Coerced clients

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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 [1117]. In fact, coercion into treatment may present an opportunity which the client may never have previously considered, and evidence suggests that some individuals 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 [1118]. It is important for the AOD worker to present it as a positive opportunity from which the client may experience some benefit. A positive attitude on behalf of the AOD worker and efforts in engaging a coerced client are key to a productive outcome. The role of educational and motivational interventions may require more attention.

Nevertheless, there are some special considerations that AOD workers ought to be aware of when dealing 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 [276]. 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 [96, 1087].

Harm reduction is also an important consideration when dealing with coerced clients [276]. This 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 [96]. The AOD worker, however, can play an important role in clarifying what the realistic goals are for each client. Often, a lack of knowledge and understanding of dependence and treatment results in unrealistic expectations, particularly in relation to the opioid treatment program (i.e., methadone and buprenorphine substitution) and the need to be abstinent from all drugs.

Coerced clients may be accessing treatment services for the first time, or may be accessing a different type of service. This provides the opportunity for a thorough assessment which may identify previously undiagnosed comorbid disorders, and presents an opportunity for treatment. AOD workers should focus on building a therapeutic relationship, and avoid overly intrusive questions that might be perceived as judgemental [276]. Barber [1119] suggests that in cases of coercion the worker should adopt a negotiation or mediation role and follow six steps in this process. These steps are:

  • Clear the air with the client (including a positive attitude and efforts with engagement).
  • 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 he/ she has all medications post-release and that he/she is aware of services, referred to and accepted by service providers where necessary [1120].