Substance Use, Mental Health Disorders Linked to Increased Risk for Criminal Involvement

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Adults with substance use disorders, comorbid substance use and mental health disorders, and increasing multimorbidity are most at risk for legal problems.

Adults with substance use disorders, comorbid substance use and mental health disorders, and greater multimorbidity were at increased risk for criminal involvement, according to national survey data published in the Journal of Clinical Psychiatry.

Investigators abstracted data from the National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC-III), which was conducted by the National Institute on Alcohol Abuse and Alcoholism between April 2012 and June 2013. The NESARC-III survey was administered to 36,309 non-institutionalized adults whose addresses were randomly selected from the 2010 census. The survey captured sociodemographic variables, lifetime and current (past-year) psychiatric diagnoses, and lifetime and current substance use disorder (SUD). Multimorbidity was assessed by counting the number of lifetime and current diagnoses, with current defined as within the past year. Lifetime criminal outcomes were captured using questions pertaining to illegal behavior from the NESARC-III antisocial personality module. Specifically, investigators extracted information on lifetime incarceration experience and current general, alcohol-related, and drug-related legal problems. Logistic regression was performed to examine the associations between psychiatric disorders, SUD, and lifetime criminal behavior.

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Of the NESARC-III participants, 28.5% reported a history of criminal behavior and 11.4% reported a history of incarceration as an adult. In addition, 1.8% reported current general legal problems, 0.8% reported current alcohol-related legal problems, and 2.7% reported current drug-related legal problems. Approximately half (48.9%) of adults reported lifetime psychiatric disorders, and 33.4% reported current psychiatric disorders. Psychiatric and SUDs were associated with a significantly increased risk for lifetime criminal behavior and lifetime incarceration. Drug use disorders were associated with the highest risk for lifetime crime (adjusted odds ratio [aOR], 6.8; 95% CI, 6.1-7.6), lifetime incarceration (aOR, 4.7; 95% CI, 4.1-5.3), and current legal problems (aOR, 3.3; 95% CI, 2.6-4.2).

The odds of criminal behavior were also high in adults with alcohol use disorder, post-traumatic stress disorder, social anxiety disorder, and bipolar I disorder. Multimorbidity and comorbidity were associated with increased risk for lifetime crime; just 47% of individuals with only SUDs and 24% of individuals with only mental health disorders reported criminal activity compared with 64% of individuals with comorbid substance use and mental health disorders. Risk for lifetime incarceration also increased with the number of lifetime diagnoses; adults with SUDs and mental health disorders were at the greatest risk for incarceration (26%) compared with adults with SUDs only (23%) and adults with mental health disorders only (8%). Controlling for antisocial personality disorder did not affect the results.

These results underscore the importance of community-based addiction treatments in minimizing patient legal involvement. Improved access to mental health services may reduce the criminal involvement of high-risk individuals, particularly individuals with comorbid substance use disorders.

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Moore KE, Oberleitner LMS, Zonana HV, et al. Psychiatry disorders and crime in the US population: results from the national epidemiologic survey on alcohol and related conditions wave III. J Clin Psychiatry. 2019;80(2):18m12317.