Psychoactive substance use in forensic psychiatry

Objective: The purpose of this article is to discuss the interface between judicial discipline and behavioral science in the context of substance-related disorders. Method: We review the epidemiology of psychoactive drug use and crime and discuss the courts' decisions on relevant landmark cases, particularly as they influence the practice of psychiatry. Results: (1) The phenomenology of addiction and crime is of great epidemiological import. (2) Our legal system inclines toward the view that the use of alcohol or other substances involves an element of choice and therefore would not amount to a legal insanity defense if the substance abuser commits a crime while intoxicated. (3) A state can confine an addict or alcoholic for compulsory treatment if that individual presents a danger to self or others. (4) The law has found that alcoholism and drug abuse are both ''willful misconduct'' and a disabling condition; the former definition contains the end in view of punitive action. The latter is aimed toward treatment and rehabilitation. (5) The law gives the right to the employer to test a suspected employee for drug abuse. The addicted or alcoholic employee has the choice to either go for treatment or face job termination. (6) Our judicial system gives serious consideration to the welfare of a child whose parents are alcoholic or drug addicted. Conclusion: The two disciplines of psychiatry and law follow their own modes in resolving issues in alcoholism and other substance abuse. We need research and new approaches to build a bridge between the two.