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Anabolic androgenic steroids and violent offending: Confounding by polysubstance abuse among 10,365 general population men
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet.
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet.
2015 (English)In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 110, no 1, 100-108 p.Article in journal (Refereed) Published
Abstract [en]

Background and AimsAnabolic androgenic steroid (AAS) use is associated with aggressive and violent behaviour, but it remains uncertain if this relationship is causal in humans. We examined the link between AAS use and violent crime while controlling for polysubstance abuse and additional suggested risk factors for violence. DesignCross-sectional study of a population-based sample. SettingIn 2005, all Swedish-born male twins aged 20-47 years were invited to participate in the Swedish Twin Adults: Genes and Environment (STAGE) survey of the Swedish Twin Register (response rate=60%). ParticipantsA total of 10365 male survey participants with information on AAS use. MeasurementData on self-reported use of AAS, alcohol and other substances, attention deficit hyperactivity disorder (ADHD) and personality disorder symptoms were linked to nation-wide, longitudinal register information on criminal convictions, IQ, psychological functioning and childhood socio-economic status (SES) covariates. FindingsAny life-time use of AAS was associated strongly with conviction for a violent crime [2.7 versus 0.6% in convicted and non-convicted men, respectively; odds ratio (OR)=5.0, 95% confidence interval (CI)=2.7-9.3]. However, this link was substantially reduced and no longer significant when controlling for other substance abuse (OR=1.6, 95% CI=0.8-3.3). Controlling for IQ, psychological functioning, ADHD, personality disorder symptoms and childhood SES did not reduce the risk further. ConclusionIn the general population, co-occurring polysubstance abuse, but not IQ, other neuropsychological risks or socio-economic status, explains most of the relatively strong association between any anabolic androgenic steroid use and conviction for a violent crime.

Place, publisher, year, edition, pages
2015. Vol. 110, no 1, 100-108 p.
Keyword [en]
Anabolic androgenic steroids; general population; polysubstance abuse; psychiatry; survey; violent crime
National Category
URN: urn:nbn:se:uu:diva-193290DOI: 10.1111/add.12715ISI: 000346699700017PubMedID: 25170826OAI: oai:DiVA.org:uu-193290DiVA: diva2:601787
Available from: 2013-01-30 Created: 2013-01-30 Last updated: 2016-08-23
In thesis
1. Substance Use and Violence: Influence of Alcohol, Illicit Drugs and Anabolic Androgenic Steroids on Violent Crime and Self-directed Violence
Open this publication in new window or tab >>Substance Use and Violence: Influence of Alcohol, Illicit Drugs and Anabolic Androgenic Steroids on Violent Crime and Self-directed Violence
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Interpersonal violence and suicide are major health concerns, leading to premature death, extensive human suffering and staggering monetary costs. Although violent behaviour has multiple causes, it is well known that acute substance intake and abuse increase the risks of both interpersonal and self-directed violence. This association is quite well established for alcohol, while a more ambiguous literature exists for other common drugs of abuse. For example, anabolic androgenic steroids (AAS), synthetic analogues to the “male” sex hormone testosterone are suggested to elicit violent and aggressive behaviour. Two studies (I and III) in the present thesis addressed the association between AAS use and being suspected or convicted of a violent crime among remand prisoners and in a general population sample, respectively. Further, using the case-crossover design to control for confounders stable within individuals, I also investigated the triggering (short-term risk) effect of alcohol and drugs such as benzodiazepines and AAS, on violent crime (Study II). Finally, a fourth study (IV) based on a large national forensic sample of suicide completers (n=18,894) examined the risk of using a violent, more lethal, suicide method, when under acute influence of alcohol, central stimulants or cannabis.

The results of this thesis suggested that AAS use in itself is not a proximal risk factor for violent crime; the observed risk is probably due to the co-occurrence of abuse of other substances. Alcohol is a strong triggering risk factor for violent crime, constant across males and females as well as individuals with or without behavioral and psychiatric vulnerability. Intake of high doses of benzodiazepines is associated with an increased risk for violent crime. Cannabis use is associated with an increased risk of using the lethal suicide method of jumping from a height. I conclude that mapping substance abuse patterns may inform violence risk assessment and treatment planning.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2013. 78 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 864
Substance abuse, violent crime, violent suicide, anabolic androgenic steroids
National Category
Forensic Science
urn:nbn:se:uu:diva-193301 (URN)978-91-554-8590-0 (ISBN)
Public defence
2013-03-15, Fåhraeus, Rudbecklaboratoriet, Dag Hammarskjöldsväg 20, Uppsala, 13:00 (Swedish)
Available from: 2013-02-21 Created: 2013-01-30 Last updated: 2013-02-28Bibliographically approved

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