Clients may be coerced into treatment through a variety of channels, for instance, through the judicial system, via family and friends, schools or workplaces, or through child protection or other services. However, AOD workers should not assume treatment will be ineffective as a result [1842, 1843]. In fact, coercion into treatment may present an opportunity which the client may never have previously considered, and evidence suggests that some people who have been legally coerced to participate in treatment stay in treatment longer and do equally as well, or better than, people not under legal coercion [1844, 1845]. It is important for the AOD worker to present treatment as a positive opportunity from which the client may experience some benefit. A positive attitude on behalf of the AOD worker and efforts to engage coerced clients are key, as a better therapeutic alliance is associated with better mental health related treatment outcomes [1845]. Given that the motivation to engage in treatment may come largely from external sources [776], educational and motivational interventions may require more attention in treatment planning and provision.
Nevertheless, there are some special considerations that AOD workers ought to be aware of when working with coerced clients. First, confidentiality may be complicated and needs to be clarified from the outset of treatment, both with the referrer and the client. Open communication is required regarding the boundaries, rights and obligations concerning confidentiality, and these should be clarified prior to the commencement of treatment [389]. Similarly, conflicts of interest between the views of the AOD worker and the conditions under which the client accesses treatment may arise and should be addressed [776]. Treatment resistance may also be a problem, as motivation to engage in treatment among coerced clients is typically external. Harm reduction is also an important consideration when working with coerced clients [389]. Harm reduction may often be a more satisfactory goal for clients but court orders and familial requests are likely to be based on an expectation of abstinence [776, 1846]. The AOD worker, however, can play an important role in clarifying what the realistic goals are for each client.
Coerced clients may be accessing treatment services for the first time or may be accessing a different type of service. This avenue provides the opportunity for a thorough assessment which may identify previously undiagnosed co-occurring disorders and presents an opportunity for treatment. However, as clients who are coerced into treatment may present with strong emotional reactions and a reduced sense of autonomy, AOD workers may need to spend time managing these reactions [1847]. AOD workers should focus on building a therapeutic relationship, and avoid overly intrusive questions that might be perceived as judgemental [389]. Barber [1848] suggests that in cases of coercion the worker should adopt a negotiation or mediation role and follow six steps in this process:
- Clear the air with the client (present with a positive attitude and make efforts to engage).
- Identify legitimate client interests.
- Identify non-negotiable aspects of intervention.
- Identify negotiable aspects of intervention.
- Negotiate the case plan.
- Agree on criteria for progress.
When working with justice health specifically, appropriate referrals and consultation with corrective services need to take place. A client being released from custody should be reviewed to ensure that they have all medications post-release and that they are aware of services, referred to and accepted by service providers where necessary [1849, 1850].