Conclusions
Laws represent the combined efforts of our elected leaders and our peers to balance the rights of individuals in society against the rights of society as a whole. Over the past 50 years, these great laws of humanity have had increasing influence on the practice of psychiatry related to conflicts between individual autonomy, provider authority, and state power. Yet most psychiatrists have a limited understanding of relevant state statutes guiding practice related to involuntary hospitalization, particularly with regard to substance use disorders. Civil commitment statutes related to involuntary hospitalization, especially definitions of mental illness and the inclusion or exclusion of substance use disorders, are important legal tools for psychiatrists to use in making treatment decisions. In the case of individuals who are gravely disabled by substance use disorders, involuntary hospitalization may save their lives. Since the 1980s, DSM-III and its progeny, in concert with findings from the past two decades of neuroscience and clinical research, identify substance use disorders in the same category as serious mental illnesses such as schizophrenia and bipolar disorder. Yet the 50 states and D.C. continue to largely address substance use disorders—at least in terms of statutory provisions—as voluntary, self-directed behavior and separate from typical models of treatment for mental illness and from the practice of involuntary hospitalization. These concerns clearly warrant more empirical evidence regarding cost-effectiveness, duration of treatment effect, and the impact of statutory language on clinical practice. Because of recent advancements in clinical practice and research, we advocate for further exploration and discussion among psychiatrists, policy makers, and legal professionals.
บทสรุป Laws represent the combined efforts of our elected leaders and our peers to balance the rights of individuals in society against the rights of society as a whole. Over the past 50 years, these great laws of humanity have had increasing influence on the practice of psychiatry related to conflicts between individual autonomy, provider authority, and state power. Yet most psychiatrists have a limited understanding of relevant state statutes guiding practice related to involuntary hospitalization, particularly with regard to substance use disorders. Civil commitment statutes related to involuntary hospitalization, especially definitions of mental illness and the inclusion or exclusion of substance use disorders, are important legal tools for psychiatrists to use in making treatment decisions. In the case of individuals who are gravely disabled by substance use disorders, involuntary hospitalization may save their lives. Since the 1980s, DSM-III and its progeny, in concert with findings from the past two decades of neuroscience and clinical research, identify substance use disorders in the same category as serious mental illnesses such as schizophrenia and bipolar disorder. Yet the 50 states and D.C. continue to largely address substance use disorders—at least in terms of statutory provisions—as voluntary, self-directed behavior and separate from typical models of treatment for mental illness and from the practice of involuntary hospitalization. These concerns clearly warrant more empirical evidence regarding cost-effectiveness, duration of treatment effect, and the impact of statutory language on clinical practice. Because of recent advancements in clinical practice and research, we advocate for further exploration and discussion among psychiatrists, policy makers, and legal professionals.
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