Addiction and the criminal - PowerPoint Presentation

1. Addiction and the criminal justice systemDr. Eric BlaauwProfessor in Addiction studiesHanze University of Applied Sciences

2. ContentWhat is addiction?The Dutch criminal justice systemAddiction and crimeForensic addiction care

3. ADDICTION

4. What is addiction?Craving or using more than intendedTaking the substance in larger amounts or for longer than you meant toWanting to cut down or stop using the substance but not managing toSpending a lot of time getting, using, or recovering from use of the substanceCravings and urges to use the substanceNegative consequences, also for othersNot managing to do what you should at work, home or school, because of substance useContinuing to use, even when it causes problems in relationshipsGiving up important social, occupational or recreational activities because of substance useUsing substances again and again, even when it puts the you in danger Tolerance and dependenceContinuing to use, even when the you know you have a physical or psychological problem that could have been caused or made worse by the substanceNeeding more of the substance to get the effect you want (tolerance)Development of withdrawal symptoms, which can be relieved by taking more of the substance.

5. Prevalence of useRecent use in the Netherlands (2009)Alcohol: 78%Tobacco: 27%Cannabis: 3,3%Cocaine: 0.3%Opioids: 0.1%

6. Alcohol addiction (%)

7. Drug addiction (%)

8. Accepted amounts of alcoholNational Health Council: no alcoholic beverages at all. Certainly not more than one a day. Not more than five days

9. Enjoy, but….

10. Prevalence in community (NL)Lifetime prevalenceSubstance use disorder 20%Affective disorder 20%Anxiety disorder 19%Year prevalence5.6% substance use disorder18% other disorder

11. What is addiction?It is a character weakness (moral model)It is due to the substance (pharmacological model)It is a disease for those who are vulnerable for it (disease model)Leshner (1997): Addiction is a chronic relapsing disease of the brain (brain disease model)

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13. What is addiction?Addiction is a complexe interplay of biological, psychological and social factors (biopsychosocial model)But also pay attention to things that give meaning to addiction and life (a.o. Frankl, 1946, 2011).

14. VIDEO

15. What is addiction?

16. What is addiction?Strong craving (aberrations in anterior gyrus cinguli)Decreased behavioral control (frontostriatal dysfunctions)Decreased cognitive control:Reduced error processing (less recognition of mistakes and learning from mistakes)Attentional biasReduced sensitivity for rewards and punishmentMore sensitivity to stress

17. Treatment goalsReduce craving: attention to attentional bias, acceptance of craving, virtual reality Improve behavioral control: reduce impulsivity and compulsivity, pay attention tot error processing, (re)activate alternative rewarding behaviorsReduce sensitivity to stress: pay attention to underlying factors, (social) skills training

18. Pay attention to somatic problemsPay attention to transfer of addiction (and crime)Pay attention to underlying vulnerabilityInvolve the environment in treatmentPay attention to life areasConsider that relapse may (will) occurThink about the aim: abstinence or control, improvement in life areas, quality of lifeSpecific points of attention from biopsychosocial model

19. The Dutch criminal justice system

20. Courts11 arrondissemental courts4 “ressorts”North east Netherlands (Leeuwarden)North Holland (Amsterdam)South Holland (The Hague)South Netherlands (Den Bosch)1 High court (The Hague)

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22. Arrondissement CourtCrown Council (Openbaar Ministerie)Parole officeAddiction parole (SVG)Salvation Army paroleParole office Netherlands (Reclassering Nederland)Netherlands Institute for Forensic Psychiatry and Psychology (NIFP)

23. Crimes in the Netherlands

24. Violent crimes

25. Prisoners in the Netherlands

26. 30 penal institutions in 2018

27. Prisoners9.145 prisoners in 201594% male59% from the Netherlands (vs 71%), 8% Suriname (2%) 6% Antilles (1%)6,5% Morocco (2%), 4% Turkey (2%)17% other (12%)More than half 20-35 years old (vs 29%)

28. TBS institutionsState institutionsVeldzicht, Balkbrug (illegal aliens)Oostvaarders clinic, AlmerePrivate institutionsFPC dr. S. van Mesdag clinic, GroningenDe Kijvelanden, PoortugaalDe Rooyse Wissel, VenrayPompestichting, Nijmegen Van der Hoeven clinic, UtrechtWoenselsepoort, Eindhoven

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31. SummaryJustice system is organized in regionsCrime rates are decreasingNo of prisoners and TBS patients decreasingMost prisoners are young malesRelationship with development of brain?

32. Addiction and the criminal justice system

33. In prison systemIn remand centers 60% substance use disorder: 30% alcohol, 38% drugsIn juvenile institutions more than 55% substance use disordersISD institutions: 100% substance use disorderOn average 54-63% have psychiatric disorder (year)

34. In tbs settingsIn TBS 100% psychiatric disorder, In TBS 65% (year) substance use disorderAt time of index offence 46% under influence of substance(s)38% substance played some role in offenceIntoxication caused escalation in 21%

35. Problem of comorbidityIn presence of comorbid disorder, substance use disorder is more severe and persistentIn presence of substance use disorder, disorders are more severe and persistentMore admissions in clinicsMore suicidesMore loss of fixed abodesMore illnessesMore violenceMore incarcerations

36. SUDs and crimesPsychiatric disorders increase risk of offendingSubstance use disorders also increase risk of offendingCrack: 6 xHeroin: 3 xCocaine: 2.5 xAmphetamines: 2.5 xCannabis: 1.5 x

37. SUDS and intimate partner violenceHuge meta-analysis (285 studies, N=627.726) done by Cafferky et al (2016)Substance abuse related to IPVRelation stronger for drugs than for alcoholProblematic alcohol use measures equally strong related as consumption measuresProblematic drug use measures stronger related than consumption measuresAmphetamines, cocaine, marijuana and other (except heroin/opiate) all equally related Meta-analysis (96 studies, N=79.698) done by Moore et al (2008)Increase in drug use and drug-related problems associated with psychological, physical and sexual aggression between intimate partnersRegardless of sex of drug user and perpetratorCocaine had strongest relation, followed by marijuana and mixedNo association with opiates

38. Alcohol and violence62% of seriously violent offenders (murder, rape, domestic violence, child abuse) drank before the offence (Review in 11 countries: Murdock e.a., 1990)Risk of aggression among alcoholics estimated to be 12 times as high (Murdock e.a., 1990).All indicators of alcohol use clearly related to intimate partner violence (reviews Cafferky et al., 2016; Foran & O’Leary, 2007)In communities with high alcohol consumption more life crimes (Bye, 2007)More domestic violence near places that sell alcohol (Livingston, 2011)50-60% of alcoholics in treatment commit domestic violence (Murphy & O’Farell, 1996)More sexual violence among alcoholics (o.a. Kraanen & Emmelkamp, 2011)

39. Relationship SUD and crimesSUDS lead to crimes. Tripartite model (Goldstein, 1995)Psychopharmacological effectEconomic necessity (need money for drugs), aka economic motivation model (Bean, 2001)The drug market is associated with violence and theft (systemic relationship)Crimes lead to sudsPsychopharmacological effect (need for soothing, guilt)Economical side effect (money is available for drugs)In criminal groups substance use is more commonReciprocal relationship Crimes -> Drugs -> Crimes ->

40. Drugs have a direct effect on people through a psychopharmacological effect (proximal effect model) on increased stress, reduced cognitive functioning, reduced anxiety regarding receiving punishment, reduced behavioral control, etc.Pharmacological effects (intoxication)Withdrawal symptomsNeurotoxic effects (prolonged use)Drugs mag indirectly increase risk of violence (indirect effects model)Marital conflict over use of drugs or alcoholDissatisfaction, e.g. about worse living circumstancesRelationship SUD and violence

41. UseWithdrawalRemarkCannabisUsually decreasedAnxiety inducedAgitation More dangerous with speed/cocaine AmphetaminesIncreasedAnxiety inducedMore dangerous with alcoholMDMA/XTCIncreasedAnxiety inducedMore dangerous with alcoholGHB/GBLDecreased?Anxiety inducedRisk with sudden withdrawalHeroinDecreased?Anxiety inducedAgitation Cocaine IncreasedAnxiety inducedAgitation More dangerous with alcohol

42. Fourth explanation: common factorsSpurious model: there is a common underlying factor to both phenomenaGeneral deviance theory: individuals prone to drug use are also prone to violence (Harrison et al., 2001; Harrison & Gfroerer, 1992; Osgood et al., 1988). But, because behaviors are unique, one should pay attention to environmental factors in onset of both behaviorsBiopsychological model: distal (personality, antisocial attitudes, marital stress, etc) and proximal factors (intoxication, situation, reduced error processing, impulsivity, etc) increase risk of violence in the context of conflict (e.g. Moore & Stewart,2005)Multiple treshold model (Fals-Stewart et al., 2003, 2005): personality and relationship risk factors increase likelihood of violence ween the individual starts using alcohol or drugs

43. Spurious modelSubstances increase tendencies that are already present. Underlying symptom and character clusters are related to heightened risk of aggressionImpulse controlProblematic symptom and Character clusters

44. Clusters related to aggressionStress, depression, anxiety, arousalImpulsivitySensation seekingHostility and antisocial attitudesHyperactivityAttentional deficitsCompulsivity

45. All models have some validityAlcohol and drugs seem to reinforce tendencies that are already present: character and situation are the underlying factors for crimesSevere drug use creates economic necessity and leads to deviant lifestyleSubstance use increases the intensity and frequency of crimesCertain symptom clusters (lack of control, increased arousal) and character clusters (impulsivity, compulsivity, antisocial attitudes) are related to increased risk of crimesThus: pay attention to the relevant symptom clusters and character clusters and pay attention to the situationSummary SUD and crimes

46. Forensic (addiction) care

47. Effects of effortsIn the past ten years200.000 less registered crimes78.000 less suspects5.500 less prisonersRecidivism after two years:After prison 48%After parole 39%After forensic treatment 30%

48. Collaboration between parole and health careAdvice for the courtsMandatory treatment with evaluationsUse of three partite agreementAimed at reduction of risk of recidivismWorking with principles of Risk-Need-Responsivity (Andrews &Bonta, 1990, 2007, 2010)Forensic addiction treatment

49. Forensic addiction treatmentRisk assessmentRisk management with relapse prevention and signaling planTreatment of addictionTreatment of comorbid disordersImprovement of life areas (finance, work, housing, free time, relationships)Restoration of roles

50. Further informationE.blaauw@vnn.nl