Flunitrazepam intake in male offenders

Abstract

The abuse of flunitrazepam (FZ) compounds is worldwide, and several studies have reflected on the consequences with regard to violence, aggression and criminal lifestyle of FZ users. Criminals take high doses of FZ or some other benzodiazepines to “calm down” before the planned crime. There is support from earlier studies that most likely, all benzodiazepines may increase aggression in vulnerable males. Chronic intake of high doses of FZ increases aggression in male rats. Because psychopathy involves aggression, we have examined whether psychopathy as well as any of the four facets of the Psychopathy Checklist-Revised (PCL-R) (Interpersonal, Affective, Lifestyle and Antisocial) are related to different substance use disorders, with the focus on FZ. We have also examined the relationship between each PCL-R item and FZ use. Participants were 114 male offenders aged 14–35 years, all of whom were convicted for severe, predominantly violent, offences. Substance use, including FZ, was not more common in those who scored high in psychopathy. Use of FZ was more common in offenders who scored high in Facet 4 (Antisocial) of the PCL-R (odds ratio = 4.30, 95% CI 1.86–9.94). Only one of the PCL-R items, “Criminal versatility”, was significantly associated with FZ use (odds ratio = 3.7). It may be concluded that intake of FZ has a specific relationship to only one of the facets and not to psychopathy per se. The findings have also important theoretical implications because Facet 4 is not a key factor of the construct of psychopathy. Clinical implications of the article: We have used the new two-factor and four-facet theoretical model of psychopathy in the young offender population, many of them with one or more substance use disorders. The present results suggest that antisocial behavior defined by Facet 4 (poor behavioral control, early behavior problems, juvenile delinquency, revocation of conditional release and criminal versatility) in the studied subjects is more typical for FZ users than it is for non-FZ users. This may have implications for assessment and treatment. Clinicians should be aware that criminals with high scores on Facet 4 have a more than fourfold odds of being a FZ user. This conclusion has an important clinical implication because FZ abuse is very common and is not always the focus of a forensic psychiatric assessment.

• Flunitrazepam intake
• Logistic regression
• Male offender
• Psychopathy
• Substance use disorders

Acknowledgments

The research presented here was supported by doctoral fellowships from Karolinska Institutet and Stockholm University, grants from the Swedish Alcohol Research Fund, the Swedish Carnegie Institute, the Swedish Foundation for Care Sciences and Allergy Research, the Swedish Medical Society of Addiction Medicine, the Swedish National Board of Forensic Medicine (Rättsmedicinalverket), and the Söderström-Königska Foundation. We are particularly grateful to the staff of the Department of Social and Forensic Psychiatry in Stockholm and to the staff of the correctional institutions for juvenile delinquents, for their co-operation and patience; and to the participants who volunteered their time. Some preliminary results from this study have been presented by AMD and discussed with researchers and clinicians from the field of addiction at the Annual Meeting of the Swedish Medical Association, November 26–28, 2003, Stockholm, Sweden. Preliminary results from this study have been presented by AMD and discussed with researchers and clinicians from the field of forensic psychiatry at the Annual Meeting of the Swedish Medical Association, November 30–December 2, 2005, Stockholm, Sweden. This article is based on the first author's dissertation, as partial fulfillment of a doctoral degree in forensic psychiatry, supervised by the third, fourth and fifth authors. We thank Dr George Farrants for helpful critical comments on the former version of this article, and several anonymous reviewers for valuable suggestions on the former and present versions of the article.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.