Joseph Silcox

Involuntary civil commitment (ICC) is a court-mandated process to place people who use drugs (PWUD) into substance use treatment. Research on ICC effectiveness is mixed, but suggests that coercive drug treatment like ICC is harmful and can produce a number of adverse outcomes. We qualitatively examined the experiences and outcomes of ICC among PWUD in Massachusetts.
Data for this analysis were collected between 2017 and 2023 as part of a mixed-methods study of Massachusetts residents who disclosed illicit drug use in the past 30-days. We examined the transcripts of 42 participants who completed in-depth interviews and self-reported ICC. Transcripts were coded and thematically analysed using inductive and deductive approaches to understand the diversity of ICC experiences.
Participants were predominantly male (57%), white (71%), age 31 to 40 (50%), and stably housed (67%). All participants experienced ICC at least once; half reported multiple ICCs. Participants highlighted perceptions of ICC for substance use treatment in Massachusetts. Themes surrounding ICC experience included: positive and negative treatment experience’s, strategies for evading ICC, disrupting access to medications for opioid use disorder (MOUD), and contributing to continued substance use and risk following release.
PWUD experience farther-reaching health and social consequences beyond the immediate outcomes of an ICC. Findings suggest opportunities to amend ICC to facilitate more positive outcomes and experiences, such as providing sufficient access to MOUD and de-criminalizing the ICC processes. Policymakers, public health, and criminal justice professionals should consider possible unintended consequences of ICC on PWUD.
•PWUD may experience health and social consequences from Involuntary Civil Commitment (ICC)•Integration of law enforcement with the ICC process increased system avoidance behaviors•The coercive nature ICC inhibited effective treatment outcomes•PWUD felt that increased use and overdose risk often followed ICC releases

Research on stigma management techniques often emphasizes reducing and challenging negative associations with stigmatization. How do people manage stigma in social groups where negative associations may be socially or professionally advantageous? We answer this question with a case study of the emerging industry of “Recovery Coaching,” where firsthand experiences with drug use and recovery are part of a credentialing system that offers entry into a professional field. Drawing on interviews with 22 participants, 15 of whom were certified recovery coaches, we demonstrate the presence of a unique stigma management technique: the professionalization of stigma. Recovery coaches explicitly leverage revealing stigmatized associations to establish and justify their membership in a professional group. We distinguish the professionalization of stigma from conventional management techniques that reduce stigma and discuss the implications of this concept for the study of destigmatization under neoliberal social and economic conditions across different subfields of sociological research.