Risk factors for criminal recidivism -- a prospective follow-up study in prisoners with substance abuse

ABSTRACT: BACKGROUND: Substance use in general has been shown to predict criminal recidivism. The present study aimed to examine potential predictors of criminal recidivism, including substance-specific substance use patterns, in prisoners with substance use. METHODS: A cohort of prisoners with substance use problems (N = 4,152) were assessed with the Addiction Severity Index (ASI) in the Swedish criminal justice system. Clients were followed for an average of 2.7 years. Criminal recidivism was defined as any return to the criminal justice system. RESULTS: During follow-up, 69 percent (n = 2,862) returned to the criminal justice system. Recidivism was associated with amphetamine and heroin use, with an additive risk for injectors, and with polysubstance use. Also, recidivism was negatively associated with alcohol, other opioids than heroin/methadone and with hallucinogenic drugs, and positively associated with previous psychiatric in-patient treatment, violent behaviour, and with a shorter index sentence. Associations remained when controlling for type of crime. CONCLUSIONS: Even when controlling for type and severity of crime, and for psychiatric problems, risk of criminal relapse was increased by substance use variables, including amphetamine, heroin and polysubstance use, and an additional risk was shown for injection drug users. These findings have implications for the need for substance abuse treatment after release from prison.     

Age at onset of substance abuse: a crucial covariate of psychopathic traits and aggression in adult offenders

To examine age at onset of substance abuse in relation to other factors of relevance to criminal behavior, we compared Life History of Aggression (LHA) scores, traits of psychopathy according to the Psychopathy Checklist--Revised (PCL-R), and violent recidivism in 100 violent offenders with early (before the age of 18) versus late onset of abuse or dependence. Of 56 subjects with a history of alcohol and/or drug abuse, an early onset was ascertained in 31. The duration of abuse did not correlate with the LHA and PCL-R scores or with violent recidivism, but the age at onset correlated strongly with all these factors and also remained their strongest correlate in multivariate models including childhood-onset attention deficit/hyperactivity disorder, conduct disorder, and drug abuse as covariates. Strong mathematical associations with aggression, psychopathy, and recidivism pointed to age at onset of substance abuse as a marker of possible complications that require preventive social, educational and medical measures.     

Differences in personality and risk characteristics in sex, violent and general offenders

Background Studies examining the characteristics of sex and violent offenders have found differences in personality and offence characteristics. However, none of these studies has examined differences in personality characteristics between violent, sex and general offenders using the Special Hospitals Assessment of Personality and Socialization (SHAPS). Method Using a retrospective archival research design, data on 153 male offenders were divided into three groups, sexual (n = 85), violent (n = 46) and general offenders (n = 22). Of the sample 139 offenders had completed the SHAPS. The Sexual Violence Risk‐20 (SVR‐20) measure was used to categorize levels of risk. Reconviction data collected over a 10‐year follow‐up period were analysed using the receiver operating characteristic analysis. Results Violent offenders had significantly more chaotic lifestyles, displayed greater psychopathology than sex or general offenders, and were most likely to reoffend, with over a quarter committing further violent offences. The sexual offender group share more in common with the general offenders, in terms of personality characteristics and recidivism rates, than with the violent offenders. More of the violent offenders were categorized as at medium or high risk of recidivism than any other group. The SVR‐20 significantly predicted any reconviction over five‐ and 10‐ year follow‐up periods. Discussion The results from this study support the use of self‐report inventories in assessing differences between offender groups. Such information may assist clinicians in prioritizing management and intervention strategies for those offenders, and in turn lower the risk of further offending. Copyright © 2006 John Wiley & Sons, Ltd.     

Treatment Gain in Violent Offenders: The Relationship Between Proximal Outcomes,Risk Reduction and Violent Recidivism

This study examines whether change in dynamic risk factors and other treatment targets over the course of violent offender treatment is associated with a reduction in violent recidivism. Data from 82 adult male violent offenders who attended a prison-based violence treatment programme were collected via retrospective file review. Therapeutic change was assessed by comparing pre- and post-treatment Violence Risk Scale (VRS) scores, ratings of denial and minimisation of violence, level of victim awareness, and motivation to change. Completion of offender treatment is found to be associated with significant change on all proximal outcome measures (i.e. reduction in dynamic risk and minimisation of violence, and increased victim empathy). However, these changes do not translate into reductions in reoffending; only one measure of within-treatment change – enhancement of victim awareness – is (negatively) associated with recidivism. These results suggest that caution is required when considering the impact of change in a restricted range of treatment targets on violent recidivism. Future research should focus on identifying reliable indicators of within-treatment change to aid idiographic assessments of violence risk and to elucidate mechanism of change.     

Substance use,substance use disorders,and comorbidity patterns in a representative sample of incarcerated male Dutch adolescents

The aim of this study was to investigate the prevalence of substance use and substance use disorders (SUDs) among incarcerated boys, and comorbidity patterns and the relationship between SUDs and violent offending and criminal recidivism. The presence of SUDs and other psychiatric disorders was assessed in a representative sample of 204 incarcerated boys aged 12 to 18 years using the Diagnostic Interview Schedule for Children (DISC). Ninety-two percent had used alcohol, 86% had used cannabis, and 33% had used other substances. The 6-month prevalence of SUDs was 55%, and 22% reported polysubstance abuse or dependence. SUDs were positively associated with comorbid externalizing and psychotic disorders. Substance dependence was negatively associated with violent offending but not with criminal recidivism. These high prevalence rates call for more attention to diagnosis and management of SUDs among incarcerated male adolescents. The negative association between substance dependence and the violent nature of the index offense needs further investigation.     

Long-term predictive validity of historical factors in two risk assessment instruments in a group of violent offenders with schizophrenia

The long-term predictive validity of the Violent Risk Appraisal Guide (VRAG) and the historical part (H-10) of the risk assessment device HCR-20 in predicting violent recidivism was investigated in a sample of (n=106) violent offenders with schizophrenia. An effort was made to validate the 9-bin categorization of different absolute risk to recidivate depending on the individual score on the VRAG. Scores on both devices were retrospectively obtained from various files and registers. Individuals were followed up after discharge from hospital for on average 86 (standard deviation=19.33) months. During follow-up 29% of the sample was reconvicted of a violent crime. Results indicated that both H-10 and VRAG had a moderate ability to predict violent recidivism and that H-10 had a slightly better accuracy. Most of the items in H-10 but only half of those in VRAG correlated significantly with violent recidivism. The 9-bin categorization of VRAG scores produced mixed results. In the Swedish sample there was a linear trend in which increased VRAG scores were associated with higher absolute risk to recidivate. However, the distribution of scores and the figures of absolute risk of recidivation were not replicated. It is concluded that historical factors seem to play an important role for the long-term prediction of future violence among a group of severely mentally ill individuals.     

Gender differences in re‐offending among psychiatrically examined Swedish offenders

Background The gender gap for violent offending is narrowing in the general population. Substance abuse and mental health problems are known risk factors for criminality. While substance abuse treatment has been associated with reduced risk of re‐offending, women seem less likely to engage than men. People misusing substances tend to be high users of emergency room (ER) services. Such use may be an indicator both of treatment failure for substance misuse and offending. Little is known about gender differences in this respect. Aims This study aims to test for gender differences in re‐offending, use of substance abuse treatment, and hospital ER visits among offenders referred for forensic psychiatric assessment in Sweden. Method The study used a longitudinal retrospective design. Data on all 31 women from a 2‐year (2000–2001) cohort of serious offenders referred for forensic psychiatric assessment in Stockholm county, and 31 men from the same cohort, were extracted from forensic service and national records. Selection of the men was by initial random sampling followed by matching on age and substance misuse. The two resulting samples were compared on health service use and re‐offending data between release and the census date (30 April 2004). Results There were no gender differences for violent re‐offending or for engagement in planned substance abuse treatment, in spite of longer time at risk for the men. Re‐offending was reduced for women but not men who did not present in the ER with physical health problems. Conclusions Our study is limited by sample size, although it included all women referred to the specialist forensic psychiatric service over 2 years, but it does indicate that differences between men and women in this situation are likely, and worthy of further study. The only way of achieving adequate sample sizes is likely to be through multi‐centre collaboration. Copyright © 2010 John Wiley & Sons, Ltd.     

Benzodiazepine use in posttraumatic stress disorder among veterans with substance abuse

Veterans with posttraumatic stress disorder (PTSD) and substance abuse may abuse benzodiazepines and develop violent dyscontrol when using them. A total of 370 veterans were compared by substance abuse diagnosis (50%), benzodiazepine use (36%), and their interaction on 1-year outcomes after inpatient discharge. Substance abusers were less likely to be prescribed benzodiazepines (26% vs. 45%). No outcome showed a differential worsening by substance abuse or benzodiazepines, although some baseline differences were noted. Outpatient health care utilization was lower in benzodiazepine users (47 vs. 33 visits). Among PTSD patients with comorbid substance abuse, benzodiazepine treatment was not associated with adverse effects on outcome, but it may reduce health care utilization.     

A classification of risk factors in serious juvenile offenders and the relation between patterns of risk factors and recidivism

Background There has been a lot of research on risk factors for recidivism among juvenile offenders, in general, and on individual risk factors, but less focus on subgroups of serious juvenile offenders and prediction of recidivism within these. Objective To find an optimal classification of risk items and to test the predictive value of the resultant factors with respect to severity of recidivism among serious juvenile offenders. Method Seventy static and dynamic risk factors in 1154 juvenile offenders were registered with the Juvenile Forensic Profile. Recidivism data were collected on 728 of these offenders with a time at risk of at least 2 years. After factor analysis, independent sample t‐tests were used to indicate differences between recidivists and non‐recidivists. Logistic multiple linear regression analyses were used to test the potential predictive value of the factors for violent or serious recidivism. Results A nine‐factor solution best accounted for the data. The factors were: antisocial behaviour during treatment, sexual problems, family problems, axis‐1 psychopathology, offence characteristics, conscience and empathy, intellectual and social capacities, social network, and substance abuse. Regression analysis showed that the factors antisocial behaviour during treatment, family problems and axis‐1 psychopathology were associated with seriousness of recidivism. Conclusions and implications for practice The significance of family problems and antisocial behaviour during treatments suggest that specific attention to these factors may be important in reducing recidivism. The fact that antisocial behaviour during treatment consists mainly of dynamic risk factors is hopeful as these can be influenced by treatment. Consideration of young offenders by subgroup rather than as a homogenous population is likely to yield the best information about risk of serious re‐offending and the management of that risk. Copyright © 2010 John Wiley & Sons, Ltd.     

A comparison of mortality rates for buprenorphine versus methadone treatments for opioid use disorder

Introduction

In offending populations, prevalence rates of mental disorders are much higher than in the general population. Nevertheless, it is unclear whether mental disorders can improve the prediction of recidivism beyond actuarial risk assessment tools.

Methods

The present prospective-longitudinal study was conducted between 2001 and 2021 and included 1066 men convicted of sexual offenses in Austria. All participants were evaluated with actuarial risk assessment tools for the prediction of sexual and violent recidivism and the Structured Clinical Interview for Axis I and Axis II disorders. Sexual and violent reconvictions were assessed.

Results

Exhibitionism and an exclusive pedophilia showed the strongest correlations with sexual recidivism in the total sample. In the child related offense subsample additionally a narcissistic personality disorder was correlated with sexual recidivism. The strongest correlation with violent recidivism was found for an antisocial and borderline personality disorder. None of the mental disorders could improve the prediction of recidivism beyond actuarial risk assessment tools.

Conclusion

Common current actuarial risk assessment tools revealed good predictive accuracy in men convicted of sexual offenses. With few exceptions mental disorders were only weakly associated with recidivism, suggesting that there is no direct link between mental disorders and violent and sexual reoffending. Mental disorders should nevertheless be considered in treatment issues.     

Assessment of dynamic violent behavior risk factors

Dynamic violent behavior risk factors have special significance since they constitute the main target for preventive intervention. Different dynamic factors as well as violent recidivism were assessed with, among other instruments, the environmental risk (Risk Management) section of the Argentinean version of the HCR-20 in 25 parolees from the Province of Buenos Aires Penitentiary System. Among other findings, the prevalence of the risk factors linked to substance abuse and socioeconomic deprivation, and the heterogeneous perception of the official institutions are very significant. Exposure to destabilizers was the factor most associated with violent recidivism.     

Sexual Offender Treatment Effectiveness Within Cognitive-Behavioral Programs: A Meta-Analytic Investigation of General,Sexual, and Violent Recidivism

The current sexual offender literature focuses on recidivism reduction in an effort to increase public safety. While cognitive-behavioral therapy (CBT) programs are considered a mainstream treatment method, it is essential to study recidivism as an indicator of treatment effectiveness. This meta-analysis examines research published since 1970 to determine the overall effectiveness of treatments in reducing recidivism among adult male sexual offenders. Decade of implementation and CBT treatment features are also assessed as moderator variables. The results from the 25 studies identified were converted into 42 weighted effect sizes utilizing a random-effects model. Significant overall effect sizes were found for sexual and violent/combination recidivism; however, multiple indices indicate heterogeneity in the effect sizes. Significant differences were found in the overall effectiveness of the treatments by decade, and the treatments delivered during the 1990s were found to be related to lower levels of sexual and violent/combination recidivism.     

The Associations of Area-Level Violent Crime Rates and Self-Reported Violent Crime Exposure with Adolescent Behavioral Health

The effects of witnessing and experiencing crime have seldom been disaggregated. Little research has assessed the effect of multiple exposures to crime. We assess independent contributions of self-reported crime and area-level crime to adolescent behavioral health outcomes. Cross sectional data on 5519 adolescents from the Comprehensive Community Mental Health Services for Children and their Families Program was linked to FBI crime rate data to assess associations of mutually exclusive categories of self-reported crime exposure and area-level crime rates with mental health and substance abuse. Self-reported crime exposure was significantly associated with poorer behavioral health. Violent victimization had the largest association with all outcomes except internalizing scores. All self-reported crime variables were significantly associated with three of the outcomes. Area-level crime rates were associated with one mental health outcome. Providers should assess direct and indirect crime exposure rather than only focusing on violent victimization.     

Parental mental disorder and offspring criminal behavior: an adoption study

It is not unreasonable to expect that some biological predisposition toward antisocial behavior may characterize the most serious of recidivistic and violent criminal offenders. This study used the adoption method to examine the contribution of mental disorder in adoptees' biological backgrounds to their recidivistic and violent criminal offending. Multiple recidivistic nonviolent criminal behavior was found at a significantly elevated rate in adopted-away sons when mental disorder and criminal involvement were characteristic of the adoptees' biological families. A similar, but nonsignificant, elevation was found for rates of violence. Parental diagnostic types associated most strongly with sons' later criminal involvement were drug abuse, alcohol abuse, and personality disorders. Parental psychoses were not related to offspring recidivism or violence in this cohort. Possible confounding effects of missing data, institutionalization prior to adoption, information given to adoptive parents by the adoption agencies about the child's biological background, historical period, perinatal factors, and selective placement were considered. Perinatal factors could not be discounted as contributors to the findings.     

Is violent method of suicide a behavioral marker of lifetime aggression?

OBJECTIVE: The main purpose of this study was to investigate whether the method of suicide is a valid behavioral marker of a lifetime history of aggression. METHOD: The authors applied the psychological autopsy method to investigate 310 individuals who committed suicide. They used structured clinical assessments and personality trait scales in interviews with family members of the deceased. RESULTS: Violent method was associated with a higher level of lifetime aggression and a higher level of impulsivity. In addition, violent method was associated with lifetime substance abuse or dependence and psychotic disorders. Controlling for age, sex, substance disorders, and other major psychopathology, the authors found that lifetime aggression and the interaction between impulsivity and aggressive behavior remained associated with violent method. CONCLUSIONS: These results support the use of violent method of suicide as a behavioral marker of a higher level of lifetime impulsive-aggressive behaviors.     

Jeu d’argent problématique et responsabilité pénale

ObjectivesIn total, 14% to 30 % of individuals with gambling disorder engage in illegal acts to finance such behavior. This clinical situation could be explained by higher gambling severity, associated substance use disorder, antisocial personality disorder and economic factors (debts, financial problems). The present work focuses, more broadly, on criminal responsibility of problematic gamblers.MethodsWe will discuss this question through different typical situations that medical experts of criminal responsibility may have to face. We will address each of the following cases: 1) isolated problematic gambling; 2) problematic gambling associated with antisocial personality disorder; 3) problematic gambling associated with a manic episode; 4) problematic gambling associated with substance use disorders; and 5) problematic gambling associated wiht dopamine agonist treatment.ResultsIsolated problematic gambling, (not associated with any psychiatric or addictive disorder): it seems consensual that individuals committing infractions in this case are criminally responsible. However, impeded ability to action control and possible sentence attenuation could be discussed in case of severe gambling disorder. Problematic gambling associated with antisocial personality disorder: if the penal offence reports solely to personality disorder, criminal responsibility would be attributed. However, if illegal or violent acting is directly linked to co-cocurrent delusional symptoms, it could be a cause of criminal non-responsibility. Problematic gambling associated with manic episode: manic episode related offence could lead to negation of criminal responsibility, while a hypomanic episode may provide grounds for sentence reduction. Problematic gambling associated with substance use disorders: in France, addiction is not considered to remove nor to impede a person's ability to understand or control his actions and is excluded from criminal non-responsibility causes. However, substance induced delusional or confusional episodes could abolish a subject's discernment or his ability to control his actions yielding to penal non-responsibility. Problematic gambling associated with dopamine agonist treatment: Criminal responsibility for dopamine agonist induced gambling related illegal acts is still controversial. Nevertheless, people committing an infraction linked to associated dementia or dopamine agonist induced mania should be considered as criminally non-responsible.ConclusionsSome clinical dimensions such as craving intensity, compulsivity, disorder's severity, volitional control might be forensic targets to assess criminal responsibility.     

Violence of young criminals predicts schizophrenia: a 9-year register-based followup of 15- to 19-year-old criminals

Violent and aggressive behavior in preschizophrenia adolescents has been described in several studies. Our aim was to investigate the extent to which violent conviction in late adolescence predicted later schizophrenia in a cohort of young criminals. We performed a 9-year register-based followup of a complete national cohort of young convicted criminals. A total of 780, 15- to 19-year-old subjects identified in 1992 were followed up in 2001 with register linkage of the Danish Psychiatric Central Register, the Danish National Criminal Register, and the Danish National Cause of Death Register. Analyses with Cox regression were performed to identify predictors of later schizophrenia. We found at followup that 3.3 percent of the cohort had been diagnosed with schizophrenia and 4.5 percent with any psychosis. Conviction of violence in late adolescence was significantly associated (odds ratio = 4.59 [95% confidence interval (1.54; 13.74)]) with future diagnosis of schizophrenia. Violent behavior can thus be seen as part of the preschizophrenia phase of young criminals.     

Parental separation at birth and criminal behaviour in adulthood

Background: Parental absence has been connected with later criminality. We studied the association between very early separation and criminality in a unique data set. Methods: The index cohort consisted of 2,906 subjects born between 1945 and 1965 in Finland who were temporarily isolated from their family immediately after birth and sent to adequate nursing homes due to tuberculosis in the family. The average separation time was 7 months. For every index subject, two reference subjects (matched for sex, year of birth and place of birth) were gathered. Data on criminal offences were obtained from Statistics Finland arising from adolescence to middle age, between January 1, 1977 and December 31, 1998. The association between parental separation and subcategories of non-violent and violent criminality and violent recidivism, respectively, in male and female offspring was analysed. Subjects who had committed at least two violent crimes were defined as violent recidivists. Results: Of the male index subjects, 12.1% as compared with 7.1% of the reference cohort (estimated relative risk RR 1.73; 95% CI 1.42–2.11) had committed violent offences. Of the male index subjects 5.2% and of the male reference subjects 3.6% were violent recidivists (RR 1.47; 1.10–1.98). Of the male index subjects 26.3% and of the reference cohort 23.4% had committed nonviolent crimes (RR 1.14; 1.01–1.29). Among females, non-violent crimes were committed by 7.9% of the index subjects and by 5.0% of the reference subjects, respectively (RR 1.54; 1.18–2.00). Violent crimes were rare among female subjects. Conclusion: Criminal behaviour was more prevalent among both male and female subjects separated at birth from their families because of tuberculosis in the family than in the reference cohort. Especially violent crimes were prevalent in the male index cohort. Even so, the differences between the index and reference cohorts were rather modest. Very early separation may have some, although limited, influence on later criminality in the offspring. Accepted: 10 January 2003 Correspondence to P. M?ki, MD     

Clozapine reduces violent behavior in heterogeneous diagnostic groups

Violent behavior is a significant problem in the psychiatric hospital setting. Persistently violent patients often require seclusion and/or restraints and typically receive high doses of medication and polypharmacy. Clozapine has been found to be effective in reducing aggression in patients with psychosis. Thus, we examined the effects of clozapine in a heterogeneous group of persistently violent patients. A chart review of the effect of clozapine in persistently violent patients was performed. Changes in the number of violent episodes and the need for seclusion and restraint were assessed for a 3-month period before and after receiving clozapine. In this group of five, carefully selected, persistently violent patients, clozapine treatment resulted in marked decreases in violent episodes and the use of seclusion and restraint. These data suggest a role for clozapine in the treatment of persistently violent patients irrespective of DSM-IV diagnosis.     

Research on the biologic aspects of violence

Violent behavior is reviewed in regard to its relationship with genetic, hormonal, neurochemical, electrical, substance abuse, and psychiatric factors. The most significant relationships were found between violent behavior and the neurotransmitter serotonin. Suggestive associations were found between violent acts and testosterone serum levels, epilepsy, and episodic dyscontrol.