Substance misuse in psychiatry:
A guide for lawyers

By Bala Mahendra
Reviewed by Jonathan Goodliffe, Solicitor

The author of this book is a consultant psychiatrist who is also qualified as a barrister. He regularly contributes to legal as well as medical journals and acts as an expert witness. This excellent book covers wide ranging medical and substance misuse issues. In legal terms the emphasis is on family and criminal law, although other subject areas such as contract and employment law are also considered.

This is not, however, just a book for lawyers. It is as good an introduction and overview as I have ever seen to the subject of substance misuse, with more emphasis than usual on the relationship between misuse and psychiatric disorders.

There is a detailed general introduction and a glossary for difficult expressions. There are then separate chapters on the leading drugs (other than nicotine) covering clinical, behavioural, assessment, management and prognosis issues, as well as medico-legal considerations.

The longest chapter (40 pages) is on alcohol. It contains, among other things, a balanced consideration of conflicting theories.

The style of this book makes for interesting and stimulating reading. This is partly because it challenges the lay reader to understand the clinical issues and how they relate to the behavioural side of substance misuse. It also considers, in layman’s language, some of the fi ner points which arise in the law. One of the reasons I fi nd it valuable is because my own interest in the subject has tended to be focused on alcohol. I am conscious that the study of problems relating to alcohol should recognise the wider drug context and that people are increasingly misusing more than one substance.

There are many insights and throw away lines in this book that have a wider interest. For instance the author refers to a Court of Appeal judgment (R v Mental Health Act Commission ex parte X (1988) 9 BMLR 77) on the Mental Health Act 1983. It may also be relevant to the interpretation of substance misuse exclusion clauses in insurance policies.

On the subject of cocaine, the author remarks:

‘It has been suggested – with little by way of any hard evidence emerging – that upheavals which are a periodic feature in fi nancial markets are occasionally due to a single trader or a group of these who have been emboldened in undue risk-taking by the intake of illicit substances, in particular cocaine, rumoured to be the substance of choice in the City of London and other fi nancial centres.’

Could the lack of hard evidence relate to the difficulty of investigating the subject and the fact that it has not been a sufficiently popular focus of evidence based research? Or should the lack of evidence be taken to suggest that the proposition is unfounded? If one were to expand the area of enquiry from financial markets strictly speaking into banking and insurance, would cocaine rather than alcohol really emerge as the primary substanceof choice? The financial downfall of Robert Maxwell, for instance, as well as his ultimate death, may have had at least something to do with his very heavy drinking.

‘Substance misuse in psychiatry - A guide for lawyers’
ISBN13: 9781846611476
Published by Jordan Publishing Ltd, £50
(discounted to £47.50 on Amazon).
By Bala Mahendra