Addiction in Criminal Offenders.

The role of substance use and morality in violent crime - a qualitative study among imprisoned individuals in opioid maintenance treatment.

Harm Reduct J. 2014 Aug
Havnes IA, Clausen T, Brux C, Middelthon AL.

Violent behavior cannot be attributed to any single factor; rather, a complexity of individual and environmental factors is involved. Previous research identifies the following as among important factors associated with increased violence risk: earlier violent crime, ‘history of problems with other antisocial behavior’ severe personality disorders, and substance abuse, . Most psychoactive substance use occurs among individuals who do not behave violently. Nonetheless, the relationship between psychoactive substances and violence warrants attention and can be conceptualized as a tripartite model: the systemic violence involved in the illegal drug market, the economic compulsive violence enacted to support costly drug use, and heroin use in particular, and the psychopharmacological violence that can occur during substance use, including acute intoxication, drug-seeking behavior associated with withdrawal, and episodes of drug-induced psychosis and paranoid symptoms.

https://harmreductionjournal.biomedcentral.com/articles/10.1186/1477-7517-11-24

Accounting for individual differences and timing of events: estimating the effect of treatment on criminal convictions in heroin users.

BMC Med Res Methodol. 2014 May
R?islien J, Clausen T, Gran JM, Bukten A.

Experimental setups and randomized controlled trials have been invaluable to the medical research revolution over the past decades. However, not all diseases and interventions lend themselves to stylized setups, and complex observational data is often the only available source of information. An analytical challenge is the often large heterogeneity between individuals in treatment regimes and the timing of various events. HIV patients drift in and out of treatment, cancer patients may, or may not, have multiple relapses and drug users will change their drug preferences, be enrolled in various treatments, drop out, overdose or die, at varying stages during the course of treatment. Nevertheless, accurate and reliable estimates of the effect of often costly interventions are still essential, both for health care professionals and policy makers. Heroin users as a group have been found to engage in high levels of criminal activity, and the reduction of crime is an important aspect of maintenance treatment. Several observational studies have found that opioid maintenance treatment (OMT) reduces the level of criminal activity among heroin users. Estimating of the effect of OMT is however complicated, as OMT patients differ greatly in characteristics and duration of engagement with treatment. Studies have found that patients cycle in and out of treatment, often for multiple episodes. Retention in treatment has consistently been found to be associated with crime outcome, and longer continuous periods in OMT has been associated with improved outcome.

https://bmcmedresmethodol.biomedcentral.com/articles/10.1186/1471-2288-14-68

Disentangling possible effects of childhood physical abuse on gray matter changes in violent offenders with psychopathy.

Psychiatry Res. 2014 Feb
Kolla NJ, Gregory S, Attard S, Blackwood N, Hodgins S.

Most violent offenders are males with a history of antisocial behavior that emerged in childhood, as indicated by a diagnosis of antisocial personality disorder (ASPD) (Kratzer and Hodgins, 1999). Among these men, a subgroup additionally presents the syndrome of psychopathy (ASPD+P), characterized by a lack of empathy, callousness, shallow affect, superficial charm, and manipulation of others (Hare, 2003). Offenders with ASPD+P begin offending at a younger age, more often engage in instrumental aggression, commit more violent offenses than other offenders, and fail to benefit from rehabilitation programs (Hare, 2003). Importantly, both phenotypes emerge early in childhood (Frick and Viding, 2009). Childhood physical abuse (CPA), defined as physical contact, constraint, or confinement designed to hurt or cause injury (Bremner et al., 2000), is experienced by many males who become persistent violent offenders (Widom, 1989) and who exhibit psychopathy in adulthood (Gao et al., 2010, Koivisto and Haapasalo, 1996). CPA has been associated with alterations in gray matter (GM) brain structures in childhood and in adulthood (McCrory et al., 2010). Alterations in similar structures have been reported in boys with conduct problems (Huebner et al., 2008) and violent offenders with psychopathy (Koenigs et al., 2011). We recently reported that violent offenders with ASPD+P displayed reduced GM volumes bilaterally in the anterior rostral prefrontal cortex and temporal poles compared with violent offenders with ASPD without psychopathy (ASPD?P) and healthy non-offenders (Gregory et al., 2012). The present study examined a sub-sample of these men to determine whether GM differences between ASPD+P and ASPD?P offenders were related to CPA.

https://www.psyn-journal.com/article/S0925-4927(13)00316-8/fulltext

A day-by-day investigation of changes in criminal convictions before and after entering and leaving opioid maintenance treatment: a national cohort study.

BMC Psychiatry. 2013 Oct
Bukten A, R?islien J, Skurtveit S, Waal H, Gossop M, Clausen T.

In treating heroin-dependent persons, opioid maintenance treatment (OMT) combined with psychosocial support has been found to be effective, and has been linked to improvements in a number of outcomes, including heroin use, mortality and criminal activity. OMT is often considered a long-term treatment. However, attrition and relapses are major challenges in OMT; treatment compliance is often poor and dropout from treatment is common. Patients who cycle in and out of treatment typically show less improvement during treatment and relapse to more drug use and criminal activity when out of treatment. For patients with several treatment episodes, the high-risk periods outside of treatment are of special concern. Studies examining the effects of OMT on criminal activity have typically compared levels of criminal involvement which have been aggregated for specific blocks of time, e.g., the period before treatment, during treatment and after treatment, and the mean total amount of criminal involvement in one period is compared with that in another period. However, categorizing the time axis into blocks of time effectively removes an important variable describing outcomes in the dynamic process of treatment, namely the continuity of change over time. Hence, comparing total amounts of crime aggregated for time periods does not optimally describe the time-varying and continuous probability of criminal activity within the different phases inside and outside of treatment. Because drug users move through different stages of both addiction and treatment, a more sensitive longitudinal approach may be required to identify and understand key factors influencing drug use and treatment over time.

https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-13-262