Category: English

Source: The Conversation – USA (3) – By Susan E. Collins, Professor of Psychiatry and Behavioral Sciences, University of Washington

Since President Donald Trump issued a July 2025 executive order aimed at “ending crime and disorder on America’s streets,” national attention has increasingly focused on involuntary treatment as a response to visible homelessness and drug use.

A few months later, in September 2025, officials in Utah announced plans for a 16-acre facility on the edge of Salt Lake City that would hold up to 1,300 people experiencing homelessness after they are removed from public spaces and offered a choice: the facility’s abstinence-based shelter or jail time. The facility also plans to include 300 to 400 beds reserved for involuntary treatment, for adults who have psychiatric and substance use disorders.

Supporters of this facility describe it as a humane alternative to the streets, while detractors liken it to prison.

Since the release of the executive order, other proposals for expanding involuntary treatment for adults with substance use disorder have been cropping up across the U.S., including in New Jersey, Washington state and New York state.

I am a licensed clinical psychologist, substance-use treatment professional and researcher at the University of Washington. Throughout my three decades in the field, my research has focused on what works when it comes to substance use treatment, including among people experiencing homelessness.

I started reading research on involuntary treatment in 2018, when Ricky’s law – Washington’s version of involuntary treatment – was implemented where I live and work.

What I have learned is that involuntary treatment for adults with substance use disorders is necessary in extreme cases, but it does not outperform voluntary care and raises serious concerns about patient safety.

‘Involuntary’ or ‘forced’ treatment

People who have substance use disorder often experience pressure to enter treatment and stop using alcohol and drugs. This pressure ranges from informal coercion, like family pleas or providers leveraging housing or other services, to formal coercion, like treatment mandated by the court system.

Involuntary treatment, referred to in the U.S. as “involuntary civil commitment,” is distinct from these approaches and is the most restrictive means of formal coercion. Civil commitment authorizes a court, often based on a health care professional’s assessment, to order the involuntary deprivation of liberty, usually by confining a person to a locked treatment facility.

Unlike court-mandated treatment, which involves consent and choice, albeit limited, involuntary treatment does not involve consent and is often administered against a person’s will, with the length of treatment determined by court order and state law.

Such treatment is typically considered when a person poses an imminent risk of serious physical harm to themselves or others – for example, expressing suicidal or homicidal intent with a plan and means to carry it out. It may also be considered in cases of grave disability, such that an adult is unable to care for themselves without assistance.

A history of abuse

There is a reason involuntary treatment is reserved for these extreme cases. In the 19th and early 20th centuries, institutional abuses were rampant in state psychiatric hospitals, where patients were often confined and stripped of their civil rights for years, sometimes indefinitely. Through reforms in the 1960s, civil commitment law was applied in fewer cases, and legal protections for patients were strengthened.

But recent decades have seen a renewed interest in involuntary treatment specifically for substance use disorder. As of early 2026, 37 states and the District of Columbia have laws allowing involuntary treatment for substance use disorder, with most having added new and expanded civil commitment statutes in just the past 10 years.

In practice, these statutes vary widely in criteria, duration and utilization, reflecting a lack of consensus about their proper role.

Heightened risk of relapse, rearrest and death

Yet even as involuntary treatment for substance use disorder is being expanded, there is no clear scientific evidence that it is effective.

Three systematic reviews – wide-ranging analyses of the peer-reviewed, scientific literature – published in 2005, 2016 and 2023 have summarized the research on coercive substance use treatment in adults.

Within these reviews, some studies that are labeled as “involuntary treatment” actually refer to mandated but voluntary treatment, not civil commitment. When limited to studies of true involuntary treatment for substance use disorder, the literature indicates no measurable benefit and in some cases clear harm.

The most commonly cited harms are higher risk of relapse, rearrest and even death after release from treatment. In fact, one international research study showed that risk of death increases two- to nearly fourfold in the weeks following release, primarily due to overdose.

Unfortunately, there is no consistent and transparent program evaluation and reporting framework for involuntary substance use treatment in the U.S. To date, Massachusetts and Washington appear to be the only states to have published outcome evaluations of their involuntary substance use treatment programs.

Data from Massachusetts echoes the pattern reflected in the larger research literature: Adults with a history of involuntary treatment experienced 40% higher risk of death from overdose than people with no involuntary treatment history.

In its eight years of operation, Washington’s involuntary treatment program has published only one program evaluation. Findings showed mixed short-term results: There were modest reductions in emergency department use and homelessness, but lower rates of follow-up treatment for substance use and no change in arrests or employment. Most important, there has been no analysis of subsequent substance use outcomes or post-release mortality.

More data and more frequent reporting are needed to determine the effectiveness and safety of involuntary treatment for substance use disorder in the U.S.

In addition to documenting quantitative outcomes, documenting patients’ own subjective experiences of involuntary treatment for substance use disorder, as has been done for patients in involuntary treatment for psychiatric disorders, may help improve its delivery, even as it remains a last resort.

Calculating the cost

While patient health and civil liberties are top priorities, states also have to consider costs. It has been long documented that voluntary inpatient substance use treatment is substantially more expensive than lower-intensity, lower-barrier treatment and service settings. However, involuntary treatment layers on further costs of secured, statutorily designated placement with formal court proceedings and ongoing legal oversight.

Involuntary treatment under Massachusetts Section 35 law costs an estimated US$76,819 per male patient annually. In Washington, the average 11-day stay costs $7,298. Washington’s program yielded a low benefit-to-cost ratio, with the program losing approximately 81 cents for every dollar spent within the first year after treatment.

The few U.S. evaluations of involuntary treatment conducted to date have thus not indicated that involuntary treatment reduces publicly funded service costs sufficiently to offset its expense.

Other solutions

Meanwhile, the evidence consistently points to lower-barrier and voluntary approaches as more effective, less costly and less risky than involuntary treatment.

For people with substance use disorder who also experience homelessness, this includes a range of affordable and supportive housing options, from abstinence-based recovery housing to low-barrier permanent supportive housing paired with services, such as Housing First. Research shows Housing First effectively increases housing stability and reduces use of publicly funded services.

Evidence also supports implementing harm-reduction programs, including street-based engagement, syringe service programs and providing naloxone kits for overdose reversal. Collectively, these programs have been shown to prevent overdose, reduce transmission of blood-borne illness and connect people to voluntary services and treatment.

Effective behavioral treatments and medications that reduce craving and overdose risk, such as buprenorphine, methadone, naloxone and naltrexone, represent the gold standards in substance use treatment and overdose prevention.

Justice system diversion programs have been shown to be effective in keeping those convicted of low-level drug use and possession crimes out of jail. Case managers for these programs help participants find housing and vocational services, improving their stability. These programs reduce recidivism and relieve an already overloaded legal system.

Given the lack of existing evidence supporting involuntary treatment, I believe expanding it beyond acute, life-threatening crises is unwarranted. It is not a substitute for investing in and delivering lower-barrier, voluntary services that already have been shown to save lives, reduce harm and foster sustainable recovery.

Susan E. Collins is a Professor in the Department of Psychiatry and Behavioral Sciences at the University of Washington, where she also maintains a clinical practice. The perspectives provided in this article are her own and do not represent the positions of the University of Washington. Dr. Collins has previously conducted research and program evaluation projects funded by local, state, and federal agencies, as well as private nonprofit organizations. In one prior study, a pharmaceutical company provided medications but no research funding. She is a cofounder and equity holder in HaRT3S, a social purpose corporation, but does not currently receive funding from the company.

– ref. What decades of research reveal about involuntary substance use treatment – and why evidence points elsewhere – https://theconversation.com/what-decades-of-research-reveal-about-involuntary-substance-use-treatment-and-why-evidence-points-elsewhere-268841

Source: The Conversation – USA – By Nina Srinivasan Rathbun, Professor of International Relations, Munk School of Global Affairs & Public Policy, University of Toronto; USC Dornsife College of Letters, Arts and Sciences

Three rounds of nuclear talks between the U.S. and Iran failed to persuade President Donald Trump that a solution to the two country’s nuclear impasse lay in diplomacy, rather than military action. A perceived lack of progress in the last of those indirect negotiations on Feb 26, 2026, was enough to prompt Trump to green-light a massive onslaught of missiles that has degraded Iran’s offensive capabilities and killed Ayatollah Ali Khamenei and several members of Iran’s senior military leadership.

In response, Tehran has launched strikes across the Middle East, targeting Israel as well as Gulf states that host U.S. airbases. At least three Americans have been killed.

While the scale of the U.S., Israeli and Iranian strikes has taken some observers by surprise, the failure of the talks that led to them was all too predictable.

For diplomacy to be successful, both sides need to agree on the issues subject to negotiation and also believe that peaceful resolution is more valuable than military engagement. This clearly was not the case in the U.S.-Iran nuclear talks of 2025 and 2026.

As someone who has researched nonproliferation and U.S. national security for two decades and was involved in State Department nuclear diplomacy, I know that even under more favorable conditions, negotiations often fail. And the chances for success in the Iran-U.S. talks were always slim. In fact, publicly stated red lines by both sides were incompatible with each other – meaning negotiations were always likely to fail.

Iran wanted the talks confined only to guarantees about the civilian purpose of its nuclear program, not its missile program, support of regional proxy groups or human rights abuses. Essentially it wanted a return to 2015’s Joint Comprehensive Plan of Action, which halted Iran’s development of nuclear technology and stockpiling of nuclear material in exchange for lifting multiple international economic sanctions placed on Iran.

Meanwhile, Trump insisted on limits to Iran’s ballistic missiles and the cutting of Tehran’s support for regional militias. These were not included in the 2015 agreement, with parties ultimately deciding that a nuclear deal was better than the alternative of no deal at all.

False hope

Nevertheless, there had been a slim chance for a breakthrough of late.

While the positions of both the U.S. and Iranian governments had ossified since May 8, 2018 – the date when the first Trump administration withdrew the United States from the Obama-era Iran nuclear deal – there had been some recent movement by Iran, according to former U.S. diplomats involved in negotiations during the Obama and Biden administrations.

With U.S. military building up in the region, Iran appeared more willing to negotiate within the nuclear arena than before. There were plausible solutions to the issue of Iran’s enrichment of uranium capabilities, including maintaining a minimum domestic capacity to develop medical isotopes and a removal of Iran’s stockpile of enriched uranium necessary to build a nuclear bomb.

There was less openness on other points of contention. Notably, there was no movement on ballistic missiles, which had always been a red line. On the eve of the round of discussions held in Geneva on Feb. 17, Trump stated: “I think they want to make a deal.” Iran’s foreign minister, Abbas Araghchi, noted progress over the “guiding principles” of the talks.

But a lot of this optimism appeared to have dissipated by the time the two sides held another round of talks on Feb. 26. While mediator Oman’s negotiators continued to talk of progress, the U.S. side was noticeably silent. Reporting since has suggested that Trump was displeased with the way the talks had gone, setting the stage for the Feb. 28 attack.

Military brinkmanship

The threat of military action was, of course, a continued backdrop to the talks.

The USS Abraham Lincoln carrier group was deployed near Iranian waters in January as a signal of support to the Iranian protesters. The USS Gerald R Ford carrier group joined the buildup before the last round of talks.

Trump warned Iran that “if they don’t make a deal, the consequences are very steep.”

The thinking may have been that Iran, weakened by both the June 2025 U.S.-Israeli strikes and diminished capabilities of Tehran proxies Hamas and Hezbollah, was playing a weak hand in the talks.

Yet Iran also signaled a willingness to engage in military action. In the run-up to the last round of talks, Iran held military exercises and closed the Strait of Hormuz for a live-fire drill. Leaders in Tehran also declared that they would not restrain its response to another attack. The world is seeing that now, with a response that has seen Iran launch missiles across the Middle East and at rival Gulf nations.

Optimism has fallen before

Trump isn’t the first president to fail to secure a nuclear deal, although he is the first to respond to that failure with military action.

The Biden administration publicly pledged to strengthen and renew the Obama-era nuclear deal in 2021. However, Iran had significantly increased its nuclear technical capability during the years that had passed since the Joint Comprehensive Plan of Action collapsed. That increased the difficulty – just to return to the previous deal would have required Iran to give up the new technical capability it had achieved for no new benefits.

That window closed in 2022 after Iran removed all of the International Atomic Energy Agency’s surveillance and monitoring under the deal and started enriching uranium to near-weapons levels and stockpiling sufficient amounts for several nuclear weapons. The IAEA, the United Nations’ nuclear watchdog, maintains only normal safeguards that Iran had agreed to before the plan of action.

Optimism also existed for a short time in spring 2025 during five rounds of indirect talks that preceded the United States bombing Iran’s nuclear infrastructure in June as part of a broader Israeli attack.

A more unstable Middle East

When I worked in multilateral nuclear diplomacy for the U.S. State Department, we saw talks fail in 2009 regarding North Korea’s nuclear weapons program, after six years of on-and-off progress. The consequence of that failure is a more unstable East Asia and renewed interest by South Korea in developing nuclear weapons.

Unfortunately, the same dynamic appears to be playing out in the Middle East.

Military strikes have already killed more than 200 in Iran and across the region. A wider war in the Middle East is a possibility, and should the Iranian regime survive, it may commit to developing nuclear weapons given that the lack of them proved no deterrent to U.S. and Israeli military action.

Talks do not necessarily need an end point – in the shape of a deal – for them to have purpose. Under situations of increased military brinkmanship, talks could have helped the U.S. and Iran step back from the edge, build trust and perhaps develop better political relations – even if an actual deal remained out of reach.

Instead, Trump opted to go a different route.

This article includes sections originally published by The Conversation U.S. on Feb. 17, 2026.

Nina Srinivasan Rathbun does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. Failure of US-Iran talks was all too predictable — but turning to military strikes creates dangerous unknowns – https://theconversation.com/failure-of-us-iran-talks-was-all-too-predictable-but-turning-to-military-strikes-creates-dangerous-unknowns-277209

Source: The Conversation – USA – By Kevin B. Smith, Professor of Political Science, University of Nebraska-Lincoln

If you gathered every American with a prison record into one contiguous territory and admitted it to the union, you would create the 12th-largest state. It would be home to at least 7 million to 8 million people and hold a dozen votes in the Electoral College.

In a close presidential race, this hypothetical state of the formerly incarcerated could decide who wins the White House.

It may sound far-fetched to conceive of former felons determining the outcome of a presidential election, not by voting but by failing to vote. But there’s a real chance they already have – not just once, but twice. That’s in addition to affecting the outcomes of some U.S. Senate and gubernatorial elections.

I am a political scientist with a long-standing interest in the question of why mass incarceration rates vary so widely across states. My 2024 book, “The Jailer’s Reckoning,” explores that question and measures its political, social and economic impacts.

One of my findings is that the sheer number of people who’ve cycled through prisons over the past 40 years is influencing election outcomes.

Scholars vigorously debate the reasons why the United States locks up more of its citizens than any other liberal democracy, or even most authoritarian regimes. Less examined are the consequences of this decades-long social experiment in mass incarceration.

The consequences, however, likely include affecting the results of close elections. Incarceration certainly plays a key role in depressing voter turnout, which lags, in no small part, because felony convictions have made so many people ineligible.

Mass incarceration has led to a fast-growing bloc of citizens who either are legally barred from voting or have just stopped bothering. Under the right circumstances, this slice of the electorate is large enough to tip an election.

Imprisonment and the franchise

Felony conviction reduces political engagement, sometimes entirely. Inmates are legally barred from voting in all but two states, Maine and Vermont. Ten states bar ex-felons from voting either permanently or for some period of time, depending on the crime, absent unusual circumstances such as a governor’s pardon.

In Idaho, Oklahoma and Texas, a criminal record means that as many as 1 in 10 citizens are ineligible to vote. Among Black Americans, that number can jump to 1 in 5.

However, even when legally eligible, ex-convicts rarely exercise the right to vote. Turnout rates among this population may be as low as 10%. Contact with the criminal justice system lowers political trust, which in turn reduces the likelihood of political engagement among ex-convicts.

Although scholars debate the exact partisan tilt of this potential constituency, there’s a consensus that it is disproportionately Democratic. The upper end of estimates suggest that if this group showed up to the polls, 70% would cast ballots for Democrats.

Even estimates that are much lower sketch a picture of an alternative political world. In 2000, roughly 7% of Florida’s 11.7 million voting-age residents were disenfranchised due to past convictions. They represented about 800,000 potential voters.

If 10% of them had voted and, say, 55% voted Democratic for president, that would have translated to a 6,000-vote swing for Vice President Al Gore. In reality, Texas Gov. George W. Bush won the state – and with it the presidency – by 537 votes.

Florida Republicans Ron DeSantis and Rick Scott may have owed their initial, tight gubernatorial victories to felony disenfranchisement, since the outcomes could have been much different if former felons had the franchise.

In 2018, Florida voters did approve a constitutional amendment to restore voting rights automatically to most former felons. But a subsequent law requiring felons to pay off fines and fees has kept nearly 1 million Floridians from being able to vote, according to the Sentencing Project, a group that opposes mass incarceration.

An electorate in the shadows

Serving time behind bars or having a felony record is not a social anomaly. It is an increasingly normalized feature of American life.

The most careful scholarly estimate suggests that at least 20 million Americans have served time in prison or lived under felony supervision, or both. That’s now a conservative estimate, as it is based on 2010 data.

Given their lack of voting habits, the millions of people in this group constitute a vast shadow electorate, far larger than the roughly 2% of American citizens legally ineligible to vote due to being currently incarcerated.

These disenfranchised or absent voters are a quiet force with the potential to reshape American democracy. The statistical models in my book show that in statewide races this constituency represents roughly a 1- or 2-percentage-point swing.

That might not sound like much, and in single-party strongholds it is not. In genuinely competitive statewide elections, however, a percentage point or two can be decisive.

Consider the 2016 presidential election. That year, the Electoral College outcome was decided by Michigan, Pennsylvania and Wisconsin. Donald Trump won all three states by less than a percentage point. Again, the outcome could easily have been different if voting rights for former felons were a given.

Kevin B. Smith does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

– ref. The nation is missing millions of voters due to lack of rights for former felons – https://theconversation.com/the-nation-is-missing-millions-of-voters-due-to-lack-of-rights-for-former-felons-273328