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  • 1. Konstenius, Maija
    et al.
    Larsson, Henrik
    Lundholm, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Philips, Bjorn
    van de Glind, Geurt
    Jayaram-Lindstrom, Nitya
    Franck, Johan
    An Epidemiological Study of ADHD, Substance Use, and Comorbid Problems in Incarcerated Women in Sweden2015In: Journal of Attention Disorders, ISSN 1087-0547, E-ISSN 1557-1246, Vol. 19, no 1, p. 44-52Article in journal (Refereed)
    Abstract [en]

    Objective: The aim of this study was to examine the prevalence of ADHD and psychiatric comorbidity, including substance use in incarcerated women. Method: This was a cross-sectional study, consisting of two parts: (a) screening using the ADHD Self-Rating Scale (ASRS) and (b) diagnostic assessment using a structured interview. Results: A sample of 96 incarcerated women was screened and 56 underwent the diagnostic assessment. Twenty-nine percent of the women met the Diagnostic and Statistical Manual of Mental Disorders (4th ed.) diagnostic criteria for adult ADHD in the diagnostic assessment. Forty-four of the women had misuse of alcohol, and 83% had misuse of narcotics the year prior to the incarceration. The ASRS showed sensitivity of 1.0 and specificity of 0.66. Conclusion: The prevalence rate of ADHD in incarcerated women was high and comparable to that in male offenders. Illicit stimulant use and antisocial personality disorder were significantly more common in women with ADHD. ASRS is useful as a screener in this population.

  • 2.
    Lundholm, Lena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Substance Use and Violence: Influence of Alcohol, Illicit Drugs and Anabolic Androgenic Steroids on Violent Crime and Self-directed Violence2013Doctoral 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.

    List of papers
    1. Use of anabolic androgenic steroids in substance abusers arrested for crime
    Open this publication in new window or tab >>Use of anabolic androgenic steroids in substance abusers arrested for crime
    2010 (English)In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 111, no 3, p. 222-226Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND: Use of anabolic androgenic steroids (AASs) has been associated with both violent crime and the use of illicit drugs. The scientific literature on polysubstance abuse as a confounder for AAS-related violence is sparse and ambiguous. With the intent of further investigating this issue, we have gathered data concerning drug abuse and AAS experience among substance abusers who have been arrested for a variety of crimes. METHODS: Data were collected from structured interviews with substance abusers (n=3597) apprehended at two remand prisons in Sweden from 2002 through 2008. Analyses concerned type of criminal act, primary drug used during the past year, and experience of AAS use. RESULTS: Those stating AAS experience (n=924, 20 women and 904 men) were more often apprehended for violent crimes (OR=1.65). This association remained significant after controlling for age and sex (OR=1.28). AAS users and non-users claimed similar primary substances of use during the past year, with the exception of benzodiazepine use, which was more common in the AAS group (OR=2.30), although this did not affect the frequency of violent crime. Among AAS-experienced participants, there was no difference in violent crime incidence between current users and former users. CONCLUSIONS: Study results suggest that AASs do not function as a proximal trigger for violence but still involve an increased risk for violence in users of illicit drugs. These findings also suggest that AAS use is highly overrepresented in women who commit crimes.

    Keywords
    Anabolic androgenic steroids; Violent crime; Substance abuse
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-130376 (URN)10.1016/j.drugalcdep.2010.04.020 (DOI)000283969900006 ()20627426 (PubMedID)
    Available from: 2010-09-07 Created: 2010-09-07 Last updated: 2017-12-12Bibliographically approved
    2. The triggering effect of alcohol and illicit drugs on violent crime in a remand prison population: a case crossover study
    Open this publication in new window or tab >>The triggering effect of alcohol and illicit drugs on violent crime in a remand prison population: a case crossover study
    Show others...
    2013 (English)In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 129, no 1-2, p. 110-115Article in journal (Refereed) Published
    Abstract [en]

    BACKGROUND:

    The association between substance abuse, particularly alcohol abuse, and violence has been well established. However, since substance abuse co-occurs with several other risk factors for violence, the causal link between substance abuse and violence and the extent to which the acute influence of alcohol, illicit drugs, benzodiazepines, and anabolic androgenic steroids have a triggering effect on violent behavior are more uncertain.

    METHODS:

    Case-crossover design was used based on data from structured face to face interviews with remand prisoners (n=194; 172 men, 22 women) suspected of violent crimes. Main outcome measure: odds ratio (OR 95% CI) for a violent crime, 24h after exposure to different substances, compared to periods of no exposure was calculated using conditional logistic regression and a Mantel-Haenszel estimator with confidence intervals for sparse data.

    RESULTS:

    Intake of alcohol (OR 6.41 CI 4.24-9.67) and large doses of benzodiazepines (OR 36.32 CI 7.14-183.65) triggered interpersonal violence. Stratified analyses of possible effect modifiers were sex, conduct/behavioral problems, trauma experiences; psychiatric vulnerability did not reveal any substantial differences.

    CONCLUSION:

    Influences of alcohol and unusually high doses of benzodiazepines are proximal risk factors for violent crime. Improved knowledge of short-term (and dose-related) risk factors may contribute to treatment planning and risk assessment of violence.

    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-188722 (URN)10.1016/j.drugalcdep.2012.09.019 (DOI)000316827600015 ()23102731 (PubMedID)
    Available from: 2012-12-19 Created: 2012-12-19 Last updated: 2017-12-06Bibliographically approved
    3. Anabolic androgenic steroids and violent offending: Confounding by polysubstance abuse among 10,365 general population men
    Open this publication in new window or tab >>Anabolic androgenic steroids and violent offending: Confounding by polysubstance abuse among 10,365 general population men
    2015 (English)In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 110, no 1, p. 100-108Article 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.

    Keywords
    Anabolic androgenic steroids; general population; polysubstance abuse; psychiatry; survey; violent crime
    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:uu:diva-193290 (URN)10.1111/add.12715 (DOI)000346699700017 ()25170826 (PubMedID)
    Available from: 2013-01-30 Created: 2013-01-30 Last updated: 2017-12-06
    4. Acute influence of alcohol, THC or central stimulants on violent suicide: a Swedish Population study
    Open this publication in new window or tab >>Acute influence of alcohol, THC or central stimulants on violent suicide: a Swedish Population study
    Show others...
    2014 (English)In: Journal of Forensic Sciences, ISSN 0022-1198, E-ISSN 1556-4029, Vol. 59, no 2, p. 436-440Article in journal (Refereed) Published
    Abstract [en]

    Alcohol and substance abuse in general is a risk factor for suicide, but very little is known about the acute effect in relation to suicide method. Based on information from 18,894 medico-legal death investigations, including toxicological findings and manner of death, did the present study investigate whether acute influence of alcohol, tetrahydrocannabinol (THC) or central stimulants (amphetamine and cocaine) was related to the use of a violent suicide method, in comparison with the non-violent method self-poisoning and alcohol/illicit drugs negative suicide decedents. Multivariate analysis was conducted and the results revealed that acute influence of THC was related to using the violent suicide method; jumping from a height (RR 1.62; 95%CI 1.01-2.41). Alcohol intoxication was not related to any violent method, while the central stimulants positive suicide decedent had a higher, albeit not significant, risk for several violent methods. The study contributes with elucidating suicide methods in relation to acute intoxication.

     

    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:uu:diva-193294 (URN)10.1111/1556-4029.12353 (DOI)000332307900020 ()
    Available from: 2013-01-30 Created: 2013-01-30 Last updated: 2017-12-06Bibliographically approved
  • 3.
    Lundholm, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Frisell, Thomas
    Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet.
    Långström, Niklas
    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.
    Anabolic androgenic steroids and violent offending: Confounding by polysubstance abuse among 10,365 general population men2015In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 110, no 1, p. 100-108Article in journal (Refereed)
    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.

  • 4.
    Lundholm, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Haggård, Ulrika
    Möller, Jette
    Hallqvist, Johan
    Department of Public Health Sciences, Division of Public Health Epidemiology, Karolinska Institutet, Stockholm, Sweden.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    The triggering effect of alcohol and illicit drugs on violent crime in a remand prison population: a case crossover study2013In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 129, no 1-2, p. 110-115Article in journal (Refereed)
    Abstract [en]

    BACKGROUND:

    The association between substance abuse, particularly alcohol abuse, and violence has been well established. However, since substance abuse co-occurs with several other risk factors for violence, the causal link between substance abuse and violence and the extent to which the acute influence of alcohol, illicit drugs, benzodiazepines, and anabolic androgenic steroids have a triggering effect on violent behavior are more uncertain.

    METHODS:

    Case-crossover design was used based on data from structured face to face interviews with remand prisoners (n=194; 172 men, 22 women) suspected of violent crimes. Main outcome measure: odds ratio (OR 95% CI) for a violent crime, 24h after exposure to different substances, compared to periods of no exposure was calculated using conditional logistic regression and a Mantel-Haenszel estimator with confidence intervals for sparse data.

    RESULTS:

    Intake of alcohol (OR 6.41 CI 4.24-9.67) and large doses of benzodiazepines (OR 36.32 CI 7.14-183.65) triggered interpersonal violence. Stratified analyses of possible effect modifiers were sex, conduct/behavioral problems, trauma experiences; psychiatric vulnerability did not reveal any substantial differences.

    CONCLUSION:

    Influences of alcohol and unusually high doses of benzodiazepines are proximal risk factors for violent crime. Improved knowledge of short-term (and dose-related) risk factors may contribute to treatment planning and risk assessment of violence.

  • 5.
    Lundholm, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Käll, Kerstin
    Wallin, Sussi
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Use of anabolic androgenic steroids in substance abusers arrested for crime2010In: Drug And Alcohol Dependence, ISSN 0376-8716, E-ISSN 1879-0046, Vol. 111, no 3, p. 222-226Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Use of anabolic androgenic steroids (AASs) has been associated with both violent crime and the use of illicit drugs. The scientific literature on polysubstance abuse as a confounder for AAS-related violence is sparse and ambiguous. With the intent of further investigating this issue, we have gathered data concerning drug abuse and AAS experience among substance abusers who have been arrested for a variety of crimes. METHODS: Data were collected from structured interviews with substance abusers (n=3597) apprehended at two remand prisons in Sweden from 2002 through 2008. Analyses concerned type of criminal act, primary drug used during the past year, and experience of AAS use. RESULTS: Those stating AAS experience (n=924, 20 women and 904 men) were more often apprehended for violent crimes (OR=1.65). This association remained significant after controlling for age and sex (OR=1.28). AAS users and non-users claimed similar primary substances of use during the past year, with the exception of benzodiazepine use, which was more common in the AAS group (OR=2.30), although this did not affect the frequency of violent crime. Among AAS-experienced participants, there was no difference in violent crime incidence between current users and former users. CONCLUSIONS: Study results suggest that AASs do not function as a proximal trigger for violence but still involve an increased risk for violence in users of illicit drugs. These findings also suggest that AAS use is highly overrepresented in women who commit crimes.

  • 6.
    Lundholm, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Thiblin, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Runeson, Bo
    Department of Clinical Neuroscience, Karolinska Institutet.
    Leifman, Anders
    Stockholm Dependency Center.
    Fugelstad, Anna
    Department of Clinical Neuroscience.
    Acute influence of alcohol, THC or central stimulants on violent suicide: a Swedish Population study2014In: Journal of Forensic Sciences, ISSN 0022-1198, E-ISSN 1556-4029, Vol. 59, no 2, p. 436-440Article in journal (Refereed)
    Abstract [en]

    Alcohol and substance abuse in general is a risk factor for suicide, but very little is known about the acute effect in relation to suicide method. Based on information from 18,894 medico-legal death investigations, including toxicological findings and manner of death, did the present study investigate whether acute influence of alcohol, tetrahydrocannabinol (THC) or central stimulants (amphetamine and cocaine) was related to the use of a violent suicide method, in comparison with the non-violent method self-poisoning and alcohol/illicit drugs negative suicide decedents. Multivariate analysis was conducted and the results revealed that acute influence of THC was related to using the violent suicide method; jumping from a height (RR 1.62; 95%CI 1.01-2.41). Alcohol intoxication was not related to any violent method, while the central stimulants positive suicide decedent had a higher, albeit not significant, risk for several violent methods. The study contributes with elucidating suicide methods in relation to acute intoxication.

     

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