Bridging Crisis and Care: Reforming Involuntary Civil Commitment Laws to Address Substance Use Disorder

Abstract

This Master’s Project examines state-level reforms to involuntary civil commitment (ICC) laws addressing substance use disorder (SUD) in the United States. With nearly 48.5 million Americans suffering from SUD in 2023 and associated societal costs exceeding $500 billion annually, many states have enacted or are considering ICC laws to compel individuals into inpatient treatment. This research utilizes a mixed-methods approach, incorporating a comprehensive literature review, comparative case studies of seven diverse states (Oregon, Alabama, Wisconsin, California, Kentucky, Massachusetts, and Ohio), and stakeholder interviews with judges, medical professionals, and affected families. The analysis identifies significant legal barriers, insufficient treatment infrastructure, and financial constraints limiting ICC effectiveness. It finds that states implementing legal reforms without parallel investments in healthcare resources often fail to achieve desired outcomes. Conversely, states like Massachusetts, which concurrently reformed its ICC laws and expanded treatment capacity, have demonstrated promising improvements. Recommendations include redefining eligibility criteria, broadening petition authority, safeguarding civil liberties, significantly enhancing healthcare infrastructure, adopting comprehensive continuum-of-care models, and investing in workforce development and sustainable financing mechanisms. The project emphasizes that effective ICC laws must function as strategic interventions paired with robust treatment resources, aiming to bridge acute crises with sustainable recovery pathways.