Chapter 49. Forensic Addiction Psychiatry

Avram H. Mack, M.D.; Monica Barros, M.D.
DOI: 10.1176/appi.books.9781585623440.359350



There is an increasing probability that the addiction clinician will, willingly or not, come into contact with legal issues in the course of practice. This reflects many trends, including the widespread use of substances of abuse, increases in the prison population, increase in litigation, and professional interest in forensic psychiatry. After all, violence, suicide, interpersonal conflicts, lawsuits, psychiatric commitment, and even crimes (and sentences) are often a part of the lives of those who misuse substances. Traditionally, such involvement has been divided into the realm of either the expert forensic consultant or the clinician. With the growth of systems for mandated treatment as "diversion" from judicial interventions (e.g., drug courts; see Chapter 33 in this volume, "Community-Based Treatment"), this dichotomy has been blurred further, and many more addiction psychiatrists may be formally engaged in forensic psychiatry. At a minimum, such work requires solid clinical skills, but it also requires an adequate familiarity with one's role in the legal system.

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Table Reference Number

Being engaged in forensics has risks and liabilities.

Know your audience to communicate suitable information.

Substances of abuse increase the risk of violence in individuals.

Correctional settings vary in the status of the individual.

Special types of mandated treatment and "diversion" may have effects on reducing recurrent criminal behavior.


Abram KM, Teplin LA, McClelland GM: Comorbidity of severe psychiatric disorders and substance abuse disorders among women in jail. Am J Psychiatry 160:1007–1010, 2003
American Academy of Psychiatry and the Law: Ethics guidelines for the practice of forensic psychiatry. Adopted May 2005. Available at: http://www.aapl.org/pdf/ETHICSGDLNS.pdf. Accessed April 13, 2007
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000a
American Psychiatric Association: Psychiatric Services in Jails and Prisons, 2nd Edition. Washington, DC, American Psychiatric Association, 2000b
Arseneault L, Moffitt T, Caspi A, et al: Mental disorders and violence in a total birth cohort: results from the Dunedin study. Arch Gen Psychiatry 57:979–986, 2000
Baillargeon J, Wu H, Kelley MJ, et al: Hepatitis C seroprevalence among newly incarcerated inmates in the Texas correctional system. Public Health 117:43–48, 2003
Baron D, Baron DA, Baron R: Testing for substances, in Clinical Textbook of Addictive Disorders, 3rd Edition. Edited by Frances R, Miller SI, Mack AH. New York, Guilford, 2005, pp 63–71
Belenko S, Peugh J: Estimating drug treatment needs among state prison inmates. Drug Alcohol Depend 77:269–281, 2005
Binder RL: Liability for the psychiatrist expert witness. Am J Psychiatry 159:1819–1825, 2002
Bird SM, Hutchinson SJ: Male drugs-related deaths in the fortnight after release from prison: Scotland, 1996–99. Addiction 98:185–190, 2003
Budney AJ, Hughes JR, Moore BA, et al: Review of the validity and significance of cannabis withdrawal syndrome. Am J Psychiatry 161:1967–1977, 2004
Bushman BJ, Cooper HM: Effects of alcohol on human aggression: an integrative research review. Psychol Bull 107:341–354, 1990
Council of State Governments: Criminal Justice/Mental Health Consensus Project. New York, Council of State Governments, 2002
Dave BP: Flying under the influence of alcohol. J Clin Forensic Med 11:12–14, 2004
Downs L, Billick SB: Involuntary intoxication. J Am Acad Psychiatry Law 28:368–369, 2000
Eronen M, Hakola P, Tiihonen J: Mental disorders and homicidal behavior in Finland. Arch Gen Psychiatry 53:597–501, 1996
Fleming MF, Anton RF, Spies CD: A review of genetic, biological, pharmacological, and clinical factors that affect carbohydrate-deficient transferrin levels. Alcohol Clin Exp Res 28:1347–1355, 2004
Friedman AS, Glassman K, Terras BA: Violent behavior as related to use of marijuana and other drugs. J Addict Dis 20:49–72, 2001
Friedman AS, Terras A, Glassman K: The differential disinhibition effect of marijuana use on violent behavior: a comparison of this effect on a conventional, non-delinquent group versus a delinquent or deviant group. J Addict Dis 22:63–78, 2003
Garner B: Black's Law Dictionary, 8th Edition. St Paul, MN, Thomson, West, 2003
Gendreau P: Offender rehabilitation: what we know and what needs to be done. Crim Justice Behav 23:144–161, 1996
Gerbasi J, Bonnie R, Binder R: Resource document on mandatory outpatient treatment. J Am Acad Psychiatry Law 28:127–144, 2000
Gossop M, Trakada K, Stewart D, et al: Reductions in criminal convictions after addiction treatment: 5-year follow-up. Drug Alcohol Depend 79:295–302, 2005
Griffith JD, Hiller ML, Knight K, et al: A cost-effectiveness analysis of in-prison therapeutic community treatment and risk classification. Prison J 79:352–368, 1999
Group for the Advancement of Psychiatry, Committee on Psychiatry and Law: The mental health professional and the legal system. Rep Group Adv Psychiatry 131:1–192, 1991
Gutheil TG: The Psychiatrist in Court: A Survival Guide. Washington, DC, American Psychiatric Press, 1998
Gutheil TG, Appelbaum PS: Clinical Handbook of Psychiatry and the Law, 3rd Edition. Philadelphia, PA, Lippincott Williams & Wilkins, 2000
Gutheil TG, Simon RI: Narcissistic dimensions of expert witness practice. J Am Acad Psychiatry Law 33:55–58, 2005
Hagedorn H, Willenbring M: Psychiatric illness among drug court probationers. Am J Drug Alcohol Abuse 29:775–788, 2003
Leonard K, Quigley B: Drinking and marital aggression in newlyweds: an event-based analysis of drinking and the occurrence of husband marital aggression. J Stud Alcohol 60:537–545, 1999
Lifson LE, Simon RI: The Mental Health Practitioner and the Law: A Comprehensive Handbook. Cambridge, MA, Harvard University Press, 1998
Mack AH, Lightdale HA: Substance-related disorders, in The American Psychiatric Publishing Textbook of Suicide Assessment and Management. Edited by Simon RI, Hales RE. Washington, DC, American Psychiatric Publishing, 2005, pp 347–364
Mack AH, Kahn JP, Frances RJ: Addiction in the workplace, in Clinical Textbook of Addictive Disorders, 3rd Edition. Edited by Frances RJ, Miller SI, Mack AH. New York, Guilford, 2005, pp 340–353
Mateyoke-Scrivner A, Webster JM, Staton M, et al: Treatment retention predictors of drug court participants in a rural state. Am J Drug Alcohol Abuse 30:605–625, 2004
Moeller FG, Dougherty DM: Antisocial personality disorder, alcohol, and aggression. Alcohol Res Health 25:5–11, 2001
Monahan J, Redlich AD, Swanson J, et al: Use of leverage to improve adherence to psychiatric treatment in the community. Psychiatr Serv 56:37–44, 2005
Murdoch D, Pihl RO, Ross D: Alcohol and crimes of violence: present issues. Int J Addict 25:1065–1081, 1990
Myers WC, Vondruska MA: Murder, minors, selective serotonin reuptake inhibitors, and the involuntary intoxication defense. J Am Acad Psychiatry Law 26:487–496, 1998
National Commission on Correctional Health Care: Standards for Health Services in Prisons. Chicago, IL, National Commission on Correctional Health Care, 2003
Office of Juvenile Justice and Delinquency Prevention: Screening and Assessing Mental Health and Substance Use Disorders Among Youth in the Juvenile Justice System: A Resource Guide for Practitioners. Available at: http://www.ncjrs.org/pdffiles1/ojjdp/204956.pdf. Accessed March 6, 2005
Peters RH, Greenbaum PE, Edens JF, et al: Prevalence of DSM-IV substance abuse and dependence disorders among prison inmates. Am J Drug Alcohol Abuse 24:573–587, 1998
Robinson v California, 370 US 660 (1962)
Rosner R: Textbook of Forensic Psychiatry, 2nd Edition. New York, Oxford University Press, 2003
Rounds-Bryant JL, Motivans MA, Pelissier BM: Correlates of drug treatment outcomes for African American and white male federal prisoners: results from the TRIAD Study. Am J Drug Alcohol Abuse 30:495–514, 2004
Schuck AM, Widom CS: Childhood victimization and alcohol symptoms in women: an examination of protective factors. J Stud Alcohol 64:247–256, 2003
Shulman KI, Cohen CA, Hull I: Psychiatric issues in retrospective challenges of testamentary capacity. Int J Geriatr Psychiatry 20:63–69, 2005
Sinha R, Easton C: Substance abuse and criminality. J Am Acad Psychiatry Law 27:513–526, 1999
Slovenko R: Psychiatry and Criminal Culpability. New York, Wiley, 1995
Spar JE, Garb AS: Assessing competency to make a will. Am J Psychiatry 149:169–174, 1992
Spunt B, Goldstein P, Brownstein H, et al: The role of marijuana in homicide. Int J Addict 29:195–213, 1994
Steadman HJ, Mulvey EP, Monahan J, et al: Violence by people discharged from acute psychiatric inpatient facilities and by others in the same neighborhoods. Arch Gen Psychiatry 55:393–401, 1998
Swanson JW: Mental disorder, substance abuse, and community violence: an epidemiological approach, in Violence and Mental Disorder: Developments in Risk Assessment. Edited by Monahan J, Steadman HJ. Chicago, IL, University of Chicago Press, 1994, pp 101–136
Swartz MS, Swanson JW, Hiday VA, et al: Violence and severe mental illness: the effects of substance abuse and nonadherence to medication. Am J Psychiatry 155:226–231, 1998
Tanda G, Pontieri FE, Di Chiara G: Cannabinoid and heroin activation of mesolimbic dopamine transmission by a common 1 opioid receptor mechanism. Science 276:2050–2054, 1997
Thomsen Hall K, Appelbaum P: The origins of commitment for substance abuse in the U.S. J Am Acad Psychiatry Law 30:33–45, 2002
Torrey EF: Violent behavior by individuals with serious mental illness. Hosp Community Psychiatry 45:653–662, 1994
United Nations: World Drug Report. 1997. Available at: http://www.un.org/ga/20special/wdr/e_hilite.htm. Accessed January 12, 2007
United States v Booker, 543 US 220 (2005)
van Oorsouw K, Merckelbach H, Ravelli D, et al: Alcoholic blackout for criminally relevant behavior. J Am Acad Psychiatry Law 32:364–370, 2004
Wagenaar AC: Liability of commercial and social hosts for alcohol-related injuries: a national survey of accountability norms and judgments. Public Opin Q 65:344–368, 2001
Wagenaar AC, Toomey TL: Effects of minimum drinking age laws: review and analyses of the literature from 1960 to 2000. J Stud Alcohol Suppl 14:206–225, 2002
Weinstein H, Kim D, Mack A, et al: Prevalence and assessment of mental disorders in correctional settings, in Handbook of Correctional Mental Health. Edited by Scott C. Washington, DC, American Psychiatric Publishing, 2005, pp 43–68

CME Activity

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Sample questions:
In forensic practice, the clinician needs to be mindful of the possible differences in the definitions of common clinical terms. Which of the following statements is false?
The relationship between mental illness, substance abuse, and violent behavior remains controversial. Which of the following statements is false?
Which of the following is not an example of a circumstance where a drug-using defendant may claim involuntary intoxication as a criminal defense strategy?
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