Historical Context

The concept of compulsory treatment for drug abusers in the United States was proposed shortly after Congress passed the Harrison Act of 1914. By 1919, the Narcotics Unit of the U.S. Treasury Department had convinced Congress to establish a chain of federal ''narcotics farms,'' where heroin users convicted of federal law violations could be incarcerated and treated for addiction (Inciardi, 1988). The first of such farms, established in 1935, was the U.S. Public Health Service Hospital in Lexington, Kentucky. Three years later, a sister hospital was established in Fort Worth, Texas. The goal of the facilities was to use vocational and psychiatric therapy to help free the addicts of their psychological dependence on drugs, to treat withdrawal illness, and to correct mental and social problems. Follow-up studies from Lexington in the 1940s indicated that addicts treated under legal coercion with posthospital supervision had better outcomes than voluntary patients, primarily because voluntary patients rarely completed the treatment program (Maddux, 1988). However, later studies failed to support these early positive findings. During the 1950s, hospital staff members recommended the enactment of a federal civil commitment law for narcotic addicts, but legal counsel in the Department of Health, Education, and Welfare considered such a law unconstitutional.

Then in 1962, President John F. Kennedy convened a White House Conference on Narcotic and Drug Abuse where nearly all members approved the civil commitment of narcotic addicts. Civil commitment was advocated as protection for society and rehabilitation for the individual. A compulsory treatment program aimed at the federal offender was enacted by the NARCOTIC ADDICT Rehabilitation Act (NARA) of 1966. By that time, about twenty-five states had laws permitting civil commitment, and a few major programs were enacted in response to public fears of growing drug-related street crime (Inciardi, 1988). California, in 1961, launched its Civil Addict Program

(CAP), the first large-scale civil commitment program to be implemented in the United States. Because of its relative success, in 1966, New York's Narcotic Addiction Control Commission (NACC) established the largest and costliest civil commitment program in history—the NEW YORK STATE

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