[Combined alcohol dependence and personality disorder and its legal consequences with respect to commitment]

People frequently consuming an excessive amount of alcohol often show symptoms of personality disorder. Personality disorder and alcohol dependence are frequently connected with each other. However, there are only very few conditions enhancing concomitant dependence and personality disorder to the rank of a mental disease according to German guardianship legislation. If the patient's condition meets the criteria of a psychic disease and endangers his own health and public safety, commitment to a mental hospital or guardianship are justified. The purpose of this clinical analysis was to compare the medical proposal for treatment with legal prerequisites which are indispensable for involuntary admission to a mental hospital. Whereas the Psychiatric Disorders Act intends to avert danger to the public, guardianship legislation aims at individual help. We present a patient who suffered from alcoholism and simultaneously met criteria of a serious personality disorder, which was classified according to ICD-10 (F 60.31). As the aggravation of the symptoms was most likely to entail serious danger to his health the judge ordered immediate involuntary admission. Two other patients had similar comorbidity but had to be released from hospital because of finalisation of detoxification. Neither dependence nor personality disorder were pronounced enough to restrict the rights of the individual. Our analysis shows that the psychiatrist must present with an expert medical report that quantifies the extent of alcoholism and personality disorder and characterises them as psychic disease. Consequently, for the purpose of quantifying the extent of dependence, we recommend to apply the European Addiction Severity Index whose suitability should be assessed.