Inpatient treatment of the mentally ill substance abuser: some medicolegal concerns.

Alcohol and drug abuses complicate medicolegal issues in psychiatry by blurring the boundaries between medicine and law. Furthermore, the usual tests for the applicability of either legal or medical measures often cannot be applied to the dually diagnosed. Specific quandaries arise with involuntary hospitalization and treatment, and with evaluating patients for the courts. The author discusses these problems, introducing the concept of state-dependent competency, using a case vignette to illustrate several points. Legal theories of behavior assume freedom of action; medical theories assume determinism. Phenomena of addiction defy such distinctions and thus may pose difficulties that cannot reliably be assigned either a medical or a legal remedy.