Sponsored
If someone you love is using drugs or alcohol and refuses all help, you may have heard that a court can order them into treatment. In most states that is true, and a family member can usually be the one to file. The harder question is whether it works, and the research on that is more discouraging than almost anything you will read elsewhere.
This page covers what these laws require, who can file, who pays, what the person actually receives, and what the outcome data shows. It is not legal advice, and the process differs enough by state that you will need to confirm the details where you live.
Key Points
- Most states have a law allowing involuntary treatment for substance use, though published counts of how many disagree.
- Having a substance use disorder alone never meets the legal standard. There must also be a danger.
- In Kentucky and Ohio, the person who files must guarantee payment for the treatment the court orders.
- Massachusetts found a higher risk of overdose after involuntary commitment than after voluntary treatment.
- Release is the most dangerous moment, because tolerance drops during forced abstinence.
- Roughly 40 percent of states with these laws never or rarely use them.
In This Article:
- Can a court order someone into addiction treatment?
- What these laws actually require
- What the research shows about whether it works
- Release is the most dangerous moment
- Who pays for court-ordered treatment
- What the person actually receives
- Where your state stands
- What has better evidence
- If someone has filed a petition against you
- Frequently asked questions
Can a Court Order Someone Into Addiction Treatment?
In most states, yes. A family member petitions a civil court, the person is evaluated, and a judge decides whether to order treatment. It is not a criminal proceeding and it does not create a criminal record. Published counts of how many states allow it disagree with one another.
The mechanism is called civil commitment. Someone close to the person files a petition, the court reviews it, an evaluation is usually ordered, and a hearing follows. If the judge finds the legal standard is met, the person can be ordered into treatment for a fixed period.
How many states permit this for substance use depends on who is counting. LawAtlas puts it at 37 states plus the District of Columbia.8 The National Center for State Courts says 35 plus DC.9 Hazelden Betty Ford’s analysis says 38 including DC.10 A 2015 study counted 33. The disagreement is not sloppiness. It reflects real differences in how researchers classify statutes that cover substance use alongside mental illness, or that exist but have no functioning process behind them.
Several states have named laws that families recognize: Florida’s Marchman Act, Kentucky’s Casey’s Law, Ohio’s equivalent provisions, Massachusetts’ Section 35, and Washington’s Ricky’s Law. This page covers what they have in common and where they differ.
If this is an emergency
If the person is unresponsive, having a seizure, or you think they have overdosed, call 911. For a mental health or suicide crisis, call or text 988.
What These Laws Actually Require
Every version requires two things, not one. A substance use disorder, and a resulting danger to the person or to others. Having a substance use disorder on its own never meets the standard, and that is the most common reason petitions fail.
Families are often surprised by this. The fact that someone is using heavily, has lost a job, or has overdosed before is not by itself enough. The statute has to be satisfied on both halves.
Ohio’s law states it plainly: the person must be experiencing alcohol and other drug abuse, and must present an imminent danger or imminent threat of danger to self, family, or others, or there must be a substantial likelihood of such a threat in the near future.13 Massachusetts requires clear and convincing evidence of a substance use disorder and a likelihood of serious harm.14 Florida requires that the person has lost the power of self-control with respect to substance use, along with a showing of harm.11
Who is allowed to file varies more than most people expect, and it is worth checking before you plan around it.
| State | Law | Who hears it | How long an order can last | Does the person who files pay? |
|---|---|---|---|---|
| Florida | Marchman Act, Fla. Stat. ch. 397 | Circuit court | Up to 5 days assessment, then up to 60 days, extendable to 90 | No |
| Kentucky | Casey’s Law, KRS 222.430 to 222.437 | District court | 60 to 360 days | Yes |
| Ohio | ORC 5119.90 to 5119.98 | Probate court | Varies, with a separate 72-hour emergency provision | Yes |
| Massachusetts | Section 35, M.G.L. c. 123 s. 35 | District or juvenile court | Up to 90 days, typically 30 to 60 in practice | No |
Florida is the most permissive on who may file: a spouse, a blood relative, a guardian, a licensed service provider, or any three adults with personal knowledge of the person. Kentucky allows a spouse, relative, friend, or guardian. Massachusetts is the narrowest of the four, limiting petitions to a spouse, blood relative, guardian, police officer, physician, or court official, which means a close friend cannot file at all.
Most states also require an evaluation by a qualified professional before a hearing. Kentucky requires two, one of whom must be a physician.
What the Research Shows About Whether It Works
The evidence is consistent and it is not encouraging. Massachusetts, one of only two states to publish outcome data, found a higher risk of overdose after involuntary commitment than after voluntary treatment for the same people. Reviews of true civil commitment have found no sustained benefit.
In October 2024, the Massachusetts Department of Public Health published a report the legislature had required it to produce. It compared outcomes for people who had undergone both voluntary treatment and involuntary commitment between 2015 and 2021, measured at 30 and 90 days after each episode.1 Because it follows the same individuals through both kinds of treatment, it avoids the usual objection that people who get committed were sicker to begin with.
After release from involuntary commitment, those individuals had a 1.4-fold increased risk of non-fatal overdose, and a possible increase in death from any cause, after controlling for other factors. Separate observational data from the same department put the risk of fatal overdose at roughly twice as high following commitment as following voluntary treatment.1,2
A narrative review published by the University of Washington’s HaRRT Center in 2025 examined five studies of genuine civil commitment. None showed sustained positive outcomes on substance use.4 Two studies from China found no long-term benefit, with relapse above 90 percent in some groups. Studies from Thailand, Taiwan and Sweden found negative or mixed results. One US group found that a third of people returned to use on the day of release.7
A 2023 review by the McMaster Health Forum assessed 60 research documents, including seven evidence syntheses. Three of those syntheses found increased risk of non-fatal overdose at follow-up, most pronounced among people using heroin and methamphetamine. A Swedish study found higher risk of death immediately after discharge compared with voluntary treatment. Findings on arrests and employment were mixed. The same review documented moral distress among the clinicians delivering involuntary treatment.5
One definition matters here, because it explains why some sources sound more positive. Several reviews labeled as studies of involuntary treatment actually examined treatment that was mandated but still voluntary, such as drug court referrals where a person chooses treatment over prosecution. When the research is limited to true civil commitment, where the person has no choice, the picture is the one described above.
It is also worth knowing how little is measured. Massachusetts and Washington appear to be the only states that have published any evaluation of their programs. Washington’s single evaluation in eight years found modest reductions in emergency department visits and homelessness, but lower rates of follow-up substance use treatment and no change in arrests or employment. It did not examine substance use outcomes or deaths after release at all.
Two arguments run the other way and deserve stating. Charlotte Wethington, whose son’s death led to Casey’s Law, has argued that families petition only in desperation, after repeated overdoses and the loss of nearly everything, and that what they are trying to protect is their child’s life. Separately, some clinicians argue the problem is that commitments are too short rather than that commitment is wrong, since severe substance use disorder often needs 90 days or more of treatment and many orders run 30 to 60 days.
Release Is the Most Dangerous Moment
Forced abstinence lowers tolerance without treating the underlying disorder. If the person returns to the dose they used before, the risk of a fatal overdose is far higher than it was. Three things reduce that risk, and a family can arrange all three.
This is the mechanism behind the outcome data, and it is the most useful thing on this page.
Opioid tolerance falls quickly during a period without use. It does not fall in a way the person can feel. When someone leaves a commitment and uses what used to be an ordinary amount for them, that amount can now be enough to stop their breathing. It is the same reason the weeks after release from jail carry such a high overdose risk. International research puts the risk of death at two- to nearly four-fold in the weeks following release from involuntary treatment, driven mainly by overdose.6
If you take one thing from this page
The day someone is released is the most dangerous day, not the finish line. Have naloxone on hand, know how to use it, and make sure the people around them do too.
Three things measurably change that risk, and none of them require the person’s cooperation to arrange:
- Get naloxone before the release date. It is available without a prescription and is often free. See where to get free naloxone, and read the rest of our harm reduction guidance if opioids are involved.
- Ask whether the facility offers medication for opioid or alcohol use disorder, and whether it continues after discharge. Buprenorphine and methadone reduce overdose death substantially, and a program that stops them at the door is the more dangerous option. Ask this before the person is placed if you can.
- Plan for the release day itself. Know the date, arrange for someone to be present, and have the next appointment already booked rather than left to chance.
Who Pays for Court-Ordered Treatment
In Kentucky and Ohio, the person who files the petition must sign a guarantee to pay for the treatment the court orders, which can run for months. Florida and Massachusetts have no such requirement. In no state can a court force an insurance company to pay.
Kentucky’s Casey’s Law requires the petition to be accompanied by a signed guarantee obligating the person who files to pay all costs of the treatment the court orders. Ohio’s statute carries the same requirement, extending to the cost of the evaluations, the costs associated with the hearing, and the cost of any treatment ordered. Given that Kentucky orders can run from 60 to 360 days, that is a substantial and open-ended financial commitment made before anyone knows what the treatment will involve.12,13
The practical effect is that in those two states, the law works best for families who can afford it. A family with no capacity to guarantee months of treatment cannot realistically use the mechanism, however sick the person is. County attorney offices in Kentucky warn petitioners about this directly, and it is worth taking seriously before signing anything.
Three limits apply everywhere:
- A court cannot order an insurance company to pay for the treatment.
- A court cannot order a private facility to accept the person.
- Neither the family nor the person chooses where the person goes.
Whether Medicaid or private insurance ends up covering any of it depends on the facility the person is assigned to, not on the court order. If cost is the reason treatment has not happened yet, that is a different problem with better solutions. Start with how to pay for rehab, or with getting treatment without insurance if there is no coverage at all.
Verify your Insurance
Verify your insurance coverage in 2 minutes - call now (have your ID card ready)
Check Your Insurance Coverage
Rehabs.org is not affiliated with any insurance.
What the Person Actually Receives
The state decides where the person goes. In Massachusetts, men committed under Section 35 may still be sent to a facility run by the Department of Correction, though the largest of those is legally required to close by the end of 2026.
Families often picture a residential treatment program of the kind they would have chosen. What the person receives is whatever bed the state has available.
Massachusetts is the clearest example because it uses its statute more than any other state, committing more than 6,000 people a year. Historically, most beds for men committed under Section 35 have been in correctional settings, including the Massachusetts Alcohol and Substance Abuse Center at Plymouth and a facility run by a county sheriff’s office. Legislation passed in December 2024 requires that Plymouth facility to close by 31 December 2026, with its beds replaced by facilities licensed or approved by the state health and mental health departments. As of mid-2026 that closure depends on replacement capacity coming online, so the system for men is in transition.2,14
Women in Massachusetts are no longer sent to correctional facilities. Following litigation that concluded in 2016, they are committed only to health-operated programs.
Duration on paper and duration in practice also differ. Massachusetts allows up to 90 days and sets no minimum, and the court cannot impose one. Most commitments run shorter than the maximum, commonly 30 to 60 days, with discharge decided on clinical grounds.
Where Your State Stands
Most states have a statute. Roughly 40 percent of the states that have one never or rarely use it. A law existing on paper is not the same as a working process, and the fastest way to find out which you have is to call the court.
This is the gap between what you will read and what you will encounter. An analysis of these laws found that around 40 percent of states with such provisions either never apply them or apply them rarely. Researchers writing in the Health and Human Rights Journal in 2025 described most of these mechanisms as largely dormant, held back by funding gaps and unresolved legal questions rather than by any decision to repeal them.3,8
Massachusetts is the outlier at the high end. Most states are nowhere near it.
A few state notes that come up often:
- California does not have a family petition process for substance use comparable to the Marchman Act. Its civil commitment framework runs through separate mechanisms, and recent legislation expanded the criteria. Confirm current scope locally before relying on it.
- Texas, Georgia and Indiana all draw regular searches on involuntary commitment, and all three have statutes, but published utilization data is thin. Treat availability as an open question until you have confirmed it locally.
- Washington’s Ricky’s Law works differently from a family petition, operating through a designated crisis responder rather than a relative filing directly.
The useful thing to do is not to research your state online. It is to call the clerk of your district, circuit or probate court and ask two questions. Does this court hear involuntary commitment petitions for substance use? And how many did it hear last year? The second question is the one that tells you whether the process is real where you live.
What Has Better Evidence
A structured approach called CRAFT got roughly two thirds of treatment-refusing people into care voluntarily in randomized trials. Separately, most people who want treatment still cannot get it, which means the barrier is often access rather than willingness.
If the goal is getting the person into treatment, there is an approach with considerably better evidence behind it than a court order.
In a randomized trial published in the Journal of Consulting and Clinical Psychology, family members trained in Community Reinforcement and Family Training, known as CRAFT, succeeded in getting 64 percent of their treatment-refusing relatives into care. The confrontational family intervention managed 30 percent, and an Al-Anon based approach 13 percent.15 A 2020 systematic review in Addiction found most CRAFT studies land above 60 percent.16 It works by changing communication and the consequences around the person rather than by confrontation or detachment.
Our guide to helping someone with addiction get into treatment covers that evidence in full, along with what a family can and cannot do legally. If a structured conversation is what you are considering, planning that conversation walks through the practical steps.
The second point is easy to miss. In 2024, 80 percent of people who needed substance use treatment in the United States did not receive it.17 If the person you are worried about is willing but has no coverage, no money, or nowhere with an open bed, this is not a refusal problem and a court order does not solve it. Start with free and state-funded rehab or what to do about wait times.
Two other things worth knowing. Medication for opioid or alcohol use disorder can often begin within days, sometimes by telehealth, without any residential placement. And support groups and family therapy are available to you whether or not the person ever agrees to anything.
If Someone Has Filed a Petition Against You
You have the right to a lawyer, and one will be appointed if you cannot afford it. You have the right to a hearing and to contest the evidence. A commitment order is a civil matter and does not create a criminal record.
Most pages on this subject are written only for the person filing. If a petition has been filed against you, here is what applies.
You are entitled to legal representation at the hearing, and if you cannot afford an attorney the court appoints one. You are entitled to be present, to hear the evidence, and to contest it. In many states you can request an independent evaluation rather than relying solely on the petitioner’s.
The legal standard is two-part, and this is where petitions most often fail. It is not enough to show that you have a substance use disorder. The petitioner must also establish the danger element, to the standard the state requires, which in Massachusetts is clear and convincing evidence. An attorney will focus there.
These proceedings are civil rather than criminal. They do not produce a criminal record, and records are generally confidential under state law. Orders can also end early. Massachusetts courts cannot set a minimum period, and discharge before the maximum is common when the criteria are no longer met.
One thing to be clear about: if an order is issued and you do not comply with it, the consequence in most states is civil contempt of court, and in some states that can mean jail. That is worth understanding before deciding how to respond.
Frequently Asked Questions
Can you force an adult into rehab?
In most states a family member can petition a civil court to order someone into treatment, but they cannot compel it themselves. A judge decides, and the legal standard requires both a substance use disorder and a resulting danger.
Which states let a family petition for involuntary addiction treatment?
Counts range from 33 to 38 states plus the District of Columbia depending on the source and how statutes are classified. Florida, Kentucky, Ohio, Massachusetts and Washington have well-known named laws.
Does court-ordered rehab work?
The available research is discouraging. Massachusetts found a 1.4-fold higher risk of non-fatal overdose after involuntary commitment than after voluntary treatment for the same individuals, and a 2025 review found no study of true civil commitment showing sustained benefit.
Who pays for court-ordered treatment?
It depends on the state. Kentucky and Ohio require the person filing the petition to guarantee payment for the treatment ordered. Florida and Massachusetts do not. No court can require an insurance company to pay.
How long can someone be held?
It varies widely. Massachusetts allows up to 90 days, Florida up to 60 with an extension to 90, and Kentucky between 60 and 360 days. Actual stays are frequently shorter than the maximum.
Is court-ordered rehab a criminal record?
No. Civil commitment for substance use is a civil proceeding, not a criminal one, and it does not produce a criminal record. Records are generally confidential under state law.
What can a family do if commitment is not an option?
Approaches with stronger evidence exist. In randomized trials, family members trained in CRAFT got about two thirds of treatment-refusing relatives into care voluntarily, roughly double what confrontational interventions achieved.
You Might Like
- How to Help Someone With Addiction Get Into Treatment
- Overdose Prevention
- Good Samaritan Laws and Overdose
- Substance Abuse Assessment
Sources
- Massachusetts Department of Public Health (October 2024). Legislatively mandated report on outcomes of voluntary and involuntary substance use treatment, 2015 to 2021.
- Health in Justice Action Lab, Northeastern University School of Law. Involuntary Commitment.
- Messinger, J.C., & Beletsky, L. (2025). What’s old is new again in addiction treatment: The expansion of involuntary commitment in the United States. Health and Human Rights Journal, May 2025.
- Harm Reduction Research and Treatment Center, University of Washington (2025). Narrative review of the literature on involuntary treatment for substance use disorder.
- McMaster Health Forum (2023). Use and regulation of involuntary substance-use treatment for adults. Rapid evidence response.
- Rafful, C., et al. Increased non-fatal overdose risk associated with involuntary drug treatment among people who inject drugs in Tijuana, Mexico.
- Outcomes for patients discharged to involuntary commitment for substance use disorder directly from the hospital (2023). Retrospective cohort study.
- Policy Surveillance Program, Temple University Center for Public Health Law Research. Laws Authorizing Involuntary Commitment for Substance Use. LawAtlas.
- National Center for State Courts. Civil commitment for substance use disorder.
- Hazelden Betty Ford Foundation. Involuntary Commitment, addiction research summary.
- Florida Statutes, Chapter 397, Hal S. Marchman Alcohol and Other Drug Services Act of 1993.
- Kentucky Revised Statutes 222.430 to 222.437, Matthew Casey Wethington Act for Substance Abuse Intervention.
- Ohio Revised Code 5119.90 to 5119.98.
- Massachusetts General Laws Chapter 123, Section 35; Mass.gov, Section 35: The process and criteria.
- Miller, W.R., Meyers, R.J., & Tonigan, J.S. (1999). Engaging the unmotivated in treatment for alcohol problems. Journal of Consulting and Clinical Psychology, 67(5), 688-697.
- Archer, M., et al. (2020). Community reinforcement and family training and rates of treatment entry: A systematic review. Addiction, 115(6), 1024-1037.
- Substance Abuse and Mental Health Services Administration (2025). Results from the 2024 National Survey on Drug Use and Health.
