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

doi:10.1016/j.psychres.2006.12.020

Psychiatry Research

Volume 153, Issue 2, 31 October 2007, Pages 195-198

https://doi.org/10.1016/j.psychres.2006.12.020 Get rights and content

Abstract

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.

Introduction

A high risk of violent and non-violent offending is associated with substance abuse (Grann and Fazel, 2004), and early-onset substance use has been identified as a major risk factor for deviant social adaptation and antisocial behaviors (Kuperman et al., 2005, Wilson and Levin, 2005). In combination with adolescent antisocial behavior, early-onset substance abuse has been described as a distinct and heritable disorder (type II alcoholism) (Cloninger et al., 1981) associated with a variety of problems, including cruelty to people and animals, criminality, risky sexual activities, and school adjustment difficulties (Gordon et al., 2004). Child psychopathology, most notably conduct disorder (CD), has also been associated with early-onset substance use and adolescent abuse (Armstrong and Costello, 2002). Attention deficit/hyperactivity disorder (AD/HD) increases the risk of developing CD, a problem constellation that clearly increases the risk of adult antisociality (Mannuzza et al., 2004, Wilens, 2004). Whether AD/HD also acts as an independent risk factor for adult substance abuse and psychosocial maladaptation has not been fully ascertained (Manuzza et al., 1989, Lahey et al., 2005). CD and HD have been identified as important childhood covariates to adulthood psychopathic traits and aggression among violent offenders (Soderstrom et al., 2004, Soderstrom et al., 2005). To test the hypothesis that age of onset of substance abuse may be a core feature in the developmental problem complex associated with psychopathic traits and with violent recidivism, we introduced this variable in covariate analyses.

Section snippets

Methods

One hundred violent offenders (n = 100, 92 men and 8 women, 17–76, median 30, years) referred by the court to forensic psychiatric investigation gave informed consent to participate in a research project describing neuropsychiatric vulnerability factors according to a protocol approved by the local Research Ethics Committee (Soderstrom et al., 2004, Soderstrom et al., 2005). DSM-IV diagnoses of abuse or dependence and of other mental disorders were based on SCID-1 and 2 interviews (First et al.,

Results

Forty-four subjects had no history of alcohol or drug abuse, and reliable information on age at onset was missing in two. In the remaining 54 subjects, age at onset varied from 10 to 76 years (median 17 years, men 17, women 18 years). Median age at onset was 22 years for alcohol abuse, 14 years for non-alcohol drug abuse, and 16 years for mixed abuse. The age at onset of abuse was strongly correlated with several forensic key features, such as aggression, violent recidivism, and all facets of

Discussion

Previous clinical psychiatric research on background factors of relevance for recidivistic violent crime has focused less on age at onset of alcohol and substance abuse than on evidence of substance abuse at the time of investigation. The present re-calculation of previously published analyses of childhood precursors to aggression and psychopathy in adulthood indicated that the age at onset of substance abuse may be a crucial feature in this developmental pattern. Type II alcoholism as

Acknowledgments

The project was supported by the National Board of Forensic Medicine, the Medical Society in Göteborg, and the Söderström-Königska Foundation.

References (20)

R. Hare
Research scale for the assessment of psychopathy in criminal populations
Personality and Individual Differerences
(1980)
H. Soderstrom et al.
Adult psychopathic personality with childhood-onset hyperactivity and conduct disorder: a central problem constellation in forensic psychiatry
Psychiatry Research
(2004)
T. Wilens
Attention-deficit/hyperactivity disorder and the substance use disorders: the nature of the relationship, subtypes at risk, and treatment issues
Psychiatric Clinics of North America
(2004)
T. Armstrong et al.
Community studies on adolescent substance use, abuse, or dependence and psychiatric comorbidity
Journal of Consulting and Clinical Psychology
(2002)
G. Brown et al.
Aggression, suicide, and serotonin: relationships to CSF amine metabolites
American Journal of Psychiatry
(1982)
C. Cloninger et al.
Inheritance of alcoholic abuse: cross-fostering analysis of adopted men
Archives of General Psychiatry
(1981)
C. Cloninger et al.
A psychobiological model of temperament and character
Archives of General Psychiatry
(1993)
D. Cooke et al.
Refining the construct of psychopathy: towards a hierarchical model
Psychological Assessments
(2001)
First, M., Spitzer, R., Gibbon, M., Williams, J., 1996. User's Guide for the Structured Clinical Interview for DSM-IV...
M. First et al.
Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II)
(1997)

There are more references available in the full text version of this article.

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Brief reportAge at onset of substance abuse: A crucial covariate of psychopathic traits and aggression in adult offenders

Abstract

Introduction

Section snippets

Methods

Results

Discussion

Acknowledgments

Personality and Individual Differerences

Psychiatry Research

Psychiatric Clinics of North America

Community studies on adolescent substance use, abuse, or dependence and psychiatric comorbidity

Journal of Consulting and Clinical Psychology

Aggression, suicide, and serotonin: relationships to CSF amine metabolites

American Journal of Psychiatry

Inheritance of alcoholic abuse: cross-fostering analysis of adopted men

Archives of General Psychiatry

A psychobiological model of temperament and character

Archives of General Psychiatry

Refining the construct of psychopathy: towards a hierarchical model

Psychological Assessments

Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II)

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