Intoxication and Insanity

Intoxication and Insanity

The preceding sections gave involuntary intoxication its own route to a defense through a capacity standard, and they limited voluntary intoxication to the narrower office of negating a required mental state.¹ A defendant whose voluntary intoxication was severe has one more argument available, which is to describe the resulting condition as insanity. That argument needs a separate answer, because insanity is a defense with its own provision in the Code, Section 4.01, and the Code addresses whether intoxication can supply the mental disease that provision requires.²

The difficulty is that an intoxicated defendant and a mentally ill defendant can look identical at the moment of the offense, since either may be unable to grasp what is being done or to hold back from doing it. What separates them is the cause of the incapacity, and the Code's other intoxication rules show why the cause carries so much weight. Those rules withhold a capacity-based defense from the voluntary drinker and reserve it for the actor whose intoxication was involuntary.³ If an impairment the defendant brought on voluntarily could be relabeled insanity, the insanity defense would reopen the very door those rules close, and any intoxicated defendant could plead around them. The opposite mistake costs just as much. A defendant with a genuine mental illness who also happened to drink would lose a defense that the illness itself established, simply because intoxicants were also in the picture.

The legally relevant question is therefore what caused the loss of capacity: the consumption or the mental condition.⁴ Three answers follow, ordered from the rule to its qualifications. The first is the rule itself: intoxication does not, in itself, constitute mental disease.⁵ The second protects the defendant who is genuinely ill, because a mental disease that produces incapacity is not forfeited by the presence of alcohol or drugs, including in some cases where the two combine to push the defendant from capacity into incapacity, subject to a limit that turns on what the defendant knew would happen.⁶ The third recognizes that chronic abuse of drugs or alcohol can itself produce a permanent mental disease.⁷ The rule comes first, and it is stated in § 2.08(3).

Intoxication Is Not Mental Disease

The Code disposes of the insanity argument in one sentence: "Intoxication does not, in itself, constitute mental disease within the meaning of Section 4.01."⁸ The cross-reference matters because Section 4.01 gives responsibility a two-part structure. A person is excused only if he lacks substantial capacity either to appreciate the criminality of his conduct or to conform it to the requirements of law, and only if that lack of capacity is the result of mental disease or defect.⁹ Subsection (3) governs the second part by removing one possible cause from the list of conditions that can count as the disease. A defendant who proves a complete loss of capacity therefore still fails if the only explanation for the loss is something he drank or took.

The reason for tying the defense to the source of the incapacity appears when subsection (3) is read beside the Code's other intoxication rules. Intoxication is relevant to the extent that it negatives an element of the offense, and the capacity-based defense is reserved for the involuntary intoxication addressed in subsection (4).¹⁰ Those two provisions give the voluntary drinker a limited defense on purpose. If the same impairment could be relabeled mental disease, the limit would disappear, and it would disappear in a way that rewards the wrong conduct, because the heavier the self-induced intoxication, the more closely it would resemble insanity and the stronger the defense would become. The Code avoids that result by asking where the incapacity came from. A voluntary choice to consume is excluded from the definition of the disease, which leaves the insanity defense for a condition that exists apart from the defendant's own consumption.

Statutes and decisions in other jurisdictions reach the same place. Arizona defines the mental disease or defect that supports its insanity defense to exclude disorders resulting from acute voluntary intoxication or withdrawal from alcohol or drugs, along with character defects, psychosexual disorders, and impulse control disorders, and the Supreme Court set that definition out in Clark v. Arizona.¹¹ A separate Arizona provision states that temporary intoxication from the voluntary ingestion of alcohol, an illegal substance, or other psychoactive substances, or from the abuse of prescribed medications, does not constitute insanity.¹² Applying a capacity-based test like the Code's, the Massachusetts Supreme Judicial Court stated the principle in Commonwealth v. DiPadova: voluntary consumption of alcohol or drugs, intoxication, and even alcoholism or drug addiction do not qualify as mental diseases or defects, so a defendant whose lack of substantial capacity is due solely to one of those conditions is criminally responsible.¹³

The rule also answers the argument that intoxication can produce a state of mind that looks like insanity. An intoxicated defendant may in fact be unable to know that his act was wrong, or unable to resist what he knows is wrong, depending on which test the jurisdiction uses, and he may argue that he should receive the defense an insane person would have. The answer is that insanity requires a mental disease or defect, and mere drunkenness cannot supply one, so a defendant who is intoxicated and nothing more is legally sane.¹⁴ The label attached to the condition does not change the analysis. A drunken frenzy remains intoxication even when it is loosely called delirium tremens, while delirium tremens in the proper medical sense is a form of mental disease treated like any other, because the law looks to the immediate condition and ignores the remote excessive drinking.¹⁵ That last distinction opens the way to the qualifications taken up in the next two sections.

The only fact separating the two defendants is the source of the incapacity, and that fact decides the result. The legally relevant question asks what caused the loss of substantial capacity, the consumption or a mental condition, and the presence of alcohol in the defendant's system does not answer it by itself.¹⁷ Cases in which alcohol aggravates a disease, or helps push a mentally ill defendant over the line into incapacity, need a closer look, and the next section gives them one.

Students lose this issue when they equate being too drunk to know right from wrong with insanity, because the incapacity may be identical in the two situations and only its cause differs. The heavy drinking is not wasted evidence for the defendant, since it remains admissible to show that a required mental state was absent, which is the one role the Code assigns to voluntary intoxication.¹⁸ Chronic alcoholism or addiction receives the same treatment as a single binge, because dependence itself falls within the excluded category, although a permanent mental illness produced by years of abuse is a different matter that a later section takes up.¹⁹

Mental Illness Plus Intoxication

The preceding section showed that a genuine mental disease keeps its force when alcohol or drugs are also in the picture, but that statement describes the easy case, where the illness would have produced the incapacity on its own. The harder case arises when the illness alone leaves the defendant able to appreciate the wrongfulness of the conduct and to control it, and the substance supplies the extra push. The Massachusetts Supreme Judicial Court addressed that situation in Commonwealth v. DiPadova, describing a mental disease or defect that interacts with alcohol or drugs so as to push the defendant "over the edge" from capacity into incapacity, from criminal responsibility into criminal irresponsibility.²¹ The rule for that case has a protective default and a limit, and the limit turns on what the defendant knew.

Where the combination of consumption and mental disease causes a defendant who was previously criminally responsible to become criminally irresponsible, lack of criminal responsibility is established even if voluntary consumption activated or intensified the mental illness, unless the defendant knew or had reason to know that the alcohol or drugs would have that effect.²² The two halves of that rule answer different concerns. The default protects the defendant who could not have foreseen what happened: a person with a mental illness who has a drink with dinner is doing what most people do without a thought about consequences, and if the drink unexpectedly triggers the illness, denying the defense would punish an effect the defendant had no way to anticipate or avoid. The limit protects the opposite interest. A defendant who knows, or has reason to know, that the substance will bring on the incapacity has chosen to run a known risk of becoming dangerous, and that kind of risk-taking is what makes voluntary intoxication a poor foundation for excuse. Responsibility therefore returns to the person who made the choice.

The phrase "reason to know" does separate work from actual knowledge. Actual knowledge covers the defendant who has seen the effect before and expects it again. Reason to know reaches the defendant who professes surprise but had been given information that would have alerted a person in that position, such as an earlier episode after drinking or a clinician's warning about the combination. Without that second prong, the limit could be avoided by claiming ignorance of facts the defendant had every opportunity to learn.

What the second version loses is the insanity route only. Intoxication the defendant brought on voluntarily still matters to the extent that it negatives a mental-state element of the offense, which remains the one office the Code assigns to it.²⁵

The knowledge limit does not reach every mentally ill defendant who drank. When the illness by itself caused the loss of substantial capacity, the defendant keeps the defense even if the defendant knew that alcohol might aggravate the symptoms, so long as the defendant already lacked criminal responsibility without the substances.²⁶ The difference is causal. Knowledge matters only where the consumption was a necessary part of the cause, because only then does the choice to drink explain the incapacity; where the illness would have produced the incapacity anyway, the drinking adds nothing to the cause, and what the defendant knew about it has nothing to attach to. Students lose this issue when they apply the knowledge limit to an illness that caused the incapacity alone, and that mistake takes away a defense the law leaves intact.

The prescription cases mark the other end of the line. In State v. Anderson the Wisconsin Supreme Court ruled that "one who mixes prescription medication with alcohol is responsible for any resulting mental state."²⁷ The rule places the consequence on the person who made the combination: the decision to add alcohol is the defendant's own act, so the resulting mental state is attributed to the defendant. Set beside the wedding-reception defendant, the pair shows which variable moves the answer. In the first version an illness the defendant did not choose supplied part of the incapacity, and nothing warned the defendant about the alcohol. Where the mental state follows from a combination the defendant chose to create, responsibility stays with the defendant. A mentally ill drinker who knows the alcohol will trigger the illness ends in the same position, which is why knowledge or reason to know is the fact to look for.

Settled Insanity

The rule that intoxication is not mental disease depends on how long the condition lasts. Acute voluntary intoxication is the impairment produced by what a defendant drank or took around the time of the offense. It does not qualify as mental disease and cannot ground an insanity defense. Chronic abuse of alcohol or drugs can have a different result: when it leaves behind a permanent mental disease, often called fixed or settled insanity, that disease can support an insanity defense even though heavy use caused it.²⁹ Most jurisdictions treat the condition as insanity rather than as intoxication, because long-term abuse can produce a lasting mental infirmity that exists independently of any one episode of drinking.³⁰ The question therefore turns on what the condition is at the time of the offense, a passing state of intoxication or a lasting disease. The presence of alcohol somewhere in the causal history does not answer it.

Two separate ideas explain why the line falls between acute and lasting conditions. The first concerns the insanity defense itself, which rests on the view that a person should not be blamed for conduct he cannot understand or control. Once prolonged abuse has produced a lasting disease, the incapacity at the time of the offense comes from the disease and not from the acute intoxicated state. The defendant then stands where any defendant stands whose mental disease has another origin, even though this disease began in voluntary conduct. The law accepts that origin because it looks to the immediate condition. A person suffering from delirium tremens is not free from fault for the drinking behind it, but the law takes notice of the mental disease that exists now and disregards the excessive drinking that lies in the remote past.³¹

The second idea explains why the exception stays narrow. The Code gives the voluntary drinker one limited use of intoxication, which is to negative an element of the offense.³² That limit would collapse if acute impairment could be relabeled as disease, since heavier drinking would then produce a stronger defense. Requiring a lasting disease prevents that result. A disease that persists beyond the acute episode is not something a single night of drinking supplies, so recognizing settled insanity does not reward the choice to drink to excess on the occasion of the offense.

Delirium tremens in its proper medical sense is the traditional illustration. It is treated like any other form of insanity, while a drunken frenzy loosely called by that name remains intoxication.³³ How far a jurisdiction extends the exception depends on how it defines mental disease. Arizona, for example, provides that temporary intoxication resulting from the voluntary ingestion of alcohol or other psychoactive substances does not constitute insanity, and the statute's own word, temporary, tracks the line between acute and lasting conditions.³⁴ The earlier discussion of Arizona's definition of mental disease also showed that it excludes withdrawal from alcohol or drugs, so a defendant there who relies on a lasting alcohol-related disease must show that the condition falls within the statutory definition.

The fact that moves the answer is the lasting disease. Both defendants drank and both claim the same incapacity, but only the first can point to a condition that persists apart from any one occasion of drinking, and that is the condition the law treats as mental disease.³⁶

A defendant in the first defendant's position may also raise a second argument, and the two work on different questions. The insanity defense asks whether a mental disease left the defendant without substantial capacity. The intoxication argument asks whether what the defendant consumed on the occasion negated a mental state the offense requires, which is the only role the Code assigns to voluntary intoxication.³⁷ Because the lasting disease and the acute intoxication are distinct conditions, neither displaces the other. The defendant may argue settled insanity on the strength of the disease and, on the same facts, argue that intoxication on the night prevented purpose or knowledge where the offense requires one.³⁸

The exception has a limit that is easy to overlook. Students lose this issue when they treat a long history of heavy drinking as settled insanity, because dependence, however severe, is not itself the disease. The preceding sections placed alcoholism and addiction in the excluded category, and what settled insanity adds is a separate mental disease, such as delirium tremens, that the abuse has produced. The trial court in Powell v. Texas shows how a court can accept a medical label and still deny a defense. It found that chronic alcoholism is a disease that destroys the sufferer's will power to resist constant, excessive drinking, and then concluded that this fact was no defense to a charge of being intoxicated in a public place.³⁹ The defense there was a constitutional one rather than an insanity plea. The contrast is still useful, because a strong compulsion to drink describes dependence itself, while settled insanity requires that the abuse have produced a mental disease that deprives the defendant of capacity when the offense occurs.