Concomitance of alcohol dependence and personality disorder: Legal consequences in respect of guardianship

People frequently consuming an excessive amount of alcohol often show sympt oms of personality disorder. Personality disorder and alcohol dependence ar e frequently connected with each other. However, there are only very few co nditions enhancing concomitant dependence and personality disorder to the r ank of a mental disease according to German guardianship legislation. If th e patient's condition meets the criteria of a psychic disease and endangers his own health and public safety, commitment to a mental hospital or guard ianship are justified. The purpose of this clinical analysis was to compare the medical proposal for treatment with legal prerequisites which are indi spensable for involuntary admission to a mental hospital. Whereas the Psych iatric Disorders Act intends to avert danger to the public, guardianship le gislation aims at individual help. We present a patient who suffered from a lcoholism and simultaneously met criteria of a serious personality disorder , which was classified according to ICD-10 (F 60.31). As the aggravation of the symptoms was most likely to entail serious danger to his health the ju dge ordered immediate involuntary admission. Two other patients had similar comorbidity but had to be released from hospital because of finalisation o f detoxification. Neither dependence nor personality disorder were pronounc ed enough to restrict the rights of the individual. Our analysis shows that the psychiatrist must present with an expert medical report that quantifie s the extent of alcoholism and personality disorder and characterises them as psychic disease. Consequently, for the purpose of quantifying the extent of dependence, we recommend to apply the European Addiction Severity Index whose suitability should be assessed.