Forensic and medical legal issues in addiction psychiatry

The forensic aspects of addiction psychiatry often are seen by the addiction psychiatrist as challenging or intrusive. In part, this is because forensic issues flow from the law, not medicine, and may be experienced by psychiatrists as foreign and unwelcome. Forensic psychiatry addresses the intersection of psychiatry and the law. In this area of psychiatry, practitioners are more comfortable with legal matters. The law, which is a dynamic and varied body of courts, cases, statutes, and regulations, is often less than comfortable with issues of psychiatric and addictive illness. The relevance of mental illness to legal matters has been the subject of discussion for centuries, most notably in law regarding criminal responsibility. Historically, addictive illness as a subset of mental illness has had a less favorable legal reception. It is only relatively recently that addictive problems been seen as something other than a form of moral weakness or depravity. Because of the voluntary element in the act of substance consumption, the legal sphere remains in many ways resistant to the idea that addiction is a disease. In forensic psychiatric circles, lively debate continues about the implications and applications of the disease concept of addiction and about the nature of the volitional aspects of substance use and the role of responsibility in addictive illness [1]. To the extent that the addiction psychiatrist becomes involved in forensic issues, he or she also is practicing forensic psychiatry. For instance, managing the special confidentiality requirements for patients suffering from addictive illness requires forensic expertise and knowledge of the federal confidentiality statute. Moreover, addiction psychiatrists frequently venture into the forensic realm when they are asked to give opinions about disability, whether a patient can give informed consent for treatment, or whether an intoxicated individual could form the specific intent to commit a crime. From working with addicted and dually diagnosed people and regulatory agencies that provide addiction services in correctional settings, addiction psychiatrists work in the forensic world. Because of the enormous scope of forensic issues in addiction psychiatry, in this article, the material will be organized according to the forensic context, rather than according to the situation in which addiction psychiatrists might find themselves depending on their area of practice. Some of the essential differences between the style of thinking and nature of practice in forensic contexts compared with usual clinical thinking in addiction psychiatry practice also will be reviewed briefly. Following this review, the article will divide forensic issues into those that arise in civil, criminal, and regulatory environments. Finally, the article will discuss liability in doing forensic work. Certain forensic issues and aspects of forensic practice will not be discussed, including matters pertaining to working with attorneys, preparation for and the giving of testimony, and similar subjects. The reader is referred to forensic psychiatry texts or other works for this information [2,3].