[seadan83]

Mandating treatment gets people into treatment, it does not mean they are treated.

Detox centers (AKA treatment) are myopic, they get you detoxed but kick you back out to your shitty life that made you do drugs in the first place. Follow up is needed to make sure people can re-establish connections with their community and not feel alone and trapped.

> the government needs some teeth so they can treat even those that are in denial.

You cannot 'treat' those people. Nobody can un-addict the drug addict except the drug-addict themselves. Others can support, but the hard work has to come from the person them-self.

What's more, current day we have many prison sentences that are effectively "go to treatment, do 30 days of parole - or go to jail." The effectiveness of this kind of treatment AFAIK is tantamount to a joke. So, the mandated treatment is kinda already what is happening and it's ineffective.

[LawTalkingGuy]

> You cannot 'treat' those people. Nobody can un-addict the drug addict except the drug-addict themselves.

This isn't true. You give them opioid antagonists such as Suboxone. It's not a one-and-done thing, true, but while on these meds they do not want and could not enjoy the drugs.

A full treatment plan, such a Portugal uses on anyone caught uncontrollably stoned in public, can take up to a few years and involves eventual job programs, etc, to leave the person happily employed and housed.

> but the hard work has to come from the person them-self.

No, this is old stigma-based thinking, just from the other point of view. There's no need for someone to do the monumental task of detoxing and through shear willpower, deny any future hits. The antagonists take effect almost immediately, blocking the need, and quickly the desire.

> "go to treatment, do 30 days of parole - or go to jail." The effectiveness of this kind of treatment AFAIK is tantamount to a joke.

True, that is nonsense. It needs to be jail, but your choice of jail with rehab or just jail, and it needs to be until a body of experts (many themselves ex users of the same drugs) feels you are ready to be released based on evidence-based treatment plans. Then, back to jail to serve your remaining sentence if applicable or released into the public if your crimes were only drug related and you're unlikely to re-offend.

[seadan83]

Up front, I think Portugal has the right idea. Decriminilize drugs and do proper treatment with long term support. That is _not_ _at_ _all_ what the US does.

Generally, forcing people to give up drugs fails miserably. That further fails if there is no support post-detox. If a person is not willing, their relapse is exceedingly likely.

In the US, release from jail is pretty much literally the door is opened and you get to walk out with what you had when you came in. There's effectively zero post-release support in the US.

What's more, not all drugs have blockers that a person can take (eg: Meth, cocaine, nicotine), and not everyone can get access to those blockers.

Blockers are great things, but if a person does not want to do the blockers - it will not be effective. That is the point, it's not effective to just stick someone in a jail to treat them of their drug addiction, blockers or not. (US jails don't detox people with blockers, it's the hard way and often without medical supervision. That is even assuming they don't find drugs in jail, US jails notoriously have prolific black markets within them, many people leave US jail more addicted than when they came in)

What's more, blockers are just one part to deal with the chemical dependency (which, as tough as that part is, is arguably the easy part of it all [which is just to say how hard it is to change your lifestyle to develop healthy coping mechanisms, to learn how to live without drugs). Thus, teaching someone new coping mechanisms for stress, particularly when they are leading a very stressful life - is an immense challenge. The US has not instituted anything like Portugal, let alone job programs for people that are not having substance abuse problems. The scale of the two problems are different too. The US has 30x the population and virtually no willingness to spend money on social programs (a ton more people, and even less money to go towards the problem)

For some stats:

"As of 2020, over 37 million people 12 and older actively used illicit substances... 25.4% of all users of illicit drugs suffer from drug dependency or addiction."

https://www.addictionhelp.com/addiction/statistics/#

There are more people in the US that could use treatment compared to there even being people in Portugal! (population of portugal, per some quick googling, is 10M)

>> "Mandatory Rehab and Relapse"

>> "Researchers compared relapse rates for those in mandated opioid addiction treatment to those in voluntary centers. They found that almost 50 percent of the mandated patients relapsed within a month of their release, while only 10 percent of voluntary graduates relapsed." [1]

> No, this is old stigma-based thinking, just from the other point of view. There's no need for someone to do the monumental task of detoxing and through shear willpower, deny any future hits.

This is not what I'm saying. Detox is one part of the journey. Undoubtedly detox is hard, but the sustained effort to stay clean is more what I was referring to. If a person does not want to change their lifestyle, or if they are busy escaping their life - then something is needed like the Portugal example.

It looks like Portugal has long decriminilized all drugs (since 2000). [2]

> It needs to be jail, but your choice of jail with rehab or just jail

To be sure, I'm speaking from a US centric perspective where the full offense is often simple possesion. The chance of re-offending there is particularly high because jail is not treatment, mandatory detox is also not treatment.

Which is kind of interesting the model example is how Portugal does it, yet they did full decriminalization 20 years ago (so jail is not even part of the picture).

[1] https://recovery.org/is-relapse-inevitable-with-forced-sobri...

[2] https://substanceabusepolicy.biomedcentral.com/articles/10.1...

-------------------

I think this conversation also goes to why the term 'addiction' is often no longer used. Detox is one thing, but teaching someone how to deal with stress takes more. When I was a heavy tobacco user, the habit part was a distinct and big part of the overall "addiction." It was one thing to get off of nicotine, it was another to learn that the way to deal with stress was not to go

[LawTalkingGuy]

> As of 2020, over 37 million people 12 and older actively used illicit substances...

And yet our cities are being destroyed by having a mere 2-10k junkies in an extreme state of decay, using the hardest drugs and living, robbing, and dying in the streets.

> many people leave US jail more addicted than when they came in

That'd be hard in this case. They're already on all the drugs they can get, but especially the hardest. But they also don't need hard prison, they could be kept in a wet paper bag if you gave them their drugs. Initial cleanup wouldn't be hard.

> What's more, not all drugs have blockers that a person can take (eg: Meth, cocaine, nicotine),

Those aren't the drugs that are being abused in the street-drug camps. (Not to minimize meth, but it's no Fentanyl...)

And even without blockers, there is regular assisted detox which is better than death.

> and not everyone can get access to those blockers.

We'd make sure they could though, that being the point. For the price we spend on clean needles we could give every junkie their blockers. Jail and programs are cheap compared to dealing with the ongoing mess, crime, and death.

> The US has [...] virtually no willingness to spend money on social programs

Canada and other countries are also having this problem, but even the USA spends a lot on social programs. The people are just getting tired of those programs being counter-productive such as the "safe" drugs supply and decriminalization.

> US jails don't detox people with blockers

We're talking about fixing things though, so that could change as easily as anything else. Certainly more easily than hiring enough ambulance attendants to continually revive the dying.

> Blockers are great things, but if a person does not want to do the blockers - it will not be effective.

Yeah, jail never polls well. That's why it's not an option though. There are many laws they're breaking, even leaving out any drug and drug-predicate crimes, and the sentence for those easily covers any authority needed to require, and time to administer, the treatment.

> It looks like Portugal has long decriminilized all drugs

No, though. Or not the related crimes, such as possession and public intoxication. They use the criminality for force you into treatment. But you don't come out with a criminal record for the drug crimes, so if that was all you did it is sort of decriminalized... Michael Shellenberger interviews João Goulão, head of Portugal's drug program, who says with a chuckle that the legal force is part of the voluntary program.

> I think this conversation also goes to why the term 'addiction' is often no longer used. Detox is one thing, but teaching someone how to deal with stress takes more. When I was a heavy tobacco user, the habit part was a distinct and big part of the overall "addiction." It was one thing to get off of nicotine, it was another to learn that the way to deal with stress was not to go

We're talking about street use of fentanyl though, where you've got at least a 25% chance/year of death. That they don't reach full recovery through one intervention isn't a problem. Once we've saved their life, and the lives and prosperity of people they were dying near, we can get to work on their stress.

Also, the people who want to redefine the terms and reshape the conversation are, to a large part, the ones who have gotten us where we are.

[themitigating]

So is jail but there's a higher probability of success with treatment. Maybe they go in and during group hear someone that inspires them. It's a personal to choice to change of course but that can be influenced