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Research ArticleRegular Articles

Nature and Utilization of Civil Commitment for Substance Abuse in the United States

Paul P. Christopher, Debra A. Pinals, Taylor Stayton, Kellie Sanders and Lester Blumberg
Journal of the American Academy of Psychiatry and the Law Online September 2015, 43 (3) 313-320;
Paul P. Christopher
Dr. Christopher is Assistant Professor, Department of Psychiatry and Human Behavior, and Taylor Stayton is a medical student, Alpert Medical School, Brown University, Providence, RI. Dr. Pinals is Assistant Commissioner, Forensic Services, and Mr. Blumberg is General Counsel, Massachusetts Department of Mental Health, Boston, MA. Dr. Pinals is also Associate Professor, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA. Ms. Sanders is a trial attorney, Committee for Public Counsel Services, Greater Boston Area, Boston, MA. Early study results were presented at the 164th Annual Meeting of the American Psychiatric Association in May 2011 and the 43rd Annual Meeting of the American Academy of Psychiatry and the Law in October 2012. Dr. Christopher received funding from NIDA (K23 DA034030).
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Debra A. Pinals
Dr. Christopher is Assistant Professor, Department of Psychiatry and Human Behavior, and Taylor Stayton is a medical student, Alpert Medical School, Brown University, Providence, RI. Dr. Pinals is Assistant Commissioner, Forensic Services, and Mr. Blumberg is General Counsel, Massachusetts Department of Mental Health, Boston, MA. Dr. Pinals is also Associate Professor, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA. Ms. Sanders is a trial attorney, Committee for Public Counsel Services, Greater Boston Area, Boston, MA. Early study results were presented at the 164th Annual Meeting of the American Psychiatric Association in May 2011 and the 43rd Annual Meeting of the American Academy of Psychiatry and the Law in October 2012. Dr. Christopher received funding from NIDA (K23 DA034030).
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Taylor Stayton
Dr. Christopher is Assistant Professor, Department of Psychiatry and Human Behavior, and Taylor Stayton is a medical student, Alpert Medical School, Brown University, Providence, RI. Dr. Pinals is Assistant Commissioner, Forensic Services, and Mr. Blumberg is General Counsel, Massachusetts Department of Mental Health, Boston, MA. Dr. Pinals is also Associate Professor, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA. Ms. Sanders is a trial attorney, Committee for Public Counsel Services, Greater Boston Area, Boston, MA. Early study results were presented at the 164th Annual Meeting of the American Psychiatric Association in May 2011 and the 43rd Annual Meeting of the American Academy of Psychiatry and the Law in October 2012. Dr. Christopher received funding from NIDA (K23 DA034030).
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Kellie Sanders
Dr. Christopher is Assistant Professor, Department of Psychiatry and Human Behavior, and Taylor Stayton is a medical student, Alpert Medical School, Brown University, Providence, RI. Dr. Pinals is Assistant Commissioner, Forensic Services, and Mr. Blumberg is General Counsel, Massachusetts Department of Mental Health, Boston, MA. Dr. Pinals is also Associate Professor, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA. Ms. Sanders is a trial attorney, Committee for Public Counsel Services, Greater Boston Area, Boston, MA. Early study results were presented at the 164th Annual Meeting of the American Psychiatric Association in May 2011 and the 43rd Annual Meeting of the American Academy of Psychiatry and the Law in October 2012. Dr. Christopher received funding from NIDA (K23 DA034030).
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Lester Blumberg
Dr. Christopher is Assistant Professor, Department of Psychiatry and Human Behavior, and Taylor Stayton is a medical student, Alpert Medical School, Brown University, Providence, RI. Dr. Pinals is Assistant Commissioner, Forensic Services, and Mr. Blumberg is General Counsel, Massachusetts Department of Mental Health, Boston, MA. Dr. Pinals is also Associate Professor, Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA. Ms. Sanders is a trial attorney, Committee for Public Counsel Services, Greater Boston Area, Boston, MA. Early study results were presented at the 164th Annual Meeting of the American Psychiatric Association in May 2011 and the 43rd Annual Meeting of the American Academy of Psychiatry and the Law in October 2012. Dr. Christopher received funding from NIDA (K23 DA034030).
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    Figure 1.

    Existence and utilization of civil commitment statutes for substance abuse in the United States July 2010 through October 2012.

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    Table 1

    Substantive Criteria and Evidentiary Standards in Civil Commitment Statutes for Substance Abuse

    CriterionStatute Exists, Used Regularly (n = 14)Statute Exists, Extent of Use Unknown (n = 6)Statute Exists, Used Rarely or Never (n = 13)All States With Statute (n = 33)
    Dangerous to others1461333
    Dangerous to self1461232
    Needs treatment*76922
    Gravely disabled or incapacitated103619
    Intoxicated/addicted†847‡19‡
    Loss of self-control§63918
    Lack of decisional capacity52613
    Danger to property112‡4‡
    Pregnant and abusing11–2
    Prior failed treatment211‖4‖
    Evidentiary Standard
    Clear and convincing115622
    Probable cause, reasonable basis1–45
    Other or unspecified standard2135
    • All values denote number of states.

    • ↵* Includes requirement that treatment is deemed necessary to treat addiction, the patient is expected to benefit from treatment, or treatment is expected to prevent other negative outcomes.

    • ↵† Substance abuse alone (either chronic or acute) is sufficient for commitment.

    • ↵‡ Includes one state in which the criterion is listed only for alcohol or drug use.

    • ↵§ Demonstrates a repeated pattern of failing to meet social, financial, or occupational responsibilities.

    • ↵‖ Required by one state for outpatient commitment only.

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    Table 2

    Maximum Length of Initial and Subsequent Commitment and Commitment Setting in States With Civil Commitment Statutes for Substance Abuse

    Commitment Periods and SettingStatute Exists, Used Regularly (n = 14)Statute Exists, Extent of Use Unknown (n = 6)Statute Exists, Used Rarely or Never (n = 13)All States with Statute (n = 33)
    Maximum initial commitment period*
            Up to 1 month2–24
            1–2 months5†117†
            2–3 months523‡10‡
            3–6 months226‡8‡
            6–12 months1†–12†
            Longer than 1 year or indefinite–12‡3‡
    Maximum subsequent commitment period*
            1–2 months2–1‡3‡
            2–3 months713‡11‡
            3–6 months116‡8‡
            6–12 months3227
            >1 year1––1
            Not applicable§–23‡5‡
    Commitment setting
            Inpatient only413‡8‡
            Inpatient or outpatient959‡23‡
            Unspecified1–23
    • ↵* Every 30 days = 1 month. Thus, 60 days = 2 months, 90 days = 3 months, etc.

    • ↵† Includes one state in which the maximum period for inpatient and outpatient commitment differ.

    • ↵‡ Includes one or more states in which the maximum commitment period for alcohol and drug use differ.

    • ↵§ The review process for ongoing commitment is neither judicial nor quasi-judicial in nature (e.g., falls under the authority of the state's mental health department).

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Journal of the American Academy of Psychiatry and the Law Online: 43 (3)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 43, Issue 3
1 Sep 2015
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Nature and Utilization of Civil Commitment for Substance Abuse in the United States
Paul P. Christopher, Debra A. Pinals, Taylor Stayton, Kellie Sanders, Lester Blumberg
Journal of the American Academy of Psychiatry and the Law Online Sep 2015, 43 (3) 313-320;

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Nature and Utilization of Civil Commitment for Substance Abuse in the United States
Paul P. Christopher, Debra A. Pinals, Taylor Stayton, Kellie Sanders, Lester Blumberg
Journal of the American Academy of Psychiatry and the Law Online Sep 2015, 43 (3) 313-320;
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