The compulsory treatment of patients for alcohol and other drug dependence is a prime example of how seemingly good intentions often can lead to unfortunate human results.

The reality is that alcohol and drug treatment is very poorly funded in Australia. Bearing this in mind, it is important to understand that compulsory treatment is much more expensive than treating people who voluntarily choose to seek help.

Another problem with compulsory treatment is that it is often people with the least chance of doing well who are treated. This means the many people who want help and really may benefit from voluntary treatment have to go without because most of the available money has been unwisely spent on compulsory treatment of people who don’t want it.

We don’t have compulsory treatment for obesity, breast cancer or diabetes. So while I am naturally not opposed to any actual life-saving interventions, why have compulsory treatment for alcohol and drug problems?

Do we have compulsory treatment for cigarette smokers when we know that two-thirds will die from a tobacco-related cause?

Compulsory treatment for alcohol and drug dependence is usually for people who are socially and economically disadvantaged. As well as the Northern Territory, where most clients with substance abuse problems are indigenous, there is also compulsory treatment in Western Australia and NSW.

Such treatment is often accompanied by serious unintended negative consequences. In particular, it compares poorly with voluntary treatment in terms of safety and cost effectiveness. Australia is active in helping the UN close down compulsory treatment for alcohol and other drug dependence in Asia. Yet state and federal governments are encouraging compulsory treatment here.

In the case of compulsory drug treatment, we are dealing with patients at the most difficult end of the spectrum. So the health budget also has to pay for security staff to prevent patients from absconding from treatment facilities.

How can this be a better investment than spending the same funds on larger numbers of people with a better prognosis where no security costs are entailed?

When drug reformer Alex Wodak and a colleague requested a grant of $50,000 from the NSW Department of Health to start SMART Recovery in Australia, they were told the department had recommended against funding, allegedly because SR was not based on evidence — even though it is based on cognitive behaviour therapy, which has been evaluated many times.

Wodak and his colleague wanted to extend the range of assistance to more people struggling with alcohol and drug problems. When they said they believed no NSW government would fund alcohol and drug treatment properly, a representative of the department responded: “You’re right. When Wodak asked why, she said: “There are no votes in doing that.

Given that the budget for alcohol and drug treatment is so small — a six-month waiting list is common for residential rehabilitation in NSW — spending money on people at the intractable end of the spectrum using a doubtful intervention means that money is not available for a much larger number of people with less severe and more treatable problems who come of their own volition for treatment and support.

With regard to treating alcohol and drug dependence, it is clearly the case that often the most successful agencies are those that are chosen voluntarily. The latter includes participating in extremely effective non-professional, community and self-help groups such as Alcoholics Anonymous, Narcotics Anonymous and, to a lesser extent, SMART Recovery.

In contrast to these groups, whose attendees come from a wide societal range, compulsory drug and alcohol treatment is often delivered unfairly. In particular it discriminates against the poor and the disadvantaged.

Would someone such as Christopher Hitchens have had to worry, when visiting Australia, that his bottle of spirits a day plus chain-smoking habit — which sent him to an early grave — put him at risk of being nabbed for compulsory treatment? Of course not. Being white, wealthy and well connected, he would have had nothing to fear. And can anyone imagine Winston Churchill, who drank a bottle of brandy a day, being made to undergo compulsory treatment?

Apart from Aboriginal alcoholics and addicts, who represent a disproportionate number of those sent for compulsory treatment, those going through compulsory treatment in NSW and Western Australia are predominantly blue-collar or unemployed, and much likelier to hail from Mount Druitt than Darling Point. This class-based inequity is one reason compulsory drug treatment programs should at least be questioned, if not opposed outright.

As Alcoholics Anonymous teaches, many people have to experience a mega-catastrophe before they start to think about turning their lives around. That certainly applied to me when, on Australia Day 1970, at the age of 24, I finally stopped drinking and taking other drugs.

However, before that turning point in my life, I would have reacted very badly if I had been frogmarched into compulsory treatment. Moreover, at the time it would have been a huge waste of money, better spent on others.

Ross Fitzgerald is the author of 36 books, including his memoir ‘My Name is Ross: An Alcoholic’s Journey’, which is available as an e-book and a talking book from Vision Australia.

The Weekend Australian, May 2-3, 2015, Inquirer, p 24