From Science Direct – International Journal of Drug Policy – by Daniel O’Brien read the full article
Abstract
Background
In Canada, involuntary stabilization programs are used to apprehend and confine youth who use drugs for the purpose of stabilization, assessment, and discharge planning. In the Canadian province of Alberta, the Protection of Children Using Drugs (PChAD) act allows parents to apply for involuntary stabilization of their children for up to 15 days. Given that research on involuntary stabilization programs is scarce, this qualitative study was designed to explore parents’ experiences with PChAD and their perceptions of the program’s benefits and drawbacks.
Methods
We conducted semi-structured interviews with 18 parents who had used PChAD for their children between 2007-2018. Interviews were conducted between 2019-2020 and were analyzed inductively using Interpretive Phenomenological Analysis.
Results
Most parents sought involuntary stabilization because they were desperate to protect their child’s health and safety, or to motivate them to reduce their substance use. Many also felt lost and overwhelmed because their child was unwilling to attend voluntary treatment, and they lacked professional guidance as to how to care for their child. Consequently, many parents used involuntary stabilization because they did not know what else to do. While some parents were grateful to have their child temporarily safe, many were disappointed because involuntary stabilization had little impact on their child’s substance use. Parents also felt they did not receive sufficient support in coordinating their child’s care following involuntary stabilization. Parents identified several risks of involuntary stabilization, such as angering the youth and undermining trust, and exposing them to negative peer influences.
Implications
It is important for policymakers and clinicians to carefully consider whether the immediate benefits of keeping youth safe are worth the potential risks. Efforts are needed to provide families with greater guidance and support, and to ensure coordinated access to a continuum of voluntary services, including treatment and harm reduction.
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Section snippets
Background
Compulsory commitment to care is used in many jurisdictions to address the harms of substance use (Vo et al., 2021; Werb et al., 2016). Compulsory commitment refers to any legal mechanism whereby individuals who use substances are not given any legal choice to avoid or leave treatment, as they are mandated by law to treatment or care (Israelsson & Gerdner, 2012). Compulsory commitment is different from “quasi-compulsory” models, in which individuals who are charged with a drug-related crime may
Local context
In Alberta, the PChAD program allows for the apprehension and involuntary care of youth under 18 years whose substance use has resulted in “significant physical, psychological, or social harm to themselves, or physical harm to others, and who are refusing voluntary addiction treatment services” (Alberta Health Services, 2021). Youth may be confined for up to 10 days in a protective safe house, with the possibility of a 5-day extension (Alberta Health Services, 2021). The application process
Study design
Interpretive Phenomenological Analysis (IPA) was chosen as the research methodology (Smith et al., 2009). IPA is an approach to qualitative inquiry that aims to produce rich, empathic descriptions of what an experience is like based on participants descriptions of their lived experience (Smith et al., 2009). At the same time, IPA studies are explicitly interpretive, such that the researcher is presumed to take an active role is conceptualizing how participants construct meaning about their
Reflexivity
For the reader, it may be helpful to know that the authors embrace a harm reduction philosophy to substance use, in which individual self-determination is prioritized. Accordingly, the authors are generally critical of involuntary approaches to substance use treatment. The goal of this research was to understand the experiences of parents, and a non-judgmental and empathic stance was adopted during interviews, which we believe helped parents speak openly about their reasons for using
Parents desperate to help youth
Most parents used PChAD because they were desperate to protect their child’s safety and well-being. The most immediate concern was to protect their child from overdose. However, many parents also wanted to protect their child from other risks, including unhealthy peer relationships, violence, sexual exploitation, or being exploited into drug dealing. Some parents were unaware of their child’s whereabouts for long periods of time, or were concerned their child was spending time in unsafe
Discussion
Although this study focussed on an involuntary stabilization program in Alberta, Canada, it has broader implications for understanding compulsory commitment for youth who use drugs. Compulsory commitment exists in many jurisdictions, yet is often criticized for being overly punitive, having low effectiveness, overriding personal autonomy, and for not providing evidence-based interventions (Chau et al., 2021; Goodyear et al., 2021; Jain et al., 2018; Pilarinos et al., 2018; Werb et al., 2016).
Limitations
By providing a detailed description of parents’ experiences with involuntary stabilization, this study helps illuminate the potential benefits and drawbacks of these programs. This addresses an important knowledge gap, as little is known about how involuntary stabilization programs may or may not meet the needs of families. Nevertheless, this study has several limitations to consider. One limitation is that youth experiences with involuntary stabilization were not explored. Consulting youth is
Conclusions
Parents identified that the main benefit of involuntary stabilization was to keep youth safe temporarily. However, many were disappointed that involuntary stabilization did not have a more lasting impact. Parents also perceived several drawbacks of involuntary stabilization, such as damaging the parent-child relationship and exposing youth to negative peer influences. Considering these risks, it is important for clinicians to work with parents to consider whether use of involuntary
Ethics approval
The authors declare that they have obtained ethics approval from an appropriately constituted ethics committee/institutional review board where the research entailed animal or human participation.
University of Alberta research ethics board (No. Pro00100551).
Funding sources
Daniel O’Brien received a graduate student scholarship to conduct this research as a part of his Master of Education degree at the University of Alberta. The award title was “Joseph-Armand Bombardier Canada Graduate Scholarship” and was awarded by the Social Sciences and Humanities Research Council in 2020 ($17,500).
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
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