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Criminal Behaviour in Users of Psychoactive Substances Who Began Treatment

Karina Diniz Oliveira*, Renata Cruz Soares de Azevedo

Department of Medical Psychology and Psychiatry, Faculty of Medical Sciences, University of Campinas (Unicamp), Brazil

*Corresponding Author:
Karina Diniz Oliveira
Rua Maria Nassif Mokarzel
270, Campinas, CEP 13084-757, Brazil
Tel: 55-19-35217514
E-mail:[email protected]

Received Date: April 23, 2015; Accepted Date: May 14, 2015; Published Date: May 21, 2015

Citation: Oliveira KD, de Azevedo RCS (2015) Criminal Behaviour in Users of Psychoactive Substances Who Began Treatment. Social Crimonol 3:121. doi: 10.4172/2375-4435.1000121

Copyright: © 2015 Oliveira KD, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Objectives: To describe the profile of substance abusers and dependents who looked for treatment in two drug rehabilitation centers in the city of Campinas, SP, and their pattern of use. To discuss the relationship between criminal behavior and the use and dependence of psychoactive substances.(PAS) Methods: Quantitative cross-section study, 183 adult participants, users and/or dependents of one or multiples PAS in treatment. Measurements: questionnaire containing sociodemographic data, pattern of consumption of PSA, and practice in committing crimes; items from Sections J, K and P of the “Mini International Neuropsychiatric Interview”. (M.I.N.I.) To provide a more accurate analysis of the data, a new variable was described as “modified” ASPD (ASPDm), which was determined by excluding the items on the MINI directly related to criminality. Results: Respondents were male, average age 40.8, less than 8 years of schooling. Poliuse of PSA: alcohol and cocaine. Criminal acts had been practiced by 40,4%; 51 complied with criteria for ASPD. Variables correlated with criminal behavior: ASPDm, absence of religious practice (OR=6,783), ASPD (OR=9,225) and antecedent of use of solvents (OR=5,442). Conclusion: In this sample, the findings suggest that, for most drug users who seek treatment, substance use is not the only associated factor with criminal behavior.

Keywords

Criminal; Behaviour; Treatment; Societies; Organizations; Personality

Introduction

Drug and alcohol consumption causes enormous damage in both individual and collective spheres. It has become a social health-related problem worldwide [1]. The United Nations Office on Drugs and Crime has estimated that from 3.3% to 6.1% of the world’s population between the ages of 15 and 64 have consumed some type of drug at least once in the last year [1]. A recent epidemiological study in Brazil indicates a lifetime rate of powder cocaine use among adults of 4%, as well as 1.8% for crack cocaine [2]. Besides health risks, the consumption of alcohol and illicit drugs has numerous consequences in social scope including its association with criminality [3]. Studies indicate a multifactorial, diversified and complex relationship between the use and dependence of drugs and transgression, including socio-cultural factors and the effects of substances on individual behaviour [3,4]. The relationship between drugs consumption and aggression is conditioned to other variables, among which cultural factors are important [5,6]. Growing in social violent contexts, home or school, may contribute to the high level of violence in modern societies. People acquire agressive behavior as they learn, for instance, other social responses [7]. Personality is conceptualized as a set of stable knowledge structures that individuals use to interpret events in their social world and to guide their behavior. Antisocial Personality Disorder (ASPD) stands out as a veryry common individual trait and can be considered a major variable associated with criminality [8,9]. A study carried out 320 incarcerated users of psychoactive substances in the United States and has showed that 35% of the respondents were diagnosed with ASPD, according to criteria of the Mini International Neuropsychiatric Interview (M.I.N.I.) [9,10]. When ASPD is associated with the use of alcohol and other drugs, the relationship with criminality becomes more complex [8,11,12]. Personality characteristics of the individual may play a role in criminal behaviour in drug users seeking treatment. Therefore, criminal behaviour should not be considered just a consequence of using drugs.The aim of this study is to evaluate the relevance of ASPD and discuss the role of aggressivity in criminal behavior.

Methods

The quantitative and transversal study described and discussed here was approved by two study organizations, Research Ethics Committees, both in the city of Campinas, São Paulo, Brazil. The research consisted basically in individual interviews. Patients’ participation was voluntary. The subjects were clearly informed that the acceptance or denial in the study would not influence their access to the centres and related services in any way. The city of Campinas, in the State of São Paulo, Brazil, has a population of over one million inhabitants. At the time of the study there were two drug rehabilitation facilities, two similar services at local universities and structured emergency units and services. The present study was carried out at two rehabilitation facilities: the outpatient service of the General Hospital at the State University of Campinas, and a Municipal Psychosocial Rehabilitation Centre, operated by the Campinas City Health Department. Both centres are regulated and funded by Brazilian Ministry of Health and therefore opened to all local citizens. The treatment is for free. At both facilities, as regular routine, all new patients are interviewed individually. In the following weeks, they take part in three sessions of a “welcoming group”. These are meetings coordinated by specialized health professionals at the facilities. After three sessions in the welcoming group, the individuals are formally taken in as patients at the centre. An individual treatment plan is drawn up for each one, including a medical check-up carried out by a team of physician. From this point on, patients are expected to participate in their assigned activities on a regular basis. Therapeutic activities always include group or individual psychotherapy, as well as appointments with a general medical practitioner and psychiatrist. The including criteria were: both gender, age 18 or over, come to the respective centre in search of treatment for substance abuse and appear for at least one pre-scheduled medical consultation, following the presence at three welcoming sessions. Interviews were conducted between January 2008 and January 2009. The excluded were those who seemed to be psychologically unable to answer the questionnaire due to: effects of substances they were taking (intoxication or intense withdrawal symptoms), cognitive difficulties, or some type of psychotic behaviour with serious positive symptoms. Individuals who were classified as not having adhered to treatment because came to the centre to participate in the welcoming group only once or twice were also excluded. The questionnaire was applied only to subjects who had been submitted to an individual medical check-up after joining in the welcoming group. On the day of the scheduled medical appointment, and immediately following it, each respondent was led to other room for an individual interview, during which the study and its objectives were explained. Those who agreed to join signed an informed consent. The instruments used in the study were:

A printed individual data form with socio-demographic information (such as gender, age, schooling, marital status, profession, and occupational situation), pattern of consumption (type of substance, age consumption began, and frequency) and possible criminal offenses.

The Section J (Alcohol Dependence and Alcohol Abuse), Section K (Substance Dependence, Non-alcohol; and Substance Abuse, Nonalcohol), and Section P (Antisocial Personality Disorder) of the “Mini International Neuropsychiatric Interview” (MINI) were also applied [10].

Criminal behaviour was investigated answering “have you ever had any criminal law problems”. For those who answered positively, the offense was specified. In order to determine as accurately as possible the relationship between ASPD and the self-reported practice of crimes, an analysis was carried out considering only criteria “a,” “d,” “e” and “f” of the M.I.N.I [10]. Thus excluding items that directly mention the practice of criminal acts (Items “b” and “c”). An adaptation, labelled the Antisocial Personality Disorder “modified” (ASPDM), was then designed, and applied when the subject indicated the presence of three out of the four criteria mentioned above. The information was entered into a databank of Version 13.1 of the SPSS Program for consolidation and analysis. The descriptive analysis measured position and dispersion of continuous variables, and frequency tables for categorical variables. The Chi Square Test was used to compare proportions, multiple logistic regression analysis was then used to identify crime-related factors, and the stepwise process was used to choose the variables to be applied. The significance level adopted for statistical testing was 5%, and the Relative Risk Confidence Interval was 95% (Figure 1).

sociology-criminology-relative-risk-confidence

Figure 1: Relative Risk Confidence Interval.

Results

Of the 183 patients who participated in the study, 145 were male. Ages ranged from 18 to 70, with average age of 40.8. Almost half of them (42.6%) reported being Catholics, 40 (21.9%) Evangelical/ Protestant and 6 (3.3%) Spiritualists. The remaining 32.2% reported having no religion. Among the 124 respondents who said they have a religion, 60 were not practicing.

Table 1 presents the subject´s pattern of PSA use. Among the respondents, 40.4% informed that they had criminal law problems during their lifetime. The most frequent offenses were assault and battery (23.5%), theft and robbery (21.8%), and homicide (8.2%). The types of offenses committed by the subjects were also analysed. Criminal offenses against property were committed by 39 of the 74 subjects who reported some type of illegal act, the crime of assault and battery being reported by 43.4% of the same 74 individuals. Table 2 presents a comparison between the two groups (with and without criminal offenses), according to the variables studied. A total of 64 respondents consumed exclusively alcoholic beverages. All of them were diagnosed with alcohol dependence. Only 15.6% of them had been involved in criminal offenses, a rate that is significantly lower (p<0.001) than for users of illicit drugs (marijuana, crack, cocaine). Table 3 shows the results of the multiple logistic regressions for the factors associated with criminality. Anti-social Personality Disorder Modified (ASPDm) and use of solvents were closely correlated to individuals who had committed theft or robbery. ASPDm (OR=13.066, p<0.0001); Lifetime use of Solvents (OR=15.382, p<0.0001). Lifetime use of amphetamines: OR=4.304, p<0.0373. Fifteen (20.3%) out of the 74 subjects who had committed some sort of criminal offense reported that their crime was homicide. The presence of criteria for ASPDm was considered a significant variable among homicides, OR=12.836, p<0.0003; as was lifetime use of solvents: OR=5.883, p<0.0056.

Variable N
183
%
Alcohol
Abuse
First use before 15 years old
Dependence
34
101
112
18.6
55.4
61.3
Cocaine Powder
Lifetime use
First use before 15 years old (n=87)
Dependence 
87
55
50
47.5
58.6
27.3
Crack Cocaine
Lifetime use
First use before 15 years old (n=67)
Dependence
67
5
50
36.6
7.9
27.3
Cannabis
Lifetime use
First use before 15 years old (n=86)
Dependence
86
47
38
47.0
54.7
20.7
Solvents
Lifetime use
First use before 15 years old (n=59)
Dependence
59
40
4
32.3
67.7
2.1
Benzodiazepinic drugs
Abuse
First use before 15 years old (n=13)
Dependence
13
2
10
7.1
13.3
5.5
Synthetic drugs
Lifetime use
First use before 15 years old (n=16)
Dependence
16
3
0
8.7
18
0
Amphetamines
Lifetime use
First use before 15 years old (n=14)
Dependence
14
5
2
7.6
35.7
1.1

Table 1: Pattern of use of psychoactive substances in people who seek for treatment in two rehabilitation facilities in the city of Campinas, Brazil.

Characteristic      n Crime Reportedn (%) No Crime Reported n (%)  p
Total 183 74 (40.4) 109 (59.6)  
Gender
Male
Female
145
38
61 (42.1)
13 (34.2)
84 (57.9)
25 (65.8)
NS
Schooling
< 8 years
≥ 8 years
147
36
 59 (40.1)
15 (41.7)
88 (59.9)
21 (58.3)
NS
Employment
Active
Inactive
62
121
20 (32.3)
54 (44.6)
42 (67.7)
67 (55.4)
NS
Religion
Yes
No
124
59
81 (65.3)
31 (52.5)
43 (34.7)
28 (47.5)
0.01*
Income
<=US$200
>US$200
98
85
40 (42.5)
34 (40.0)
58 (57.5)
51 (60.0)
NS
Marital status
Steady partner
No steady partner
80
103
31 (38.8)
43 (58.3)
49 (61.2)
60 (41.7)
NS
Children
No
Yes
64
119
27 (42.2)
47 (39.5)
37 (57.8)
72 (60.5)
NS
Diagnosed with ASPD**
No
Yes
132
51
32 (24.5)
42 (82.4)
100 (75.8)
9 (17.5)
<0.001*
Diagnosed with ASPDm***
No
Yes
150
33
47 (31.3)
29 (85.3)
102 (68.7)
4 (14.7)
0.0006*
Number of substances currently used
1 or 2
3 or more
100
83
21 (21)
52 (62.7)
79 (79)
31 (37.3)
<0.001*
Dependence on substances
1 or 2
3 or more
147
36
50 (34)
24 (66.7)
97 (66)
12 (33.3)
<0.001*
Treatmentcentre
Caps-AD (Municipal Rehab Centre)
ASPA Unicamp (University Rehab Centre)
133
50
51 (38.3)
23 (46)
82 (61.7)
27 (54)
NS

Table 2: Profile of substance users and self-reported criminal behaviour.

Variable   Criminal behaviour
    Yes               No
p OR
Classified with ASPD     42                 09 <0.0001 9.225
Have no religion     31                 28 0.0172 6.783
Classified with ASPDm     29                 04 0.0006 6.244
Lifetime use of solvents     44                 15 <0.0001 5.442

Table 3: Multivariate analysis of the factors associated with criminal behaviour.

Discussion

The main focus of this study is to discuss variables related to self-reported criminal behaviour in alcoholics and drug addicts who sought help at either of the two health centres described above. The socio-demographic profile of the population evaluated was similar to those found in other studies on patients who seek treatment in Brazil, composed mainly of men, in the fourth decade of life [13]. The relationship between criminal behaviour and the use of drugs and alcohol is well-known, especially of those who use stimulants of the central nervous system [12-14]. According to some studies, personality characteristics are the main reason for aggressive behavior. Circunstancial factors, as PSA abuse, may catalyze the aggressive tendencies. Destructive people tend to misunderstand the reality, harassing rotine acts. Simple requirements can be understood as an insult. For these people, violence is an acceptable and preferred way of dealing with interpersonal conflicts [15]. In addition, the consumption of alcohol contributes to increase aggressiveness and impulsiveness, which can also facilitate criminal acts [11,12] Impulsiveness in these situations, is often a precipitating factor of the offense, and the alcohol acting as a de-inhibiting factor catalyses violent acts [5]. According to Cherpitel, alcohol restricts cognitive capacity and leads to excessive social behaviors [5]. Thus, aggression is not necessarily the outcome of alcohol consumption if nonaggressive reactions are salient after a provocation. An intoxicated person may therefore not correctly perceive the reasons for other people’s behavior, making the actions of others appearing to be more provocative than they would do in a sober perceiver [16]. In our study, individuals with dependence for multiple drugs committed more criminal offenses than those who were dependent on only one substance. The poly-substance users are more exposed to risks, showing greater occupational, social and emotional difficulties, and tend to abandon treatment more frequently [17]. The rate of 40.4% of the subjects reporting criminal offense is very high in comparison with the general population in the Campinas area, where the arrest rate is 22 per 100,000 inhabitants [18]. The criminal offenses reported by the subjects were against persons (mostly assault and battery) and against property (especially theft and robbery). 43.4% of the subjects who declared criminal behaviour mentioned theft and robbery. For the cocaine and crack users, criminal offenses against property are correlated with the behaviour of seeking drug. Symptoms of withdrawal, mainly intense craving and extreme search for the substance, might lead to thefts and robberies [12,13]. It seems that such types of offense had been committed more in function of the effects of craving, to get money to buy the drug [19]. Among the 74 subjects in the study who reported criminal offense, 15 (20.3%) said they had committed at least one homicide. Aggressive behavior is more frequent in people who, besides their violent tendencies, are alcohol and PSA abusers. Some studies add, those who do not present this personality trace, seldon became aggressive while intoxicated [5], considering this, a factor that was closely associated with patterns of reported criminal behaviour was the diagnosis of ASPD [20]. Studies point out that the rate of ASDP in the general population varies between 1% and 3% [21] but in the sample studied here this rate was significantly higher (27.9%). Substance use, abuse and dependence among individuals with ASDP is relatively common, a fact that may corroborate the findings here [22,23]. This was seen in a number of studies that analysed samples from substance users whose levels of correlation with antisocial personality disorder varied from 20% to 68% [24]. The wide variation seems to be in function of the nature of the samples, most of which were comprised in prison inmates. The influence of ASPD criteria on reported criminality in this study was seen for crimes both against persons and property. The correlation between ASPD and crimes against property has been noted in other studies as well [22]. However, this type of crime in this study was also committed by users who do not seem to show antisocial behaviour. The craving might lead to misconducting behaviour, when the users feel themselves in need of the substance. The positive correlation between ASPD and the practice of crimes is reinforced by other studies that also conclude that ASPD is one of the factors responsible for this correlation, among psychoactive drug users, especially those of powder and crack cocaine. Not only ASPD and modified antisocial personality disorder were associated with the practice of crimes, but the reverse is also true: the absence of ASPD, and its modified version, corresponds to lower rates of criminal behaviour. Among the subjects of this study, 68% of those who did not show modified antisocial personality disorder had never committed any crime. Our results indicate that analysis of the relation between drug use and criminality must consider personality disorders. In the absence of ASPDm, this observation was much less significant. Some shortcomings of this study should be considered. One criterion for inclusion in the study was the subjects who had come to at least one pre-scheduled medical check-up. This criterion probably eliminated individuals who did not seek treatment and who may show characteristics that are different from those currently studied. Another shortcoming was the evaluation of criminal behaviour based on self-reports, without reference to their actual criminal records. This fact could have generated sub-reported information. The aim of this study was to assess criminal behaviour in alcoholics and drug addicts who sought treatment, particularly those who presents antisocial personality disorder traces. The criminal behaviour in this sample was higher than general population. However, when we analyze the ASPD role, important differences are shown. The ASPD criteria stood out as the closest factor correlated with reported criminal behaviour in the population studied. Furthermore, the results show that the majority of persons with no ASPD traces do not commit any crime. The findings here suggest that, for most drug users who seek treatment, substance use is not the only associated factor with criminal behaviour.

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