Brief reportCriminal recidivism in offenders with personality disorders and substance use disorders over 8 years of time at risk
Introduction
There is a high risk of violent recidivism in offenders in many countries (Grann et al., 2008). It is well known that clinical data, particularly the diagnosis of either personality disorder (PD) or substance use disorder (SUD), are associated with an increased risk of recidivism in criminals (Asnis et al., 1997). However, less is known about the influence of the common co-morbidity of these two disorders on general and violent criminal recidivism.
Prior studies have shown that half or more individuals with Cluster B PDs, mainly antisocial and borderline personality disorders, have co-occurring alcohol use disorder or drug use disorder (Verheul, 2001, Walter et al., 2009). However, it is not clear whether the co-occurrence of both disorders is also related to higher recidivism in criminals.
It has been argued that particularly the psychopathic traits increase the risk of violent behavior and recidivism (Dolan and Doyle, 2000). Psychopathic traits including impulsive–aggressive behavior, affective shallowness, and social maladjustment are associated with a high risk of violent behavior (Kiehl, 2006) and with violent recidivism in long-term outcome studies measured by Hare's Psychopathy Checklist (PCL) (Stone, 2002).
This is the first study that investigates specific recidivism rates in criminals with PDs and co-occurring SUD, compared to other diagnostic groups with PDs and SUDs only. This study used reliable and independent diagnostic assessments, and prospectively collected data over 8 years of follow-up to investigate the risk of criminal recidivism in these different diagnostic groups, and to analyze the simple recidivism as well as the violent recidivism. A priori we expected the highest simple and violent recidivism rate in criminals with PDs and co-occurring SUD.
Section snippets
Subjects
All 379 defendants were included who were subject to court orders for forensic psychiatric evaluation from the Forensic Psychiatry Clinic of the University of Basel for criminal responsibility, risk assessment and the need for forensic treatment, between 1989 and 2000. Two hundred sixty-seven were diagnosed as suffering from personality disorders (PD-), substance use disorders (SUD-), and 112 offenders had other psychiatric diagnoses. Eighty-five percent were males and the median age was 33.4
Personality disorders and substance use disorders
Most criminals had only one personality disorder diagnosis. However, 43% in either group suffered from two or more personality disorders. As shown in Table 1, there was a significant higher rate of Cluster A PDs in the PD- group, than in the PD + SUD group (χ2 = 48.07, d.f. = 1, p < 0.0001). The frequency of Cluster B and Cluster C PDs did not differ between these two groups (PD- and PD + SUD). At baseline, the rates for current alcohol use disorder and drug use disorder were not different in the two
Discussion
As expected, we found that criminals with both PD and SUD had a two-fold higher risk for general recidivism than the PD group without co-occurring SUD. The higher overall recidivism rate for this group supports previous results that found poorer treatment outcome, including worse psychosocial functioning, more problematic substance use, and more legal problems in patients with substance use disorders and co-occurring personality disorders (Galen et al., 2000). This co-morbidity is very common,
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