Hall Kathleen Thomsen, Appelbaum Paul S
Department of Psychiatry, University of Massachusetts Medical School, Worcester 01655, USA.
J Am Acad Psychiatry Law. 2002;30(1):33-45; discussion 46-8.
Policymakers in the United States have long been perplexed by how to deal with substance abuse. As attitudes shifted in the 19th century toward viewing substance abuse as a medical problem akin to insanity rather than as a moral failing, greater emphasis was given to the potential for treatment. Thus, by the middle of the 19th century, states began developing substance abuse commitment codes and institutions to which substance abusers could be committed. Public ambivalence over whether substance abusers should be seen as having an illness or a weakness of will, however, was reflected in the lack of sustained support for these efforts, in contrast to support accorded systems for commitment of the mentally ill. Contemporary policymakers are faced with the same ambivalence, as they struggle with the extent to which substance abusers ought to be subjected to involuntary treatment. The legacy of the early years of substance abuse commitment lives on.
长期以来，美国的政策制定者一直对如何应对药物滥用问题感到困惑。随着19世纪人们的态度转向将药物滥用视为类似于精神错乱的医学问题，而非道德缺陷，人们更加重视治疗的可能性。因此，到19世纪中叶，各州开始制定药物滥用收治法规和机构，药物滥用者可以被送往这些机构。然而，公众对于药物滥用者应被视为患有疾病还是意志薄弱存在矛盾态度，这反映在对这些努力缺乏持续支持上，与对精神病收治系统的支持形成对比。当代政策制定者也面临同样的矛盾态度，因为他们在努力确定药物滥用者应在多大程度上接受非自愿治疗。早期药物滥用收治的遗留问题依然存在。
