Civil commitment among patients with alcohol and drug abuse: Practical, conceptual, and ethical issues

OBJECTIVES: The authors sought to examine the conceptual and public policy underpinnings of involuntary treatment for individuals who engage in alcohol and/or substance abuse. METHODS: The authors reviewed the relevant scientific and legal literature with a focus on the state of Florida, and compared and contrasted civil commitment statutes for addiction patients with those for patients with severe mental illness. RESULTS: Aside from episodes of acute intoxication and withdrawal delirium, most individuals with addiction disorders are mentally competent. This finding raises serious ethical questions about the detention of individuals with substance abuse disorders against their will. CONCLUSIONS: Treatment for alcohol and drug abuse requires a concerted, multidisciplinary strategy to have a long-lasting impact on the disease process. Although structured and intensive aftercare may carry attendant expenses, it is ultimately more affordable than short-term incarceration and legal proceedings. One potential legal-based treatment alternative would be mandating outpatient involuntary commitment for individuals with severe addictive disorders.