Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

360 IV. SPECIAL POPULATIONSDisabilityClaims for disability insurance (whether through the state or a private organization)may be based on a claim of addiction. Each case is decided on its ownmerits, but addiction psychiatrists are naturally the experts of choice. If the casegoes to court, the expert would seem essential. Complex management of addictionsin pain cases requires expertise to sort out whether or not return to work isindicated or possible.Other areas in which an addiction psychiatrist may have special expertiseinclude malpractice cases, either when a patient alleged that a physician made apatient become addicted, or when the physician was impaired by substances.Since workplace actions frequently lead to legal consequences, the addictionpsychiatrist is frequently involved in consultation regarding the workplace(Chapter 15, this volume). Sexual harassment cases may be brought in eithercriminal or civil settings and addictions may be raised as in issue in such cases aswell.ADDICTION AND CORRECTIONAL PSYCHIATRYThe nationwide decline in crime has been associated with a rise in the numberof incarcerated Americans, and a great proportion of these individuals haveactive SUDs or are dually diagnosed. It is important for a psychiatrist to reviewthe issues of correctional psychiatry, so that he or she may be prepared to adviseon screening, treatment, and recommendations for release. Basic guidelineshave been delineated for correctional facilities both by the American PsychiatricAssociation Manuscript (American Psychiatric Association, 2000b) and theNational Commission on Correctional Health Care (2003).There are three very different incarceration settings: lockup (upon arrest),jail (following arraignment, during trial, prior to sentencing, or in sentences ofup to 1 year), and prison (postsentencing more than 1 year). Psychiatric issuesdiffer greatly among these settings (Weinstein, Kim, Mack, Malavade, &Saraiya, in press). SUDs present different pictures in each setting.Correctional Center EpidemiologySubstance use and SUDs are essentially epidemic among the incarcerated.Peters, Greenbaum, Edens, Carter, and Ortiz (1998) found that 74% of inmatesin the U.S. criminal justice system have a lifetime DSM-IV SUD. Abram andTeplin (1991) found that a large majority of male jail detainees with severemental disorders had a co-occurring SUD at some point in their lifetime. Morethan half who had current severe psychiatric disorders had a co-occurring SUDor had used a substance at the time of arrest. These prevalence rates were signif-