DOCKET NO. PETITION FOR COMMITMENT OF ALCOHOLIC OR SUBSTANCE ABUSER G.L. c. 123, § 35 Trial Court of Massachusetts District Court Department DIVISION DOB OR AGE NAME OF RESPONDENT GENDER MALE IN THE MATTER OF FEMALE PETITION FOR COMMITMENT of Alcoholic or Substance Abuser G.L. c. 123 § 35 The undersigned petitioner hereby applies to this court for an order committing the respondent named above for inpatient care and treatment for alcoholism and/or substance abuse for a period not to exceed 90 days under the provisions of G.L. c. 123, § 35. The petitioner has reason to believe that there is a likelihood of serious harm as a result of the respondent's chronically or habitually consuming or ingesting alcoholic beverages and/or controlled substances or intentionally inhaling toxic vapors to the extent that such use substantially injures the respondent's health or substantially interferes with the respondent's socialSIGNATURE DATE SIGNED PETITIONER'S or economic functioning or that the respondent has lost the power of PETITIONER'S PRINTED NAME x PETITIONER'S TITLE OR RELATIONSHIP, IF ANY, TO RESPONDENT EXCERPTS FROM G.L. c. 123, §§ 1 and 35 G.L. c. 123, § 1. Definitions. '''Likelihood of serious harm', (1) a substantial risk of physical harm to the person himself as manifested by evidence of, threats of, or attempts at, suicide or serious bodily harm; (2) a substantial risk of physical harm to other persons as manifested by evidence of homicidal or other violent behavior or evidence that others are placed in reasonable fear of violent behavior and serious physical harm to them; or (3) a very substantial risk of physical impairment or injury to the person himself as manifested by evidence that such person's judgment is so affected that he is unable to protect himself in the community and that reasonable provision for his protection is not available in the community." G.L. c. 123, § 35. Commitment of alcoholics or substance abusers. "For the purposes of this section, 'alcoholic' shall mean a person who chronically or habitually consumes alcoholic beverages to the extent that (i) such use substantially injures his health or substantially interferes with his social or economic functioning, or (ii) he has lost the power of self-control over the use of such beverages. "For the purposes of this section, 'substance abuser' shall mean a person who chronically or habitually consumes or ingests controlled substances or who intentionally inhales toxic vapors to the extent that (i) such use substantially injures his health or substantially interferes with his social or economic functioning, or (ii) he has lost the power of self-control over the use of such controlled substances or toxic vapors. "Any police officer, physician, spouse, blood relative, guardian or court official may petition in writing any district court . . . for an order of commitment of a person whom he has reason to believe is an alcoholic or substance abuser . . . . [T]he court shall immediately schedule a hearing on the petition and shall cause a summons and a copy of the application to be served upon the person . . . . [I]f there are reasonable grounds to believe that such person will not appear and that any further delay in the proceedings would present an immediate danger to the physical well-being of the respondent, said court may issue a warrant for the apprehension and appearance of such person before it. No arrest shall be made on such warrant unless the person may be presented immediately before a judge of the district court . . . . The court shall order examination by a qualified physician or a qualified psychologist. "If, after a hearing and based upon competent testimony, which shall include, but not be limited to, medical testimony, the court finds that such person is an alcoholic or substance abuser and there is a likelihood of serious harm as a result of the person's alcoholism or substance abuse, the court may order such person to be committed for a period not to exceed 90 days, followed by the availability of case management services provided by the department of public health for up to 1 year; provided, however, that a review of the necessity of the commitment shall take place by the superintendent on days 30, 45, 60 and 75 as long as the commitment continues. A person so committed may be released prior to the expiration of the period of commitment upon written determination by the superintendent that release of that person will not result in a likelihood of serious harm. Such commitment shall be for the purpose of inpatient care in public or private facilities approved by the department of public health . . . for the care and treatment of alcoholism and substance abuse. The person may be commited to the Massachusetts correctional institution at Bridgewater, if a male, or at Framingham, if a female, if there are not suitable facilities available . . . ; provided, however, that the person so committed shall be housed and treated separately from convicted criminals. Such person shall, upon release, be encouraged to consent to further treatment and shall be allowed voluntarily to remain in the facility for such purpose. "Nothing in this section shall preclude any public or private facility for the care and treatment of alcoholism or substance abuse . . . . from treating persons on a voluntary basis." http://www.mass.gov/courts/courtsandjudges/courts/districtcourt/petition_for_commitment.pdf (Rev. 07/12) American LegalNet, Inc. www.FormsWorkFlow.com