Financial Equity in Involuntary Treatment for Substance Use Disorders

Involuntary civil commitment for individuals who are chronically impaired as a result of their substance use remains highly controversial. At present, 37 states have legalized this practice. Increasingly, states are allowing private third-parties, such as friends or relatives of the patient, to petition courts for involuntary treatment. One such approach, modeled on Florida's Marchman Act, does not determine status based on the petitioning party's willingness to commit to pay for care. In contrast, Kentucky's approach, widely known as "Casey's Law," predicates such involuntary commitment on the third party's willingness to commit in advance to pay for the patient's treatment. This article reviews the history and current status of existing law on this subject and then argues that psychiatrists should advocate strongly against involuntary substance treatment laws that rely upon third-party pledges of payment.