United States law: Alcoholism as a defence in criminal cases

The subject of alcoholism as a defence to criminal charges is explained in the article:  Alcoholism as a Defense to Crime.  The general point made in the article is that the law has adopted an approach similar to the English approach of accepting alcohol intoxication as a defense to crimes of specific intent but not general intent.

Courts have done this because they have found it difficult to categorise alcoholism as an illness.  Here’s what the paper says about alcoholism as a disease:

“…chronic alcoholism, when designated as a disease, is not a disease in the same sense as tuberculosis or cancer. For example, the World Health Organization was not contemplating a physical illness when it announced that alcoholics are those excessive drinkers whose dependence upon alcohol has attained such a degree that it shows a noticeable mental disturbance or an interference with their bodily and mental health, their interpersonal relations, and their smooth social and economic functioning; or who show the prodromal signs of such developments.47

Disease is used in this context to refer to the uncontrolled, apparently compulsive, and self-harming characteristics of the alcoholic’s drinking patterns. One of the difficulties with a definition that speaks of “interpersonal relations” and “smooth social and economic functioning” is that no lesion can be identified to show the existence of the disease. Thus, a court is unable to see the differences between an alcoholic and a normal excessive drinker. The problem is complicated by the fact that medical experts have not reached a consensus on the precise nature and manifestations of alcoholism. Dr. Ruth Fox, a leading authority on alcoholism, points out that

There is disagreement as to how to define, classify, and diagnose alcoholism. Gather two dozen experts together for the purpose of stating scientifically what it is they are expert in, and you will quite likely be confronted with, if not as many definitions, at least half-a-dozen, each quite useful in its own way, but each differing from the other.4

In addition to the difficult problem of defining and diagnosing alcoholism, physicians themselves are not absolutely unanimous that alcoholism is a disease. Many of them still consider it a habit or a complex personal condition resulting from the individual’s inability to adjust satisfactorily to the social environment. 9 This lack of agreement among the experts as to the nature, etiology, manifestations, and symptoms of chronic alcoholism is also largely responsible for the lack of knowledge concerning the proper methods of medical treatment for the condition.5 ” It certainly presents enormous difficulties for a court in determining the criminal responsibility of the alleged chronic alcoholic.”

The paper sets out the difficulty faced by courts in dealing with alcohol related offending and that it is not enough to show that a person is an alcoholic to avoid conviction for  a criminal offence:


“To raise a valid defense, it is obviously not sufficient for the defendant to show merely that he is an alcoholic. As Hutt and Merrill observe, the alcoholic defendant “would have to show (1) that he was so intoxicated that he was unable to control his activity, and (2) that it was his intoxication rather than some other cause that led to the act with which he is charged.””‘ In light of current medical knowledge on alcoholism, both questions will present difficult problems in factual determination. An alcoholic, unless psychotic or otherwise mentally deranged, does not lose his ability to evaluate spheres of reality so as to enable him to raise an insanity defense under the M’Naghten rule. Nor does the compulsion to drink distort his thought processes and power of self-control in other unrelated areas of behavior. Moreover, although medical experts are generally agreed in calling alcoholism a disease, the unanimity disappears on the question of what kind of disease it is. Many psychiatrists are reluctant to call alcoholism a mental disease, though they concede that mental disturbance is one of the characteristic traits of alcoholism. Even assuming that alcoholism is a mental illness, it is only remotely similar to familiar forms of insanity, and would hardly be accepted as a proper basis for an insanity defense under any of the existing legal tests. The conclusion seems obvious. To establish a constitutional defense of chronic alcoholism to prosecution for public intoxication would not inevitably make alcoholism a constitutional defense to other serious crimes, nor impose on state courts a constitutional doctrine of criminal insanity.1”


I have attempted to address these issues in my paper,  Medico-legal Aspects of High Dose Baclofen in Criminal and Family Law Cases.   The theory behind baclofen explains how alcoholism is, in fact, a disease and this eliminates much of the difficulty in determining whether a person under the influence of alcohol is suffering from an illness which can affect the mental element of an offence.  The theory suggests that in alcoholism there is an anxiety disorder which has a neurological origin. This should suffice to allow courts to consider whether an offender may have a mental impairment which should be taken into account.  Not all alcohol consumption is a result of this illness, however.   My paper goes on to give guidance on when to raise alcohol consumption in relation to an offence as an indicator of an underlying illness.  I have used DSM 5 criteria to guide practitioners and courts as to what to look for in an offender’s history to determine whether an illness is present.  Expert evidence of a doctor with experience in alcoholism and baclofen treatment can then be elicited to support the defense.





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