coerced into it. As already indicated, conceptually this is a rather crudeand simplistic way of describing the decision-making processes of drug

users about treatment entry. A number of studies have found that coercionis most usefully conceptualized as a continuum rather than as a dichoto-mous variable (Anglin et al., 1989; Anglin and Hser, 1990; Farabee et al.,1998; Hiller et al., 1998; Longshore et al., 2004: 11112).

A key article by Marlowe and colleagues (1996) established two centralpoints. First, they demonstrated that coercive pressures at drug treatmententry were operative in multiple life spheres (1996: 82). In other words,coercion is a multi-dimensional concept, with coercive pressures emanatingfrom diverse sources, including family and financial concerns as well as the

criminal justice system (Polcin and Weisner, 1999; Marlowe et al., 2001;Polcin, 2001: 5945; Longshore et al., 2004: 112). As Bean puts it:

In a different form [coercion] occurs also outside the criminal justice system,

for rarely do offenders enter treatment free of all forms of coercion, whether

from friends, relatives or others. To talk, therefore, of coercion and com-

pare this unfavourably with voluntary decisions to enter treatment is to be

too optimistic about the nature of many drug users lives.

(2004: 229)

Second, and most interestingly, Marlowe and colleagues went on to showthat legal pressures may exert substantially less influence over drug treatmententry than do informal, extra-legal influences (1996: 81). Research subjectsperceived treatment-entry pressures as stemming predominantly from psy-chological, financial, social, familial, and medical domains respectively




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(1996: 81). Again, for many people it may be false to assume that the appli-cation of criminal justice leverage dramatically increases the level of coercionthey feel to enter treatment. This leads on to another important point.Coercion is an inherently subjective concept because it is the perception of

persuasion by threat that influences behaviour and not the level of threat thatobjectively exists (Wild et al., 1998; Polcin, 2001: 5945; Young, 2002;Longshore et al., 2004: 11213). This has obvious research implications forthe measurement of coercion.

This subjective dimension to coercion (external pressure) suggests import-antly a close link with the concept of motivation (internal pressure). In thedrugs field, there are a number of models of motivation for change, perhapsthe best known of which is Prochaska and DiClementes (1986) cycle ofchange, which suggests that individuals progress through a series of stages asthey change their addictive behaviour. Despite its strong research and clinicalinfluence, the cycle of change has been heavily criticized in recent years(Sutton, 2001; Davidson, 2002) and increasingly distinctions are drawnbetween motivation to enter treatment and motivation to engage in treatment(Drieschner et al., 2004; see also Longshore and Teruya, 2006). Nevertheless,however it is conceptualized, motivation is widely viewed as a critical factorin treatment participation, retention and success (Hiller et al., 2002).

It has been argued that coerced treatment is doomed to failure preciselybecause individuals do not have this internal motivation. As we have alreadyseen though, the assumption that all individuals referred through criminal

justice routes lack any interest in or desire for treatment is a false one(Farabee et al., 2002; Hiller et al., 2002) and, as Hough (2002: 991) sug-gests, in reality many voluntary treatment entrants begin their treatmentengagement with a degree of ambivalence (Klag et al., 2005: 1781). The crit-ical question then is how we can conceptualize and understand the relation-ship between external pressure (coercion) and internal pressure (motivation).It has been suggested that legal coercion may increase readiness for treat-ment (Gregoire and Burke, 2004; cf. Stevens et al., 2006), while others haveargued the contrary. Both viewpoints imply that internal and external pres-

sures are not entirely separate or independent domains. Rather, there is aninteractive relationship between them. There is some evidence that this inter-action may have a significant impact in some circumstances. Several studieshave found that the combination of strong external pressures and stronginternal motivation can lead to better treatment outcomes than those pro-duced by either factor on their own (Simpson and Joe, 1993; de Leon et al.,1994; Longshore et al., 2004: 11516). Longshore and colleagues hypothe-size that: External and internal motives may jointly affect treatment successwhen external pressure is internalised or transformed by the person into

an internal motive (2004: 11516). Some recent contributions to the litera-ture (Longshore and Teruya, 2006; Stevens et al., 2006; Wild, 2006) arguethat unravelling these complex interactions between legal pressure, otherexternal pressures, perceptions of coercion and internal motivation is vitalfor more conceptually robust research on coerced treatment.




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Turning from coercion to the second central concept, treatment, this ison the face of it easier to define. In the British context, the National Treat-ment Agency (NTA) has produced the following definition:

[Drug treatment] describes a range of interventions which are intended to

remedy an identified drug-related problem or condition relating to a personsphysical, psychological or social (including legal) well-being. Structured drug

treatment follows assessment and is delivered according to a care plan, with

clear goals, which is regularly reviewed with the client. It may comprise a

number of concurrent or sequential treatment interventions.

(NTA, 2002: 2)

Other definitions broadly speaking offer variations on this theme. The crit-ical issue here concerns the objectives of treatment interventions. This isimportant as there is a significant debate about whether viewing drug treat-ment through a criminal justice lens has distorted service provision.3 It is clearfrom the NTAs definition, and other similar ones, that the social domain isonly one of three drug-related problem areas that treatment may seek toaddress. Within that domain, criminal activity and coming into contact withthe criminal justice system represent only one set of problems. In this sense,the level of priority given to crime reduction as an objective of coerced treat-ment in its own right (as opposed to a useful by-product) may actually shiftin a fundamental way what is meant by the term treatment. This is not sim-ply a semantic point. The prioritization of crime reduction might result in a

preference for particular treatment modalities that might differ from thosethat would be suggested were physical or psychological well-being the pri-mary treatment goals. It could be hypothesized, for example, that withincoerced treatment there might be a greater emphasis on methadone prescrib-ing, given its perceived effectiveness as a tool for reducing offending by heroinusers (Gossop et al., 2001). Certainly, the recent British experience has beenthat in some local areas rapid prescribing has been seen as a way of makingcoerced treatment more attractive to users, a strategy which may be in sometension with a more careful and clinically driven approach to prescribing.

Clearly, the concept of coerced treatment is more complex than it mightfirst appear. A failure to grasp this has significantly impeded the accuratemeasurement of the effects of coercion into treatment on treatment processand outcome variables (Klag et al., 2005: 1783). As a consequence the evi-dence base is actually much weaker than might be suggested by the numberof studies in this area. A more conceptually sophisticated approach is essen-tial both for future research and future policy development.

Ethical issues

The ethics of coerced drug treatment is a matter of much debate and raisessome fundamental questions. There are several inter-linked issues concerningjustice and human rights that will be explored here.




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In the previous section, it was suggested that the significance of legal coer-cion tends to be over-stated, given that drug users generally make decisionsabout treatment under the influence of pressures from a range of sources.However, Stevens and colleagues make the point that the coercive pressure

exerted by the State on individuals has a distinctive character, as the State hasagencies to deal with those who try to avoid it (2005a: 207). The questionthen is on what moral basis this pressure is placed on drug-using offenders.Two answers are often given: first, on the grounds of benevolence (its goodfor them); second, on the basis of the crime prevention benefits to commu-nities that may result from effective treatment (its good for us).4

Neither answer is persuasive. The first is difficult to sustain as people inliberal societies are not usually under any obligation to do what is good forthem. Individuals generally have a right to pursue unhealthy lifestyles ifthey so wish and are not obliged to seek help to alleviate any afflictionsfrom which they may suffer. Indeed, the right to refuse treatment has beenheld to come within the ambit of Article 8 of the European Convention onHuman Rights (Havers and Neenan, 2002; cf. Caplan, 2006). The secondanswer raises arguments that have some echoes of older debates about theethics of rehabilitation in the penal system. Norval Morris (1974) arguedover 30 years ago that the use of imprisonment for the sole or primary pur-pose of rehabilitation was incompatible with justice. The core of the ethicaldifficulty identified by Morris is the problem of treating individuals only asmeans and not as ends, an argument that draws on Kantian moral philoso-

phy. If every individual is seen to have an intrinsic value, then his or herrights should not be sacrificed solely in order to protect others. From thisperspective, the justification of coerced treatment on crime preventiongrounds is highly problematic in ethical terms.

A different moral basis for the use of coercion has been suggested byGostin (1991) who argues that it can be ethical provided that it, first,restricts the liberty of the recipient no more than the alternative disposalalready justified by the offence, second, is consistent with due legal process(see also Porter et al., 1986) and, third, is targeted at those most in need of

and susceptible to treatment. Against this yardstick, current practice inBritain raises some difficulties. Individuals who refuse or fail to complywith treatment may indeed end up with a harsher punishment than theywould have received on the basis of their original offence. For example,under recent provisions in the Drugs Act 2005, a person who is arrestedand subsequently released without charge but who tested positive for opi-ates or cocaine at the police station might receive up to three months inprison should they fail to attend their required drug assessment. In otherwords, an individual could be wrongly arrested and later released but still

end up facing charges and possible imprisonment simply for not turning upfor an assessment at a drugs service.

Concerns of this kind recall aspects of the critique of rehabilitation in the1970s which argued that in practice it had often turned out to be harsh andexcessive, prolonging interventions beyond what a purely punitive system




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would have required (von Hirsch, 1976; Allen, 1981; Cohen, 1985). Theyrelate too, albeit less directly, to the more polemical arguments of ThomasSzasz (1963) and others about the rise of the Therapeutic State in which themedical role or label is used to cloak what is in fact a moral and political

enterprise of social control. In this vein, Fischer argues that Drug TreatmentCourts in North America, with their symbolism of health and treatment,obscure the fact that punishment is the persistent and predominant modeof addiction control (2003: 244).

However, some of these criticisms may be seen as misplaced or overblown.Coerced drug treatment involves a constrained choice rather than actual com-pulsion. The rights of individuals are therefore not subordinated to those ofothers as they are able to choose whether or not to enter treatment. Indeed,British policy-makers have been at pains to emphasize the idea of choicerather than coercion. The latest initiative is called Tough Choices and thelanguage of coercion appears to have entirely disappeared from the mostrecent guidance documents that have been issued.

The validity of this argument hinges on whether individuals targeted forlegal coercion are genuinely able to give proper informed consent to treat-ment. Is the appearance of choice in fact an illusion? Is consent in effectgiven under duress? These questions are ultimately only answerable empir-ically. There is little research evidence directly on this point but Stevens andcolleagues (2005a: 208) suggest that in their experience coerced drug userstend to view the offer made to them as a genuine choice and opportunity

rather than as an imposition. Nevertheless, attempting to get informed con-sent from potentially vulnerable individuals in a highly stressful environment(typically in the police station or at court) risks being ethically problematic.5

The requirement for genuine and informed patient consent is firmly estab-lished in medical law and ethics (Herring, 2006). The question of consentthus raises issues of professional ethics for health workers. As Bateman(2001) argues, nurses and other health professionals are bound by codes ofethics which enshrine their duty to act in the interests of individual patientsat all times. If a drug user is coerced into treatment and their consent is not

genuine, should the health professional decline to treat them? A furtherrelated issue is the question of patient confidentiality and the sharing ofinformation between drug agencies and the criminal justice system. In orderto monitor compliance with coerced treatment, criminal justice agenciesrequire information about whether offenders are attending and engagingwith treatment. Barton has explored this area in a series of articles (Barton,1999a, 1999b; Barton and Quinn, 2002). He notes that the practice of con-fidentiality within mainstream health care is complex and ambiguous. In thecriminal justice context, he suggests that for information sharing there is a

fundamental tension between practice driven by the needs of individuals andpractice guided by the demands of the risk management of groups con-sidered to be high-risk offenders (Barton and Quinn, 2002). In otherwords, for drug treatment provision, the crime reduction agenda may distortthe exercise of professional discretion concerning patient confidentiality.




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A final set of ethical issues concerns the equity of access to treatment ser-vices. The core concern is whether coerced treatment involves offenders jump-ing the treatment queue ahead of non-offenders and, if it does, how can thisbe justified? Finch and colleagues (2003) describe how the provision of

DTTOs in one area created what they considered to be unacceptable inequal-ities in access to treatment. This of course can only happen where there is alocal shortfall of capacity in the treatment system relative to demand. Yet, inthe British context at least, it is arguable that the criminal justice agenda hasactually levered in additional funding which has improved access to treat-ment both for offenders and non-offenders. A slightly more nuanced argu-ment is that coerced treatment distorts how priorities for treatment access aredetermined. Barton (1999a), for example, reports how in one area womencame to be squeezed out of treatment because they were not high prioritiesfrom a criminal justice perspective. Rush and Wild (2003), reporting onCanadian research, suggest that the operation of a coerced treatment pro-gramme in Ontario was disproportionately drawing young males into thetreatment system and that this raised the issue of equity of access. Again, it ispossible to see the potential distorting impact of drug treatment being viewedthrough the criminal justice lens.

In summary, there are a number of ethical concerns about coerced drugtreatment. It is clear that there are some significant and serious issues of just-ice and human rights at stake which merit further debate. A theme runningthrough the discussion here has been that many of the ethical questions relate

to the ways in which the use of coercion and the criminal justice agenda candistort the principles and practice of drug treatment.

Criminological issues

Coerced treatment for drug users in contact with the criminal justice systemraises a number of significant criminological issues, which will be explored inthis section. The concept obviously resonates strongly with rational choice

theory (Cornish and Clarke, 1986), one of the new criminologies of every-day life that have become so influential over the last 25 years in providinga new way of thinking about crime and social order in late modernity(Garland, 2001). It is an underpinning assumption that drug-using offenderswill weigh up the costs and benefits of accepting treatment and make arational decision. The coercion or leverage provided by the criminal justicesystem is intended to alter the costbenefit ratio in favour of treatment. Theindividual offender is thus conceived as a rational calculator making choicesin order to maximize benefits and minimize costs (Frisher and Beckett, 2006).

However, there is a real paradox in the reliance on rational choice the-ory in relation to coerced drug treatment. The interventions are predicatedon the targeted individuals acting as rational calculators, yet at the sametime those individuals are viewed as addicted consumers who are con-sidered to lack the capacity to exercise properly their freedom to choose




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(Reith, 2004). In empirical terms, this notion of addictive consumption,which is a key part of the rationale for coerced treatment, has been chal-lenged by several studies (e.g. Grapendaal et al., 1995). At a more theor-etical level, recent work by Pat OMalley and others (OMalley, 1999,

2002, 2004: 15571; Gomart, 2002; OMalley and Valverde, 2004; Reith,2004) has shown how these paradoxical problems of freedom are actuallyquite central to understanding contemporary modes of governing the conductof drug users. It is this dialectic between addiction and freedom whichunderpins changing representations of drug users and changing responses totheir behaviour.

The idea of freedom has become a central theme more broadly withinstudies of contemporary politics and government (Rose, 1999; OMalley,2004). Nikolas Rose (1999), for example, has argued that within neo-liberalgovernmental strategies, we are increasingly governed through freedom. Heobserves that: The programmatic and strategic deployment of coercion has been reshaped upon the ground of freedom, so that particular kinds ofjustification have to be provided for such practices (1999: 10). He goes onto argue that these justifications include:

The argument that the constraint of the few is a condition for the freedom of

the many, that limited coercion is necessary to shape or reform pathological

individuals so that they are willing and able to accept the rights and respon-

sibilities of freedom, or that coercion is required to eliminate dependency and

enforce the autonomy of the will that is the necessary counterpart of freedom.(1999: 10)

From this perspective, coerced drug treatment can clearly be seen as a strat-egy that is constructed on the ground of freedom. This should not be mis-taken as meaning that we have entered the sunny uplands of liberty andhuman rights, as Rose (1999: 10) nicely puts it, but rather that certain valuesand ideas given the name freedom have come to provide the grounds onwhich governmental power is exercised. This leads to an important point.Coerced treatment is based on a very particular formulation of freedom in

which the drug user is imagined as a choice-maker (OMalley, 2004:1613) and furthermore one who is obligedto choose. It is here that theapparent paradox of freedom described aboveaddicts with attenuatedfree will are at the same time expected to act as rational calculatorsisresolved. Within coerced treatment initiatives drug users are not required toexercise their full and sovereign free will, they are simply obliged to make achoice from a highly constrained set of options (typically, prison or treat-ment). Hence, OMalley (2004: 169) argues that choice displaces free willin this formulation of freedom. The idea of Tough Choices, the name for

the latest British drug-crime initiative, is particularly apt in this respect.Another, and related, feature of neo-liberal government is its distinctive

focus on risk and risk management. Indeed, the concept of risk has becomea central motif across the social sciences over the last 15 years (Beck, 1992;Douglas, 1992; Hope and Sparks, 2000; Garland, 2003; OMalley, 2004)




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and understanding the nature of risk management practices has beendescribed as one of the central theoretical problems for contemporary crim-inological enquiry (Sparks, 1997: 432). Sparks notes that there is an intrin-sic connection between the notions of rational choice and of risk (1997:

424), or, as OMalley puts it, they are compatible and complementary terms(2004: 169). The costbenefit calculations undertaken by rational actors areabout maximizing benefits and minimizing risks. However, in respect ofdrug-using offenders, the animating idea of coerced treatment is that theythemselves are particular sources of risk to others, a form of risk that hasbeen termed actuarial (Feeley and Simon, 1994; OMalley, 2004: 22). In thissense, coerced treatment can be viewed as a technology for the identificationand management of the actuarial risk of drug-driven crime. Its rise toprominence in recent years can therefore be understood as part of the widerrise of risk (Garland, 2003) within neo-liberalism.

Within the risk management technology of coerced treatment, drug testingserves a critical function and has been described as a necessary prerequisitefor criminal justice treatment (Carver, 2004). It is frequently used in the ini-tial identification of high-risk offenders, the tests providing data in a flowof information for assessing risk (Feeley and Simon, 1994: 179). For ex-ample, in the British context, testing of arrestees takes place in police cus-tody suites (Deaton, 2004), identifying individuals who may subsequentlybe targeted for drug treatment as they progress through the criminal justiceprocess.6 Once individuals have been channelled into treatment, testing can

also provide a means of monitoring and enforcing compliance, providingthe material basis for surveillance (Simon, 1993: 187) which, as Ericsonnotes, is a key component of the administration of risk:

Surveillance is the production of knowledge about (monitoring), and super-

vision of (compliance), subject populations. Knowledge production and

supervision are mutually reinforcing, and together they create surveillance as

a system of rule Surveillance is THE vehicle of risk management.

(1994: 161, capitals in original)

In contrast to Becks (1992) influential thesis, David Garland (2003) hassuggested that the core issue in todays risk society is not about moderntechnology and its unwanted side-effects but rather concerns choices aboutlife-style and consumption. He argues that these kinds of choices and someof their associated risk technologies have a particular resonance within con-temporary consumer capitalism: [Criminological] accounts that highlightrational choice and the responsiveness of offenders to rewards and disincen-tives chime with the individualistic culture of our consumer culture(Garland, 2001: 198). In these terms, the management of the risks associated

with the consumption of illegal drugs and involvement in drug subculturesobviously goes to the heart of the matter. Coerced treatment, in particular, isarchetypal of contemporary risk management practices in three senses. First,it involves managing the risks posed by a particular form of disordered con-sumption (Reith, 2004) and its related life-style. Second, it utilizes the notion




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of choice and the responsiveness of drug-using offenders to rewards and dis-incentives in order to manage risks. Third, it deploys surveillance, typicallyvia the use of drug testing, as a key tool for this risk management.

The attempted coercion or channelling of drug-using offenders into drug

treatment is a form of what Nikolas Rose describes as the government ofconduct within circuits of inclusion (2000: 187). These circuits are associ-ated with a criminology of the self, that characterizes offenders as normal,rational consumers, just like us (Garland, 2001: 137, emphasis in original).For those individuals who cannot be accommodated in this way, they aregoverned within circuits of exclusion (Rose, 2000: 187) linked to a crim-inology of the other, of the threatening outcast, the fearsome stranger, theexcluded and the embittered (Garland, 2001: 137, emphasis in original).For coerced drug treatment in the criminal justice system, these exclusionarycircuits predominantly involve the use of imprisonment. Those individualswho reject the offer of treatment will often face prison. Similarly, and inpractice much more commonly, those who accept treatment but subse-quently find themselves unwilling or unable to comply with its requirementsmay be incarcerated. Coerced treatment thus fits with the more general pat-tern of control practices within neo-liberal government.

Summarizing, the area of coerced treatment intersects with some majorthemes in criminology today. In particular, it feeds into important debatesabout the distinctive place of risk in late modern society. It is also closelylinked with the new styles of criminological thinking that have emerged

over the last couple of decades and which are associated with contemporarystrategies for crime control. It thus represents an important site for theengagement with these highly significant areas of criminological debate.

Conclusions

This article has suggested that to frame the debate about coerced drug treat-ment simply in terms of whether it works is premature and misleading.

The conceptual confusions that have characterized much of the research todate rule out any possibility of definitive declarations about effectiveness.One contribution of the article is to indicate some of the conceptual build-ing blocks that might underpin the future development of a much morecoherent and useful evidence base.

Entering into the effectiveness debate is arguably premature in anothersense too. There are profound ethical issues raised by coerced treatment thatdo not appear to have been fully examined yet. Some commentators havedirectly linked the question of ethics with that of effectiveness, arguing that

coerced treatment is only ethically justifiable if it achieves positive outcomes(Gostin, 1991). However, this begs some questions. The whole moral basisfor the approach is far from clear and there are concerns about potentialconflicts with principles of justice in its practical application. Perhaps even




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more significant are the issues of consent and confidentiality. It is the case,in the British context at least, that much of the drug treatment provision intowhich individuals are coerced is part of the National Health Service. Itshould be a matter of disquiet at the very least that the principles of patient

consent and confidentiality may operate to a different standard when patientsare coerced into health services by the criminal justice system.Finally, it has been argued that the issue of coerced treatment throws some

interesting light on some of the big questions of criminological thought andshould therefore be seen as a central issue for contemporary criminology.Notably, it goes to the heart of debates about the distinctive place of notionsof risk and freedom within crime control practices at the beginning of the21st century, debates which are at the forefront of criminological enquirytoday (Loader and Sparks, 2002). Coerced drug treatment in the criminaljustice system should be of interest to a much broader set of constituenciesthan the drug specialists who have occupied the area up to now.

Notes

An earlier version of this article was presented at a seminar at the Universityof Leeds in March 2005. Thanks to participants for their feedback. Thanksalso to Christiane Allard, Phil Hodgson, Douglas Marlowe, Alex Stevensand anonymous reviewers for this journal for helpful comments on an earl-

ier version. The usual disclaimer applies.1 As Berridge (1996: 303) notes, there had in fact been discussions in Britain

at the turn of the 20th century about the possibility of compulsory treat-ment for drug addicts under the inebriates legislation. While this did notmaterialize, it illustrates that in the British context the idea of coercedtreatment is not completely new, even if thepractice is relatively novel.

2 The DTTO was replaced in April 2005 by the Drug Rehabilitation Re-quirement (DRR) which involves a similar programme of drug testing andtreatment.

3 There is a parallel here with the wider community safety literature in which ithas been argued that the pre-eminence of the law and order agenda may bedistorting the provision of mainstream public services (Crawford, 2002: 233).

4 Thanks to Alex Stevens for suggesting this way of summarizing the twopositions.

5 In a recent research project in which the author was involved, a court-based drugs worker gave an example of the type of situation sometimespresented in practice: Youre assessing somebody whos literally holdingthe wastepaper basket in front of them, heaving into it [] And then yousay Id just like you to sign these forms [] and they will sign anything.

6 Empirical studies cast doubt on the idea that the risks of offending associ-ated with drug use constitute an objective or fixed risk that can be measuredand managed by drug testing and treatment (e.g. Grapendaal et al., 1995;on testing, see Seddon, 2005: 16).




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