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The role of alcohol and drugs in triggering criminal violence: a case-crossover study
Department of Public Health Sciences, Division of Social Medicine, Karolinska Institutet, Stockholm, Sweden.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Preventive Medicine.
2006 (English)In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 101, no 1, 100-108 p.Article in journal (Refereed) Published
Abstract [en]


To investigate the triggering effects of alcohol, illegal substances and major classes of prescribed psychotropic drugs on criminal violence.


A case-crossover design, using each subject as its own control.


A consecutive sample of 133 violent offenders was recruited from a forensic psychiatric evaluation unit and a national prison evaluation unit in Sweden during 2002-03.


Offenders were assessed with structured interviews. Risk estimates were based on hazard periods of 24 hours. We used standard Mantel-Haenszel methods for statistical analyses.


A 13.2-fold increase of risk of violence [95% confidence interval (CI): 8.2-21.2] was found within 24 hours of alcohol consumption. This increase in violence risk was similar among individuals combining alcohol with benzodiazepines [Relative risk (RR) = 13.2, 95% CI: 4.9-35.3]. Use of benzodiazepines alone in regular doses (RR = 0.4, 95% CI: 0.2-0.5) or antidepressants [selective serotonin reuptake inhibitors (SSRIs) or tricyclics] (RR = 0.4, 95% CI: 0.3-0.8) was associated with a lowered risk for violence.


This study confirmed that alcohol is a strong trigger of criminal violence. Benzodiazepines in combination with alcohol caused no further increase of violence risk. Benzodiazepines in regular doses and antidepressants may inhibit violence, but further studies are needed to verify causality. The case-crossover method can contribute to research on the proximal causes of criminal violence.

Place, publisher, year, edition, pages
2006. Vol. 101, no 1, 100-108 p.
Keyword [en]
Alcohol, case-crossover, drugs, mental disorders, risk factors, substances, triggers, violence
National Category
Medical and Health Sciences
URN: urn:nbn:se:uu:diva-113384DOI: 10.1111/j.1360-0443.2005.01293.xISI: 000234543000014PubMedID: 16393196OAI: oai:DiVA.org:uu-113384DiVA: diva2:290713
Available from: 2010-01-28 Created: 2010-01-28 Last updated: 2013-12-09Bibliographically approved

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