Title: In re a Minor
Citation: N/A
Docket Number: SJC-12747
State: Massachusetts
Issuer: Massachusetts Supreme Court
Date: March 17, 2020

NOTICE:  All slip opinions and orders are subject to formal 
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SJC-12747 
 
IN THE MATTER OF A MINOR. 
 
 
 
Middlesex.     November 4, 2019. - March 17, 2020. 
 
Present:  Gants, C.J., Gaziano, Lowy, Budd, Cypher, & Kafker, 
JJ. 
 
 
Practice, Civil, Civil commitment, Standard of proof, Appeal, 
Moot case, Findings by judge.  Moot Question.  Due Process 
of Law, Commitment. 
 
 
 
 
Petition for commitment for alcohol or substance use 
disorder filed in the Middlesex County Division of the Juvenile 
Court Department on February 19, 2019. 
 
 
The case was heard by Susan V. Oker, J. 
 
 
The Supreme Judicial Court granted an application for 
direct appellate review. 
 
 
 
Eva G. Jellison for the juvenile. 
 
Maura Healey, Attorney General, & Jesse M. Boodoo, 
Assistant Attorney General, for the Attorney General, amicus 
curiae, submitted a brief. 
 
Karen Owen Talley & Afton M. Templin, Committee for Public 
Counsel Services, for Committee for Public Counsel Services & 
others, amici curiae, submitted a brief. 
 
 
2 
 
 
 
GAZIANO, J.  In this case, a sixteen year old high school 
student (juvenile) claims error in a Juvenile Court judge's 
decision to commit him for substance use disorder treatment 
pursuant to G. L. c. 123, § 35.  His case requires us to decide 
whether and how the science of adolescent brain development 
recognized in Diatchenko v. District Attorney for the Suffolk 
Dist., 466 Mass. 655, 667–668 (2013), S.C., 471 Mass. 12 (2015), 
bears on a judge's decision to order commitment of juveniles for 
treatment.  Additionally, the juvenile challenges whether 
appeals from commitment under this provision are moot after a 
respondent has been released; whether the evidence presented was 
sufficient in this case; and whether a judge deciding a petition 
for commitment under G. L. c. 123, § 35, must consider less 
restrictive alternatives to commitment. 
 
For the reasons to be discussed, we conclude that the 
juvenile's order of commitment must be vacated. 
 
Background.  1.  Standards for commitment under G. L. 
c. 123, § 35.  General Laws c. 123, § 35, sets forth the 
requirements and procedures by which an individual may be 
committed involuntarily for treatment of a substance use 
disorder.  See Matter of G.P., 473 Mass. 112, 116-118 (2015).  A 
"police officer, physician, spouse, blood relative, guardian or 
court official" may petition for an order of commitment under 
this provision.  G. L. c. 123, § 35.  Upon receipt of a 
3 
 
 
petition, the court shall schedule an immediate hearing and 
shall issue a summons to the person sought to be committed.  Id.  
"[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," the court may issue warrants of apprehension, 
as necessary, to secure the individual's appearance for a 
hearing.  Id.  When the person appears, he or she has a right to 
counsel, and must be examined by a qualified physician, 
psychologist, or social worker.  Id.  See Matter of G.P., supra 
at 117. 
 
To issue an order of commitment, the judge must find, by 
clear and convincing evidence, that (1) the person whose 
commitment is sought is an individual with an alcohol or 
substance use disorder, as defined by G. L. c. 123, § 35; and 
(2) there is a likelihood of serious harm as a result of the 
person's alcohol or substance use disorder, as defined in G. L. 
c. 123, § 1.  The statutory scheme presents three distinct paths 
by which a judge may find a "likelihood of serious harm."  G. L. 
c. 123, § 1.  A "likelihood of serious harm" exists if a judge 
finds: 
"(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 
4 
 
 
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." 
Id.  See Matter of G.P., 473 Mass. at 124-125.  This harm must 
be "imminent," which in this context means "a substantial risk 
that the harm will materialize in the reasonably short term -- 
in days or weeks rather than in months."  Id. at 128. 
 
Because the Appellate Division of the District Court does 
not have jurisdiction to consider appeals in Juvenile Court 
cases, appeals from commitment orders issued by the Juvenile 
Court are heard by the Appeals Court.  See Matter of G.P., 473 
Mass. at 123 n.17; Rule 11(b) of the Uniform Trial Court Rules 
for Civil Commitment Proceedings for Alcohol and Substance Use 
Disorders, Mass. Ann. Laws Court Rules, Trial Court Rules, at 
997 (LexisNexis 2018) (uniform rules).   Upon request, the 
Appeals Court "shall expedite consideration of any appeal."  
Rule 11(b) of the uniform rules. 
 
2.  The juvenile's commitment hearing.  In February 2019, 
the juvenile's mother petitioned the Juvenile Court under G. L. 
c. 123, § 35, to commit her son for involuntary treatment.  Her 
affidavit asserted that the juvenile was putting himself in 
danger by using and selling Xanax.  When he was apprehended 
5 
 
 
pursuant to a warrant, the juvenile was found with a large 
bottle of Xanax pills, and a second bottle of crushed Xanax, on 
his person. 
 
Prior to the issuance of the warrant, the mother testified 
that she recently had discovered that the juvenile was still 
using Xanax (notwithstanding his participation in earlier 
treatment programs).  By reading her son's text messages, she 
gleaned that, on at least one recent occasion, he had been 
unable to remember events of the previous evening due to drug 
use.  The mother sketched for the court the juvenile's treatment 
history, which included multiple placements in residential 
treatment, one prior commitment under G. L. c. 123, § 35, and 
January enrollment in a recovery high school, a school specially 
designed for youth with substance use disorders.  She stated 
that, on some unspecified date, the juvenile had been found 
sleeping on a bench at 2 A.M., and that he sometimes turned off 
his cellular telephone to avoid being found by his mother.  On 
this evidence, the judge ordered a warrant of apprehension. 
 
When the juvenile arrived at court, Janice Hrabovszky, a 
Juvenile Court clinician, interviewed him and his mother.  She 
also contacted the juvenile's school clinician by telephone.  
Hrabovszky concluded that the juvenile had a substance use 
disorder.  She based this determination on her interview with 
6 
 
 
his mother, his history of drug treatment, and his multiple 
positive drug tests, as reported by the school clinician. 
 
Additionally, Hrabovszky opined that the juvenile's 
substance use disorder put him at risk of harm.  She pointed to 
accounts by his mother that the juvenile had ridden in 
automobiles with unlicensed drivers who were driving while under 
the influence, an instance where the juvenile became verbally 
aggressive toward school staff over confiscated property, and an 
overdose that had occurred "a number of years ago" as a result 
of mixing Xanax and alcohol.  Hrabovszky viewed that overdose as 
relevant to the need for commitment because the juvenile's 
mother had found open bottles of alcohol in his room and he had 
been carrying a large bottle of Xanax on his person when he was 
arrested.  Hrabovszky also noted the concern, conveyed by the 
juvenile's mother, that the Xanax the juvenile had had in his 
possession was not pharmaceutically produced, and that it 
potentially could be laced with toxic substances.  The basis for 
the mother's knowledge about the producer of the Xanax was 
unclear from Hrabovszky's testimony. 
 
The juvenile's mother stated that she generally was able to 
tell when her son was using drugs (she estimated her own 
accuracy at ninety-five percent certainty), and that she had had 
him drug tested repeatedly, either at home, at school, or 
through the court.  When asked what behaviors derived from his 
7 
 
 
substance use put the juvenile at risk of harm, the mother 
pointed to his increased verbal aggression and missed curfews.  
She also noted that the pills were "not actual Xanax . . . not 
the legit ones."  When the judge inquired further about this 
concern, the mother mentioned a newspaper article she had read 
that indicated that "pressed" (not legitimately manufactured) 
pills might be laced with other substances.  The mother also 
repeated her concern that the juvenile had mixed Xanax with 
alcohol, but did not specify a particular occasion on which she 
knew he had done so, apart from the overdose several years 
earlier.  On cross-examination, the mother explained that, while 
she had not seen her son use Xanax and alcohol together (or 
either of them separately), she had found open beer bottles in 
his room.  She inferred the mixing of substances because, "I 
know that he's admitted that he's drinking, and then he's also 
admitted that he's taken the Xanax.  So . . . ." 
 
The juvenile denied currently mixing drugs and alcohol. 
 
On this evidence, the judge ordered the juvenile committed 
for ninety days for treatment. 
 
Discussion.  We address three sets of issues.  First, we 
consider whether appeals from commitment orders under G. L. 
c. 123, § 35, become moot when a committed individual is 
released.  We then turn to the question of the evidence in this 
case, and examine both how the science of adolescent brain 
8 
 
 
development should inform a judge's consideration of a petition 
to commit a juvenile, and whether there was sufficient evidence 
to order commitment here.  Finally, we consider the juvenile's 
due process arguments. 
 
1.  Mootness.  "Ordinarily, litigation is considered moot 
when the party who claimed to be aggrieved ceases to have a 
personal stake in its outcome."  Commonwealth v. Dotson, 462 
Mass. 96, 98 (2012), quoting Blake v. Massachusetts Parole Bd., 
369 Mass. 701, 703 (1976).  Because individuals committed under 
G. L. c. 123, § 35, have a personal stake in litigating a 
wrongful commitment, even after release from confinement, we 
conclude that appeals from an order of commitment pursuant to 
G. L. c. 123, § 35, are not moot.1 
 
When considering other statutory provisions that allow 
involuntary civil commitment, we have determined that the 
continuing stigma of a potentially wrongful commitment alone 
sufficed to defeat a claim of mootness.  See Matter of F.C., 479 
Mass. 1029, 1029-1030 (2018) (appeals from expired or terminated 
involuntary commitment and treatment orders under G. L. c. 123, 
§§ 7, 8, and 8B, not moot because "[a]t the very least, a person 
who has been wrongfully committed or treated involuntarily has a 
                                                          
 
 
1 To the extent we previously have indicated that an appeal 
from an order of commitment became moot upon the individual's 
release, see, e.g., Matter of G.P., 473 Mass. 112, 113 (2015), 
we now conclude otherwise. 
9 
 
 
surviving interest in establishing that the orders were not 
lawfully issued, thereby, to a limited extent, removing a stigma 
from his name and record" [quotation and citation omitted]).  
See Pembroke Hosp. v. D.L., 482 Mass. 346, 351 (2019) (same for 
appeals from commitment under G. L. c. 123, § 12); Matter of 
M.C., 481 Mass. 336, 343 (2019) (same for involuntary commitment 
under G. L. c. 123, § 16). 
 
In addition to any continuing stigma, involuntary 
commitment for substance use disorder treatment implicates other 
legal interests.  For example, as was the case here, a previous 
commitment has been considered evidence of a substance use 
disorder, potentially making it easier for an individual to be 
recommitted for a subsequent period of treatment, sometimes 
months or years later.  Moreover, under G. L. c. 123, § 35, the 
court is required to submit the individual's personally 
identifiable information, including name, Social Security 
number, and date of birth to the Department of Criminal Justice 
Information Services.  For an adult, absences from work due to 
commitment may result in the loss of employment, leading to 
ongoing economic detriment and potentially increasing the risk 
of homelessness.  For a student, absences from class may have an 
impact on the student's academic achievement, advancement to the 
next grade level, likelihood of dropping out of school, or 
chance of admission to postsecondary school programs -- harms 
10 
 
 
that continue beyond commitment.  Just as with other civil 
mental health commitments, an individual wrongfully committed 
for involuntary substance use treatment and then released also 
retains an interest "in establishing, after discharge, that the 
order[] by which [he or she was] committed [was] unlawful, 
thereby, to a limited extent, removing a stigma from [his or 
her] name and record" (quotation and citation omitted).  See 
Pembroke Hosp., 482 Mass. at 351.2 
 
Because these ongoing consequences implicate an 
individual's privacy, reputation, and future liberty, they also 
support the conclusion that an individual has a personal stake 
in the outcome of litigating an appeal from an order of 
commitment, even after the individual is released.  Therefore, 
appeals from an order of commitment pursuant to G. L. c. 123, 
§ 35, are not moot solely because the individual is no longer 
committed. 
 
2.  Evidence necessary for commitment.  a.  The role of 
youth in substance use disorder commitment hearings.  The 
juvenile argues that if a judge does not take into account the 
lower "baseline" for impulsiveness, self-control, and judgment 
that is developmentally typical for juvenile brains, the judge 
                                                          
 
 
2 In addition, commitment under G. L. c. 123, § 35, makes an 
individual ineligible to hold a license to possess a firearm for 
a minimum of five years, and possibly longer, as the individual 
must petition successfully for relief from ineligibility. 
11 
 
 
erroneously may order a juvenile committed for youthful 
misbehavior alone.  The juvenile asserts that impulsiveness, 
incomplete self-control, and lack of judgment -- known hallmarks 
of youth brain development -- may be confused with symptoms of 
substance use disorder, resulting, as he argues happened here, 
in improper commitments. 
 
As the United States Supreme Court and this court have 
recognized, the science of adolescent brain development attests 
to the ways in which a "transient rashness, proclivity for risk, 
and inability to assess consequences" are hallmarks of young, 
developing brains.  Miller v. Alabama, 567 U.S. 460, 472 (2012).  
See Diatchenko, 466 Mass. at 667–668.  This research is relevant 
to petitions to commit a juvenile under G. L. c. 123, § 35, 
because, in determining whether an individual meets the relevant 
statutory definitions, a judge is required to assess an 
individual's judgment, self-control, and social functioning, 
precisely those areas of juvenile brains that are recognized as 
underdeveloped.  See G. L. c. 123, § 1 (defining third prong of 
"likelihood of serious harm" with reference to whether very 
substantial risk is created because "[a] person's judgment is so 
affected" by substance use disorder); G. L. c. 123, § 35 
(defining alcohol and substance use disorder, in part, by 
reference to whether use substantially interferes with 
12 
 
 
individual's social functioning and whether that individual has 
lost power of self-control over substance). 
 
In this case, the juvenile contends that the judge, without 
finding any nexus with the juvenile's substance use disorder, 
impermissibly relied on the fact that the juvenile missed 
curfew, spent time with reckless peers, sold Xanax, and yelled 
at school staff in support of a finding of substance use 
disorder.  This behavior, the juvenile argues, may be grounds 
for parental or school discipline.  It possibly could support a 
petition for a child in need of services, or even delinquency 
proceedings.  Without a nexus to the likelihood of serious harm 
resulting from a substance use disorder, however, rebellious or 
difficult teenage misbehavior cannot support a petition for 
commitment under G. L. c. 123, § 35. 
 
Considering the implications of teenage brain science in 
determining whether commitment is necessary for substance use 
treatment does not create two different standards for the 
commitment of adults and the commitment of juveniles.  See G. L. 
c. 123, § 35 (no distinctions in standards for juveniles and 
adults).  Rather, taking into account a juvenile's youth 
necessarily is required as part of the fact-intensive, 
individualized assessment these petitions demand.  See Matter of 
G.P., 473 Mass. at 125 ("the assessment of risk is a 
probabilistic one, and necessarily must be made on the basis of 
13 
 
 
the specific facts and circumstances presented").  We agree with 
the juvenile, however, that, in some cases, difficulties in 
distinguishing typical adolescent lapses in judgment or self-
control from those driven by substance use disorder may make a 
judge's already difficult task more challenging in juvenile 
commitment proceedings.  In those cases, a judge should make 
clear that his or her decision was founded on a causal nexus 
between a likelihood of serious harm and substance use disorder, 
rather than developmentally typical adolescent misbehavior. 
 
b.  Sufficiency of the evidence.  The juvenile maintains 
that, even had the judge properly focused her inquiry on the 
causal relationship between an alleged substance use disorder 
and the possible resulting likelihood of serious harm, the 
evidence here was insufficient to sustain his commitment.  We 
agree. 
 
i.  Standard of review.  The hearing judge is in the best 
position to weigh the evidence, assess the credibility of 
witnesses, and make findings of fact; a reviewing court accepts 
these findings unless they are clearly erroneous.  See Matter of 
A.M., 94 Mass. App. Ct. 399, 401 (2018), citing G.E.B. v. 
S.R.W., 422 Mass. 158, 172 (1996).  When considering a challenge 
to the sufficiency of the evidence at an evidentiary hearing, we 
"scrutinize without deference the propriety of the legal 
criteria employed by the [motion] judge and the manner in which 
14 
 
 
those criteria were applied to the facts."  Matter of A.M., 
supra, quoting Iamele v. Asselin, 444 Mass. 734, 741 (2005).  
See Matter of G.P., 473 Mass. at 129-130 (deferring to judge's 
subsidiary findings, but reviewing without deference legal 
conclusion as to whether "a substantial risk of serious harm to 
others" was met). 
 
ii.  Substance use disorder.  In order to commit an 
individual under G. L. c. 123, § 35, a judge first must find 
that the individual has a substance use disorder, an alcohol use 
disorder, or both.  Both disorders are marked by "chronic or 
habitual consumption" to the extent that using the substance 
either "substantially injures" the individual's health or 
"substantially interferes with the person's social or economic 
functioning," or results in the individual having "lost the 
power of self-control over the use" of the substance.  See G. L. 
c. 123, § 35. 
 
The judge found that the juvenile here had both a substance 
use disorder and an alcohol use disorder.  While no court 
condones underage drinking, it is essential for judges to 
distinguish between a juvenile's illicit alcohol use or 
experimentation, on the one hand, and alcohol use disorder, on 
the other.  The key to that distinction, as indicated in the 
statutory definition, is chronic or habitual use to such an 
extent that it results in a "substantial injury" to the 
15 
 
 
juvenile's health or social functioning, or a loss of the power 
of self-control over his or her consumption of alcohol.  See 
G. L. c. 123, § 35.  At the hearing, the evidence of the 
juvenile's alcohol use came from his mother.  She testified, 
"It's been numerous times, now, that I've found alcohol in his 
room. . . .  Open beers, right next to his bed."  While this 
situation understandably is concerning, finding open beer 
bottles in a teenager's room, even in circumstances indicating 
consumption on week nights, does not suffice to demonstrate that 
the juvenile has an alcohol use disorder.3  The fact that the 
juvenile consumed beer, by itself,4 does not show substantial 
injury to the juvenile's health or social functioning stemming 
directly from chronic or habitual alcohol consumption, or that 
the juvenile attempted to stop drinking but could not do so.  
"Most teens do not escalate from trying drugs to developing an 
addiction or other substance use disorder . . . ."  National 
Institute on Drug Abuse, Principles of Adolescent Substance Use 
Disorder Treatment:  A Research-Based Guide, at 4 (Jan. 2014).  
                                                          
 
 
3 Contrast Matter of A.R., Mass. App. Div., No. 18-ADMH-
124SO (Dist. Ct. Dec. 18, 2018) (alcohol use disorder found, 
where respondent recently had been fired for drinking at work, 
and testimony indicated that he consumed between two and ten 
drinks every day). 
 
 
4 The mother testified at one point that she had seen two 
bottles of beer in the juvenile's room, and at other points that 
she had seen beer in the juvenile's room on multiple occasions. 
16 
 
 
We conclude that the record is inadequate to support a finding 
of an alcohol use disorder. 
 
The judge's finding of a substance use disorder is on 
firmer footing.  While evidence of treatment history must be 
evaluated carefully to ensure that it bears upon an individual's 
current condition, treatment history often may be relevant in 
these proceedings.  Compare Matter of R.G., Mass. App. Div., No. 
19-ADMH-30NO (Dist. Ct. Sept. 25, 2019) (long treatment history 
was considered and properly combined with recent evidence to 
find ongoing alcohol use disorder), with Matter of I.M., Mass. 
App. Div., No. 19-ADMH-36NO (Dist. Ct. June 5, 2019) (commitment 
under G. L. c. 123, § 35, from two years earlier properly was 
disregarded when unconnected to evidence of continuing alcohol 
use disorder).  Here, Hrabovszky, the court clinician, 
interviewed the juvenile and his mother, and spoke with a school 
clinician by telephone; on this evidence, she concluded that the 
juvenile had a substance use disorder.  Although much of her 
stated reasoning was based on the fact of the juvenile's prior 
treatment, Hrabovszky did conduct her own independent 
evaluation.  Moreover, the juvenile's voluntary treatment 
history, September commitment under G. L. c. 123, § 35, and 
recent enrollment at a specialty school for juveniles with 
substance use disorders support the inference that other 
17 
 
 
clinicians previously had evaluated him and also had come to the 
conclusion that he had a substance use disorder. 
 
Granted, on this record, the presence of a substance use 
disorder is not beyond dispute.  Apart from the incident his 
mother learned of from the text messages, there was little 
direct evidence that the juvenile's consumption of Xanax was 
threatening his health or impairing his social functioning at 
work or at school.5  Nevertheless, it was not clearly erroneous 
to find, based on his treatment history and continuing drug use, 
that the juvenile had a substance use disorder. 
 
iii.  Likelihood of serious harm.  The judge did not 
specify which of the three disjunctive definitions she used in 
finding a likelihood of serious harm.  See G. L. c. 123, § 1.  
There was no evidence that the juvenile was suicidal (first 
prong); nor was there any evidence that the juvenile was 
homicidal or exhibiting other violent behavior (second prong).  
Thus, the judge must have made her finding based on the third 
prong, which requires "a very substantial risk of physical 
                                                          
 
 
5 The juvenile was attending school, where he had friends, 
and had a job at a grocery store, where his supervisor reported 
only one unexcused absence.  His mother stated that this absence 
was on a Saturday when the juvenile was at home and said that he 
did not feel like going to work.  The conflicts at school, which 
were of serious concern to his mother, appear to have derived 
from the juvenile's alleged drug distribution and, specifically, 
a conflict involving a particular transaction with another 
student, rather than from his own drug use. 
18 
 
 
impairment or injury . . . as manifested by evidence that [a 
respondent'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, § 1.  In this case, the only evidence in the record that 
might support a finding of very substantial and imminent harm 
are two concerns of the juvenile's mother:  the evidence 
suggesting (1) that the Xanax in the juvenile's possession was 
adulterated with a dangerous additive, and (2) that the juvenile 
was consuming alcohol and Xanax together. 
 
As to the possibly adulterated Xanax, the mother testified 
that, when she had had the juvenile's Xanax tested at some prior 
point, she had learned it was not pharmaceutically produced; she 
did not indicate that this testing revealed the presence of 
dangerous additives.  Instead, she mentioned a newspaper article 
discussing cases of tainted pills in Stoneham.  While 
adulterated drugs might pose a significant risk to drug users, 
mere reports of tainted drugs somewhere in the Commonwealth, 
without any specific nexus to the case before the court, are 
insufficient to support the legal conclusion that there was an 
imminent and "very substantial risk of physical impairment" to 
the juvenile.  See G. L. c. 123, § 1. 
 
As to the concern that the juvenile was mixing alcohol and 
Xanax, the mother stated that, although she had not observed him 
19 
 
 
doing so, the juvenile had admitted to having mixed alcohol and 
Xanax on some unspecified prior occasion.  She could not 
remember the last time he had admitted to having mixed these 
substances.  While there was evidence that the juvenile was 
consuming both substances (open beer bottles in his room, and a 
positive drug test for benzodiazepines from the school), when 
the mother was pressed on cross-examination, it became clear 
that the asserted mixing essentially was an inference by her.  
Hrabovszky testified that the juvenile denied to her that he was 
consuming beer and Xanax at the same time.  The judge of course 
was free to discredit the juvenile's reported statement.  
Nonetheless, the mere possibility that the juvenile was mixing 
the substances does not rise to the level of an imminent and 
"very substantial risk of physical impairment or injury."  G. L. 
c. 123, § 1.  Compare Matter of A.M., 94 Mass. App. Ct. at 402–
403 ("the possibility that [A.M.'s] illicit drug use in 
combination with an unspecified prescribed medication regimen 
that has mere potential to be life threatening [does not rise] 
to 'imminent serious harm'"), with Matter of C.R., Mass. App. 
Div., No. 19-ADMH-48SO (Dist. Ct. Sept. 25, 2019) (commitment 
was appropriate where there was reliable testimony that 
individual had received Vivitrol shot, that she had continued to 
drink heavily on Vivitrol as recently as three days prior to 
hearing, and that Vivitrol and alcohol can be fatal when mixed). 
20 
 
 
 
Setting aside the evidence of youthful recklessness 
unrelated to a substance use disorder, we conclude that the 
evidence in the record that properly could have shown a 
connection between the juvenile's substance use disorder and a 
likelihood of imminent serious harm -- evidence that the Xanax 
was tainted or that the juvenile had consumed it with alcohol -- 
was insufficient to support a finding of imminent and "very 
substantial risk of physical impairment or injury."  G. L. 
c. 123, § 1.  The finding therefore must be reversed, and the 
order of commitment vacated and set aside. 
 
3.  Due process constraints in substance use disorder 
commitment hearings.  In addition to challenging the sufficiency 
of the evidence in his case, the juvenile argues that due 
process requires additional safeguards at hearings pursuant to 
G. L. c. 123, § 35.  He maintains that a judge must make more 
specific and substantial subsidiary findings than the judge made 
here and that, at all commitment hearings under G. L. c. 123, 
§ 35, a judge must consider less restrictive alternatives to 
commitment. 
 
a.  Sufficiency of factual findings.  The judge's findings 
at the end of the hearing were terse:  "I do find, by clear and 
convincing evidence, . . . that you are an individual with an 
alcohol and substance abuse disorder.  And that the failure to 
commit you would create a likelihood of serious harm.  And that 
21 
 
 
there is no less restrictive alternative."  The juvenile 
contends that these limited findings were insufficiently 
detailed to comport with the requirements of due process.  While 
the findings met all that is required by the explicit statutory 
language,6 we agree that due process mandates something more. 
 
"[T]he constitutional demands of due process" dictate that 
a "statement of findings and reasons, either in writing or 
orally on the record, is a minimum requirement where a defendant 
faces a loss of liberty."  Brangan v. Commonwealth, 477 Mass. 
691, 708 (2017).  See id. at 707 (due process requires factual 
findings demonstrating consideration of relevant bail factors); 
Commonwealth v. Hartfield, 474 Mass. 474, 484 (2016), citing 
Commonwealth v. Durling, 407 Mass. 108, 113 (1990) (due process 
requires written or oral statement that illuminates "the 
evidence relied upon and the reasons for revoking probation"); 
Doucette v. Massachusetts Parole Bd., 86 Mass. App. Ct. 531, 539 
                                                          
 
 
6 The language of G. L. c. 123, § 35, places minimal 
requirements on a judge's findings.  A judge must find "that 
such person is an individual with an alcohol or substance use 
disorder and there is a likelihood of serious harm as a result 
of the person's alcohol or substance use disorder."  G. L. 
c. 123, § 35.  Second, "[t]he court, in its order, shall specify 
whether such commitment is based upon a finding that the person 
is a person with an alcohol use disorder, substance use 
disorder, or both."  Id.  The uniform rules do not require more 
elaborate factual findings.  See Rules 6(a), 8(a) of the uniform 
rules, supra at 992, 994-995.  Rule 7(a) of the uniform rules, 
supra at 993, contains the only other required finding:  that a 
judge may rely on hearsay evidence "only if the judge finds that 
it is substantially reliable." 
22 
 
 
(2014) (same for revocation of parole).  Cf. Mendonza v. 
Commonwealth, 423 Mass. 771, 775 (1996) (indicating that written 
findings of fact and reasons for detention are statutorily 
mandated by G. L. c. 276, § 58A [4], in order to detain 
individual before trial on grounds of dangerousness).7 
 
This minimum requirement applies here, for "[a]n order of 
commitment under [G. L. c. 123, § 35,] results in a substantial 
curtailment of liberty."  Matter of G.P., 473 Mass. at 126.  The 
judge's recitation of statutory standards, while meeting the 
minimum explicitly stated requirements in the statute, does not 
set forth findings sufficient to elucidate which subsidiary 
facts she relied upon in reaching her conclusions. 
 
Therefore, in hearings pursuant to G. L. c. 123, § 35, a 
judge must make clear, in writing or orally on the record, the 
evidence he or she credited in support of the legal conclusion 
that the respondent had a substance or alcohol use disorder, as 
well as the evidence supporting an imminent likelihood of 
                                                          
 
 
7 When other fundamental rights similarly are burdened, we 
have required that judges make clear the evidence they relied 
upon and the reasoning they undertook to reach their 
conclusions.  See Doe, Sex Offender Registry Bd. No. 496501 v. 
Sex Offender Registry Bd., 482 Mass. 643, 657 (2019) (requiring 
express findings by Sex Offender Registry Board that support 
assigned sex offender classification level); Adoption of Yale, 
65 Mass. App. Ct. 236, 239 (2005), quoting Custody of Eleanor, 
414 Mass. 795, 799 (1993) (for termination of parental rights, 
"[c]areful factual inspection and specific and detailed 
findings" by trial judge are required in order to "demonstrate 
that close attention has been given the evidence"). 
23 
 
 
serious harm stemming from that disorder.  Relevant facts tend 
to show the reasons for a finding of the existence of a 
disorder, as opposed to use of a substance, as well as the 
likelihood of the harm, its imminence, its seriousness, and the 
nexus between the harm and the underlying substance or alcohol 
use disorder. 
 
Additionally, where a judge relies on hearsay, the judge's 
written or oral findings should indicate why the judge found 
that hearsay reliable.  See rule 7 of the uniform rules, supra 
at 993 (in proceedings under G. L, c. 123, § 35, where hearsay 
may be admissible, it "may be relied upon only if the judge 
finds that it is substantially reliable").  In Matter of G.P., 
473 Mass. at 121-122, we allowed the use of hearsay evidence at 
hearings on commitments for substance use disorder treatment, 
only so long as the judge found that evidence to be 
substantially reliable.  See id. at 122 (because "hearsay 
evidence may well play an extremely significant role in these 
hearings," it is critical that judge "ensure[s] that any hearsay 
on which he or she relies is 'substantially reliable'").  For 
probation revocation hearings, in which substantially reliable 
hearsay likewise is admissible, we have required judges to state 
explicitly the reasons supporting the reliability of any hearsay 
they rely upon.  See Hartfield, 474 Mass. at 485 ("Even if not 
required by court rule, we conclude that, where a judge relies 
24 
 
 
on hearsay evidence in finding a violation of probation, the 
judge should set forth in writing or on the record why the judge 
found the hearsay evidence to be reliable"). 
 
The same conclusion is compelled here.  As part of the more 
detailed findings that due process requires, a judge relying on 
hearsay evidence at substance use disorder commitment hearings 
should make clear, in writing or on the record, what specific 
indicia of reliability led him or her to conclude that the 
hearsay evidence supporting the determination that commitment 
was necessary is substantially reliable.8 
 
The requirement that a judge make explicit those findings 
the judge necessarily must have made implicitly need not impose 
a significant burden on the hearing judge.  In Matter of G.P., 
473 Mass. at 122, we recognized "the extremely short time frame" 
in which hearings under G. L. c. 123, § 35, take place.  By 
allowing these findings to be made orally on the record, and 
therefore to be made relatively quickly, we continue to 
                                                          
 
 
8 In Matter of G.P., 473 Mass. at 122, we pointed to 
Commonwealth v. Patton, 458 Mass. 119, 132-133 (2010), in which 
we identified a nonexclusive list of factors for judges to 
consider in determining whether hearsay is reliable, namely, the 
level of factual detail (rather than generalized and conclusory 
assertions); whether the statements were made based on personal 
knowledge and direct observation; whether the statements were 
corroborated; whether the statements were made under 
circumstances that support the veracity of the source; and 
whether the statements were made by disinterested witnesses.  
See Commonwealth v. Durling, 407 Mass. 108, 121 (1990). 
25 
 
 
acknowledge the "practical considerations" faced by judges and 
all parties in hearings under G. L. c. 123, § 35.  See Matter of 
G.P., supra. 
 
b.  Consideration of less restrictive alternatives.  In 
Matter of G.P., 473 Mass. at 129 n.24, we left open the question 
whether, as the juvenile contends, due process requires a judge 
to consider less restrictive alternatives in all commitment 
hearings for substance use disorder treatment.  Faced squarely 
with that question here, we answer affirmatively. 
 
"The Fourteenth Amendment to the United States Constitution 
and arts. 1, 10, and 12 of the Massachusetts Declaration of 
Rights establish a fundamental right to liberty and freedom from 
physical restraint that cannot be curtailed without due process 
of law."  Brangan, 477 Mass. at 702.  See Pembroke Hosp., 482 
Mass. at 347; Matter of E.C., 479 Mass. at 119 ("The right of an 
individual to be free from physical restraint is a paradigmatic 
fundamental right" [citation omitted]).  Laws that directly 
infringe on fundamental rights, such as liberty from constraint, 
are subject to strict scrutiny.  See Brangan, supra at 703; 
Commonwealth v. Libby, 472 Mass. 93, 96-97 (2015); Commonwealth 
v. Weston W., 455 Mass. 24, 30 (2009).  "To pass the strict 
scrutiny standard, the [law] must be narrowly tailored to 
further a legitimate and compelling governmental interest and be 
26 
 
 
the least restrictive means available to vindicate that 
interest."  Weston W., supra at 35. 
 
The juvenile argues that only after less restrictive 
alternatives have been considered may commitment be deemed the 
least restrictive means by which to vindicate the government's 
interest.9  The argument has merit.  Because these cases are 
intensely fact-specific, there is no way to ensure that 
commitment is the least restrictive means of vindicating the 
government's interest, unless and until a judge has considered 
less restrictive alternatives in each case.  For the statute to 
survive strict scrutiny, this inquiry must be undertaken. 
 
We reached a similar conclusion in Commonwealth v. Nassar, 
380 Mass. 908, 917-918 (1980).  There, we required judges to 
find that no less restrictive alternatives to civil commitment 
were appropriate before authorizing commitment pursuant to G. L. 
c. 123, §§ 7-8 (civil commitment of mentally ill person whose 
release would create likelihood of serious harm to individual or 
others).  While that holding did not rest explicitly on grounds 
of substantive due process, its reasoning closely mirrored 
strict scrutiny principles.  Nassar, supra ("we think it natural 
                                                          
 
 
9 The parties do not dispute that the government has a 
compelling and legitimate interest in protecting its residents 
from the often tragic consequences of substance use disorder.  
In addition, because it is not contested here, we assume without 
deciding that G. L. c. 123, § 35, is narrowly tailored. 
27 
 
 
and right that all concerned in the law and its administration 
should strive to find the least burdensome or oppressive 
controls over the individual that are compatible with the 
fulfilment of the dual purposes of our statute, namely, 
protection of the person and others from physical harm and 
rehabilitation of the person"). 
 
While Nassar, 380 Mass. at 917-918, was decided on 
statutory grounds, here we reach the constitutional question.  
For G. L. c. 123, § 35, to be constitutional as applied, the 
hearing judge must find, by clear and convincing evidence, that 
there are no appropriate, less restrictive alternatives that 
adequately would protect a respondent from a likelihood of 
imminent and serious harm. 
 
To be appropriate, a less restrictive alternative need not 
eliminate all risk to a respondent.  Rather, the proper focus is 
on whether there are any viable, plausibly available options 
that bring the risk of harm below the statutory thresholds that 
define a likelihood of serious harm ("substantial risk" for 
prongs one and two, and "very substantial risk" for prong 
three).  See Matter of G.P., 473 Mass. at 128-129 (discussing 
"quantum of risk" necessary to meet standards of G. L. c. 123, 
§ 1). 
 
For example, in this case the judge found a likelihood of 
serious harm.  She then weighed commitment against the voluntary 
28 
 
 
program that the juvenile had been scheduled to start within one 
week.  She concluded that, because she did not have confidence 
the juvenile actually would attend that program, it did not 
serve adequately to reduce the risk of harm.  This determination 
was within her discretion and satisfies the requirement that due 
process imposes. 
 
As a practical matter, in evaluating less restrictive 
alternatives, judges may seek guidance from the qualified 
physicians, psychologists, and social workers who already are 
required to testify in these cases.  Where, as here, the 
respondent is accessing, or may soon access, various forms of 
treatment and services, the respondent's counsel may argue their 
sufficiency to mitigate risk.  In such cases, consideration of 
less restrictive alternatives should evaluate the ways in which 
involuntary commitment can disrupt ongoing treatment efforts, as 
well as connections to the community and familial relationships.  
Particularly for juveniles, supportive relationships with family 
and community have been deemed protective against future 
substance use.  See Section 35 Commission Report, at 6 (July 1, 
2019).10  Ultimately, in crafting this requirement, our intention 
                                                          
 
 
10 The Section 35 Commission was established in 2018, see 
St. 2018, c. 208, § 104, to study "the efficacy of involuntary 
inpatient treatment for non-court involved individuals diagnosed 
with a substance use disorder."  It is chaired by the Secretary 
of Health and Human Services, and is staffed by representatives 
from numerous specifically identified private entities and 
29 
 
 
is to ensure, in accordance with the principle of due process, 
that involuntary commitment remains a viable, but carefully 
circumscribed, tool of last resort.  See id. (recommending 
expansion of easily accessed, "low-threshold," community-based 
treatment models and reservation of commitment for most severe 
cases).11 
 
Conclusion.  Because the juvenile was committed on 
insufficient evidence, the finding of a substance use disorder 
creating an imminent and very substantial risk of harm must be 
reversed, and the order of commitment must be vacated and set 
aside.  The matter is remanded to the Juvenile Court for entry 
of an order consistent with this opinion. 
 
 
 
 
 
 
 
So ordered. 
                                                          
 
professional groups involved in substance use treatment or 
public health, as well as representatives from a number of State 
agencies and members of the Legislature.  See Section 35 Report, 
at 35 (July 1, 2019) (Appendix A). 
 
 
11 In its July 2019 report, the Section 35 Commission 
presented seventeen recommendations to the Commonwealth.  Its 
top recommendation was that the Commonwealth 
 
"should expand development of low-threshold, treatment on 
demand models, including harm reduction interventions in 
community-based settings, immediate access to medication-
assisted treatment (MAT) and expansion of bridge clinics, 
addiction consult services, outreach and engagement 
programs, post-overdose intervention programs, syringe 
services programs, and family intervention programs." 
 
Section 35 Commission Report, supra at 6.  Thirteen of the 
recommendations were adopted.  Id.