Main Question Post
There is a wide array of different substance-related and addictive disorders available for providing a diagnosis to someone in the Diagnostic and Statistical Manual, fifth edition (DSM-5). The overall idea of a substance-related disorder stems around the fact that the substances reinforce behaviors by providing a sense of reward in the person’s brain leading to symptoms surrounding not only behavioral changes but also cognitive and physiological changes as well (American Psychiatric Association, 2013). The activation of the reward system in the brain is not just caused by substances but can also be caused from other addictive behaviors like gambling disorder (American Psychiatric Association, 2013). Therefore, when someone takes the substances or gambles, their brain provides them with a feeling of satisfaction not only mentally, but also sometimes physically. This feeling is what can lead people to become addicted because they continually seek out that sense of reward over and over again which can lead to a high tolerance causing people to take more substances or complete their addictive behavior more than before in order to achieve the same feeling (American Psychiatric Association, 2013).
Some criteria used to distinguish substance-related disorders are changes in self-control, having social impairments, as well as partaking in the use of substances despite the level of risk (American Psychiatric Association, 2013). These characteristics are associated with the person spending most of their time trying to obtain the substances and distancing themselves from their regular activities to partake in using the substances (American Psychiatric Association, 2013). This can involve the person waking up every day with their plan of obtaining the drugs and then using them regardless of what other duties they should be doing like being with family or going to work. Other characteristics would be things like not being able to cut down or stop the use and having difficulty with maintaining relationships (American Psychiatric Association, 2013). Having a substance-related disorder is associated with detoxification, withdrawal, and repeated relapses (American Psychiatric Association, 2013). A person with one of these disorders finds themselves struggling to not use the substances leading to a withdrawal and if the person is substance free for a period of time, they often find themselves relapsing and using the substances again to relieve their withdrawal symptoms.
Intoxication is caused from the use of the substances and can lead to multiple different effects like impairments in judgment, perception, or attention (American Psychiatric Association, 2013). The use of different substances can cause different symptoms of intoxication, but some symptoms can be similar. For example, alcohol related symptoms of behavioral problems like aggression are similar to the aggressive symptoms found from sedative, hypnotic, or anxiolytic use disorder (American Psychiatric Association, 2013). Many of the symptoms from the use of different substances can lead to someone involving themselves with criminal behavior.
Howard et al. (2021) stated that having a substance use disorder is associated with having a higher risk of criminal behavior throughout a person’s entire life. Using substances can sometimes lead to the development of another mental disorder which is referred to as a substance-induced disorder like substance-induced psychotic disorder (American Psychiatric Association, 2013). However, some disorders are found to be comorbid with a substance rather than induced by the substance itself and one commonly associated disorder is antisocial personality disorder (Howard et al., 2021). Having antisocial personality disorder and a substance use disorder put the person at a higher risk of criminal behavior due to the related symptoms of both disorders like disinhibition (Howard et al., 2021).
A common symptom of many substance-related disorders is aggression which can be a factor for the involvement of criminal behavior in those with these disorders. Many disorders, like alcohol use disorders, are associated with negative affectivity and disinhibition which means a person can have more intense negative emotions and a lack of inhibition which may lead to aggressive and violent behavior which can become criminal behavior (Cavicchioli et al., 2020). Substance use disorders are also associated with having impulsive tendencies which can also be a factor in the relationship of substance use disorders and criminal activity (Cavicchioli et al., 2020). Impulsivity can lead someone to take part in any behavior, especially risky behavior, and not think about the future consequences like getting in trouble with the law. There are also the consequences associated with a person trying to get the substances or money for the substances that can lead them to commit a criminal act such as prostitution or theft (American Psychiatric Association, 2013).
Having a substance-related or addictive disorder can present itself with some forensic implications like obtaining proper treatment. A study was completed that found that 26% of the sample of people in a correctional facility with a substance use disorder recidivated within one year (Blonigen et al., 2020). A similar percentage was found for veterans in a residential substance use treatment program who ended up recidivating once released from the program (Blonigen et al., 2020). Treatment for those with substance use disorders that are involved with the criminal justice system are not always tailored to match the needs of the individuals such as focusing on preventing recidivism (Blonigen et al., 2020). Veterans are especially vulnerable to the lack of focused treatment because they may suffer from specific traumas, like combat related PTSD, which was found to be a factor in recidivating therefore showing the need for interventions tailored to focus on helping prevent recidivism (Blonigen et al., 2020). It was also found that a lack of social support upon release from treatment is a factor in recidivism and those in treatment who lack interpersonal skills were found to not have many social supports outside of treatment (Blonigen et al., 2020). Therefore, if someone comes into treatment with a lack of interpersonal skills, they are at a high risk of having less support outside of treatment making it vital to tailor interventions towards gaining positive social skills to help them build supports to prevent recidivism.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596Links to an external site.
Blonigen, D. M., Macia, K. S., Smelson, D., & Timko, C. (2020). Criminal recidivism among justice-involved veterans following substance use disorder residential treatment. Addictive Behaviors, 106, 106357. https://doi.org/10.1016/j.addbeh.2020.106357Links to an external site.
Cavicchioli, M., Ramella, P., Movalli, M., Prudenziati, F., Vassena, G., Simone, G., & Maffei, C. (2020). DSM-5 maladaptive personality domains among treatment-seeking individuals with alcohol use disorder: The role of disinhibition and negative affectivity. Substance Use and Misuse, 55(11), 1746–1758. https://doi.org/10.1080/10826084.2020.1762650Links to an external site.
Howard, R., Hasin, D., & Stohl, M. (2021). Substance use disorders and criminal justice contact among those with co‐occurring antisocial and borderline personality disorders: Findings from a nationally representative sample.Links to an external site. Personality and Mental Health, 15(1), 40–48. https://doi.org/10.1002/pmh.1491Links to an external site.
