Allowing drug addicts to ‘die with the rights on’ is the real ‘disease’ in the drug crisis!
It is my opinion that involuntary treatment must have a prominent place in the treatment of addictive disorders. Generations in the future will look back on our response to the addiction epidemic and say, “What were they thinking”? Allowing addicted individuals to “die with their rights on” is the true iatrogenic disease of our time. Lawyers and advocates lobby for individual rights while individuals are dying by the thousands.
We as a society are allowing patients with “diseases of their brains” to make poor decisions with the very same brains that are diseased in order to protect their free will. We know forced treatment and contingent treatment works especially while the individual is recovering from short- and long-term drug effects.
Most aggressive patients are playing out a script of violence that has happened over and over in their lives. If you know the script, you are way ahead of the game when planning treatment options. The dance of aggression is specific to each patient and the drug is merely a catalyst that speeds up or disinhibits the process. Most drugs of abuse increase aggressive behavior, including THC intoxication and withdrawal, which is commonly present in the patients we evaluate who have been charged with serious crimes of violence.
Are some drug related crimes ever considered in an insanity defense or not? Why? Some examples of drug-related paranoid psychotic homicides include the Manson family. What makes one murderer, who committed their crime under-the-influence, not guilty by reason of insanity and another guilty with mitigating factors?
Most state statutes and federal law look down on insanity pleas that are associated with chronic substance use. Exceptions can include “involuntary intoxication” that is out of the defendants control. The horrific story of the Manson family and routine heavy LSD and alcohol use is one example. The Manson Girls and Tex could not sell an insanity defense because of their chronic voluntary use. If the murders had occurred after a single or first use of LSD, they might have had a chance at insanity as a defense. Historically, voluntary intoxication has been frowned upon by most cultures since recorded history.
Lord Chief Justice Matthew Hale in 1736 wrote, “ A person who commits an offense while he or she is afflicted with dementia affectata (intoxication), shall have no privilege by the voluntary contracted madness, but shall have the same judgment as if he were in his right senses.” This dictum has become know as the voluntary intoxication exclusion.
Narcan is no substitute for a good psychiatric assessment to include a suicide risk assessment. Narcan wakes the patient up to the same reality they were experiencing before they overdosed. A psychiatric assessment and suicide risk assessment gives the treatment team the tools they need to design a program of resilience and recovery.
John Thompson, MD – Professor, Chair, and Director, Division of Forensic Neuropsychiatry
Founding Director, Fellowship in Forensic Psychiatry; Tulane University School of Medicine