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Origins of Commitment for Substance Abuse in the United States

NCJ Number
194633
Journal
Journal of the American Academy of Psychiatry and the Law Volume: 30 Issue: 1 Dated: 2002 Pages: 33-45
Author(s)
Kathleen T. Hall M.D.; Paul S. Applbaum M.D.
Date Published
2002
Length
13 pages
Annotation
This article describes the origins of substance abuse commitment codes in the United States. It follows the evolution of discourse concerning substance abuse from a moral offense to be remedied through arrest and incarceration to a medical problem best handled with treatment.
Abstract
This article contends that the history of substance abuse commitment legislation began in post-Revolution America where alcohol misuse was at first considered a moral offense. Those who abused alcohol at this time were likely arrested and incarcerated. By the 19th century, the social welfare and public health movements helped to reshape the way society viewed alcohol abuse; personal volition became an issue as public understanding shifted to consider alcoholism as a medical problem requiring treatment rather than punitive punishment. However, opposition to medical alternatives remained, with the main argument being that alcoholism was a vice and morality could not be legislated. Despite the opposition, the article reports that 14 States enacted substance commitment codes in the last half of the 19th century. This article illustrates it's main points by offering three case studies in the States of New York, Massachusetts, and Minnesota. In New York, legislation was adopted in 1864 to allow for the detention of those who voluntarily committed themselves to the New York facility for treatment. However, the courts in New York struck down this legislation, ruling that due process principles were violated in detaining voluntary patients. In 1867 New York became one of the first States to allow substance abusers in police custody to be remanded to treatment facilities in lieu of incarceration. The Massachusetts case study describes an 1885 statute permitting the commitment and treatment of substance abusers in State insane asylums. The result was that State hospitals became overcrowded with substance abusers who were housed alongside of the truly mentally insane. The third case in Minnesota describes how the county government was required to take on the financial burden of treating substance abusers who were ordered by the court to voluntarily commit themselves for treatment. As problems with this system mounted, the courts found that commitments under these circumstances were unconstitutional. The authors conclude by suggesting that substance abuse commitment legislation in the 19th century did not have the curative results promised by the medical community. Issues of the nature of substance abuse, the role of coercion in treating such abuse, and the usefulness of treatments remain on-going debates in public policy making.

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