How to Deal with a Difficult Family Member Who Refuses Help

Why You Should Not Have Them Committed to Treatment Against Their Will… It is the Last Option, not the First

The definition of ‘coerce’ per the Merriam-Webster Dictionary:

• To compel to an act or choice
• To achieve by force or threat
• To restrain or dominate by force

“Before you read this section, please understand that Family First Intervention does not perform Coerced Interventions. The section you are about to read explains why. Many people have read this article and instantly think that is what we do. We explain why coerced interventions do not work and why we do not take this approach or endorse it. Although there are extreme circumstances explained in this article where a Coerced Intervention approach may be warranted, there is a 180-degree difference between our Family Systemic Intervention approach, which teaches detachment, accountability, and boundaries, and the approach of coercion ultimatums.”

This objection, sadly, is the silent killer. Of all the actions families can take against our advice, this one has the most significant short- and long-term damaging effects. We call it the silent killer because families rarely let us know this is their intention. We frequently hear about the failed approach after the family has gone about things their way. At the same time, many families bring up the idea, at which time we provide feedback. We believe that upon hearing us tell them how mistaken an approach it is, they wouldn’t dare admit to taking that route. The science and evidence suggest that coerced interventions and having someone committed should only be employed as an absolute last resort.

“Involuntary interventions take away clients’ self-control, and both involuntary and coerced interventions can undermine clients’ motivation. Since motivation and self-control are strengths that dual disorder treatment aims to cultivate, the use of involuntary and coerced interventions requires particular care.”

Integrated Treatment for Dual Disorders, A Guide to Effective Practice, Mueser, K.T., Noordsy, D.L, Drake, R.E, & Fox, L. 2003, p.249

A family should always give intervention, addiction, and mental health professionals the opportunity to help their loved one before taking matters into their own hands. A family needs to make sure their loved one has the chance to go to treatment respectfully and willingly through the process of intervention. Families, at times, confuse boundaries and accountability with coercion, ultimatums, and involuntary commitment. Boundaries and accountability are not coercion; they are the ways a family says: “You can’t do this to us anymore. Anything that happens to you now is of your own making and doing.” Interventions also allow the intended patient to accept help willingly; involuntary and coercive interventions do not. If a family were to bring their loved one to treatment through coercion or involuntary commitment, he would rightfully believe he is in treatment, not by choice, but because of you. The coercive approach feeds the resentment narrative while confirming the false perception that everything that goes wrong is someone else’s fault.

A Coercive and Involuntary approach is justified when these three rules are met:

1. When involuntary commitment would prevent harm to the person, harm so great that the person cannot rationalize the alternative.
   
2. The person does not have a reason to suffer the harm that the involuntary commitment tries to prevent.
   
3. The harm will occur to the person if the involuntary commitment is not performed, and it will reduce the likelihood that the harmful act will occur.

Justification is dependent on these four scenarios:

• The seriousness of the harm to be avoided
• The extent of the person’s rational responsibility
• The likelihood of harm
• The likelihood that the involuntary intervention will diminish the chance of harm

Integrated Treatment for Dual Disorders, A Guide to Effective Practice,
Mueser, K.T., Noordsy, D.L, Drake, R.E, & Fox, L. 2003, p.250
Medicine and Moral Philosophy, Culver & Gert, 1982

PLEASE NOTE: We are not saying that involuntary or coercive interventions are harmful. They are very effective and should be used when professionals deem them necessary. We are saying that automatic interventions and coercive approaches should be used as a last resort, not the first, when clinically suggested and performed by professionals as ordered by a court of law. Families are incapable of navigating the solutions to addiction and mental health disorder treatment. The higher the emotions, the lower the intelligence, and the closer the family is to the person needing help, the further removed they are from the solution.

For more information on coerced and involuntary interventions, please read the “What are Different Mental Health Intervention Strategies?”