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Beyond a Moment in Time: Rethinking Capacity and Compassion in Addiction Psychiatry.

Anees Bahji1

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Summary

Decision-making capacity in addiction is not static but a dynamic process influenced by neurobiology and environment. Understanding this fluctuating capacity is key to restoring patient autonomy and guiding ethical interventions.

Keywords:
Addiction PsychiatryAutonomyCapacity AssessmentDecision-Making CapacityInvoluntary TreatmentRelational EthicsSubstance use Disorders

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Area of Science:

  • Psychiatry
  • Neuroscience
  • Bioethics

Background:

  • Conventional models view decision-making capacity as a fixed, binary state.
  • This static approach inadequately addresses the complexities of capacity in addiction.

Purpose of the Study:

  • To challenge the traditional understanding of decision-making capacity in addiction psychiatry.
  • To propose a dynamic, temporal, and relational framework for assessing capacity.

Main Methods:

  • Clinical experience synthesis.
  • Ethical theory application.
  • Review of neurobiological and social influences on judgment.

Main Results:

  • Decision-making capacity in addiction is a fluctuating, context-dependent process.
  • Substance use disorders destabilize cognitive and affective systems, impacting judgment.
  • Traditional discrete assessments fail to capture this instability.

Conclusions:

  • Capacity should be understood as a dynamic process, not a static trait.
  • Meaningful autonomy requires considering trajectory, support systems, and enabling conditions.
  • Policy should consider time-limited interventions to restore agency and ethical care.