1. Addiction and the criminal justice system
Dr. Eric Blaauw
Professor in Addiction studies
Hanze University of Applied Sciences
Dit is het voorblad.
De enige tekst die hier toegevoegd mag worden is de naam van de persoon die de presentatie geeft.

2. Content What is addiction? The Dutch criminal justice system
Addiction and crime
Forensic addiction care

3. ADDICTION

4. What is addiction? Craving or using more than intended
Taking the substance in larger amounts or for longer than you meant to
Wanting to cut down or stop using the substance but not managing to
Spending a lot of time getting, using, or recovering from use of the substance
Cravings and urges to use the substance
Negative consequences, also for others
Not managing to do what you should at work, home or school, because of substance use
Continuing to use, even when it causes problems in relationships
Giving up important social, occupational or recreational activities because of substance use
Using substances again and again, even when it puts the you in danger
Tolerance and dependence
Continuing to use, even when the you know you have a physical or psychological problem that could have been caused or made worse by the substance
Needing more of the substance to get the effect you want (tolerance)
Development of withdrawal symptoms, which can be relieved by taking more of the substance.

5. Prevalence of use Recent use in the Netherlands (2009) Alcohol: 78%
Tobacco: 27%
Cannabis: 3,3%
Cocaine: 0.3%
Opioids: 0.1%

6. Alcohol addiction (%)

7. Drug addiction (%)

8. Accepted amounts of alcohol
National Health Council: no alcoholic beverages at all.
Certainly not more than one a day. Not more than five days

9. Enjoy, but….

10. Prevalence in community (NL)
Lifetime prevalence
Substance use disorder 20%
Affective disorder 20%
Anxiety disorder 19%
Year prevalence
5.6% substance use disorder
18% other disorder

11. What is addiction? It is a character weakness (moral model)
It is due to the substance (pharmacological model)
It is a disease for those who are vulnerable for it (disease model)
Leshner (1997): Addiction is a chronic relapsing disease of the brain (brain disease model)

13. What is addiction?
Addiction is a complexe interplay of biological, psychological and social factors (biopsychosocial model)
But also pay attention to things that give meaning to addiction and life (a.o. Frankl, 1946, 2011).

14. VIDEO

15. What is addiction?

16. What is addiction?
Strong craving (aberrations in anterior gyrus cinguli)
Decreased behavioral control (frontostriatal dysfunctions)
Decreased cognitive control:
Reduced error processing (less recognition of mistakes and learning from mistakes)
Attentional bias
Reduced sensitivity for rewards and punishment
More sensitivity to stress

17. Treatment goals
Reduce craving: attention to attentional bias, acceptance of craving, virtual reality
Improve behavioral control: reduce impulsivity and compulsivity, pay attention tot error processing, (re)activate alternative rewarding behaviors
Reduce sensitivity to stress: pay attention to underlying factors, (social) skills training

18. Specific points of attention from biopsychosocial model
Pay attention to somatic problems
Pay attention to transfer of addiction (and crime)
Pay attention to underlying vulnerability
Involve the environment in treatment
Pay attention to life areas
Consider that relapse may (will) occur
Think about the aim: abstinence or control, improvement in life areas, quality of life

19. The Dutch criminal justice system

20. Courts 11 arrondissemental courts 4 “ressorts”
North east Netherlands (Leeuwarden)
North Holland (Amsterdam)
South Holland (The Hague)
South Netherlands (Den Bosch)
1 High court (The Hague)

22. Arrondissement Court Crown Council (Openbaar Ministerie) Parole office
Addiction parole (SVG)
Salvation Army parole
Parole office Netherlands (Reclassering Nederland)
Netherlands Institute for Forensic Psychiatry and Psychology (NIFP)

23. Crimes in the Netherlands

24. Violent crimes

25. Prisoners in the Netherlands

26. 30 penal
institutions
in 2018

27. Prisoners More than half 20-35 years old (vs 29%)
9.145 prisoners in 2015
94% male
59% from the Netherlands (vs 71%),
8% Suriname (2%)
6% Antilles (1%)
6,5% Morocco (2%),
4% Turkey (2%)
17% other (12%)
More than half years old (vs 29%)

28. TBS institutions State institutions
Veldzicht, Balkbrug (illegal aliens)
Oostvaarders clinic, Almere
Private institutions
FPC dr. S. van Mesdag clinic, Groningen
De Kijvelanden, Poortugaal
De Rooyse Wissel, Venray
Pompestichting, Nijmegen
Van der Hoeven clinic, Utrecht
Woenselsepoort, Eindhoven

31. Summary Justice system is organized in regions
Crime rates are decreasing
No of prisoners and TBS patients decreasing
Most prisoners are young males
Relationship with development of brain?

32. Addiction and the criminal justice system

33. In prison system
In remand centers 60% substance use disorder: 30% alcohol, 38% drugs
In juvenile institutions more than 55% substance use disorders
ISD institutions: 100% substance use disorder
On average 54-63% have psychiatric disorder (year)

34. In tbs settings In TBS 100% psychiatric disorder,
In TBS 65% (year) substance use disorder
At time of index offence
46% under influence of substance(s)
38% substance played some role in offence
Intoxication caused escalation in 21%

35. Problem of comorbidity
In presence of comorbid disorder, substance use disorder is more severe and persistent
In presence of substance use disorder, disorders are more severe and persistent
More admissions in clinics
More suicides
More loss of fixed abodes
More illnesses
More violence
More incarcerations

36. SUDs and crimes Psychiatric disorders increase risk of offending
Substance use disorders also increase risk of offending
Crack: 6 x
Heroin: 3 x
Cocaine: 2.5 x
Amphetamines: 2.5 x
Cannabis: 1.5 x

37. SUDS and intimate partner violence
Huge meta-analysis (285 studies, N= ) done by Cafferky et al (2016)
Substance abuse related to IPV
Relation stronger for drugs than for alcohol
Problematic alcohol use measures equally strong related as consumption measures
Problematic drug use measures stronger related than consumption measures
Amphetamines, cocaine, marijuana and other (except heroin/opiate) all equally related
Meta-analysis (96 studies, N=79.698) done by Moore et al (2008)
Increase in drug use and drug-related problems associated with psychological, physical and sexual aggression between intimate partners
Regardless of sex of drug user and perpetrator
Cocaine had strongest relation, followed by marijuana and mixed
No association with opiates

38. Alcohol and violence
62% of seriously violent offenders (murder, rape, domestic violence, child abuse) drank before the offence (Review in 11 countries: Murdock e.a., 1990)
Risk of aggression among alcoholics estimated to be 12 times as high (Murdock e.a., 1990).
All indicators of alcohol use clearly related to intimate partner violence (reviews Cafferky et al., 2016; Foran & O’Leary, 2007)
In communities with high alcohol consumption more life crimes (Bye, 2007)
More domestic violence near places that sell alcohol (Livingston, 2011)
50-60% of alcoholics in treatment commit domestic violence (Murphy & O’Farell, 1996)
More sexual violence among alcoholics (o.a. Kraanen & Emmelkamp, 2011)

39. Relationship SUD and crimes
SUDS lead to crimes. Tripartite model (Goldstein, 1995)
Psychopharmacological effect
Economic necessity (need money for drugs), aka economic motivation model (Bean, 2001)
The drug market is associated with violence and theft (systemic relationship)
Crimes lead to suds
Psychopharmacological effect (need for soothing, guilt)
Economical side effect (money is available for drugs)
In criminal groups substance use is more common
Reciprocal relationship Crimes -> Drugs -> Crimes ->

40. Relationship SUD and violence
Drugs have a direct effect on people through a psychopharmacological effect (proximal effect model) on increased stress, reduced cognitive functioning, reduced anxiety regarding receiving punishment, reduced behavioral control, etc.
Pharmacological effects (intoxication)
Withdrawal symptoms
Neurotoxic effects (prolonged use)
Drugs mag indirectly increase risk of violence (indirect effects model)
Marital conflict over use of drugs or alcohol
Dissatisfaction, e.g. about worse living circumstances

41. Use
Withdrawal
Remark
Cannabis
Usually decreased
Anxiety induced
Agitation
More dangerous with speed/cocaine
Amphetamines
Increased
More dangerous with alcohol
MDMA/XTC
GHB/GBL
Decreased?
Risk with sudden withdrawal
Heroin
Cocaine

42. Fourth explanation: common factors
Spurious model: there is a common underlying factor to both phenomena
General deviance theory: individuals prone to drug use are also prone to violence (Harrison et al., 2001; Harrison & Gfroerer, 1992; Osgood et al., 1988). But, because behaviors are unique, one should pay attention to environmental factors in onset of both behaviors
Biopsychological model: distal (personality, antisocial attitudes, marital stress, etc) and proximal factors (intoxication, situation, reduced error processing, impulsivity, etc) increase risk of violence in the context of conflict (e.g. Moore & Stewart,2005)
Multiple treshold model (Fals-Stewart et al., 2003, 2005): personality and relationship risk factors increase likelihood of violence ween the individual starts using alcohol or drugs

43. Spurious model
Substances increase tendencies that are already present. Underlying symptom and character clusters are related to heightened risk of aggression
Problematic
symptom and
Character clusters
Impulse control

44. Clusters related to aggression
Stress, depression, anxiety, arousal
Impulsivity
Sensation seeking
Hostility and antisocial attitudes
Hyperactivity
Attentional deficits
Compulsivity

45. Summary SUD and crimes All models have some validity
Alcohol and drugs seem to reinforce tendencies that are already present: character and situation are the underlying factors for crimes
Severe drug use creates economic necessity and leads to deviant lifestyle
Substance use increases the intensity and frequency of crimes
Certain symptom clusters (lack of control, increased arousal) and character clusters (impulsivity, compulsivity, antisocial attitudes) are related to increased risk of crimes
Thus: pay attention to the relevant symptom clusters and character clusters and pay attention to the situation

46. Forensic (addiction) care

47. Effects of efforts Recidivism after two years: In the past ten years
less registered crimes
less suspects
5.500 less prisoners
Recidivism after two years:
After prison %
After parole %
After forensic treatment 30%

48. Forensic addiction treatment
Collaboration between parole and health care
Advice for the courts
Mandatory treatment with evaluations
Use of three partite agreement
Aimed at reduction of risk of recidivism
Working with principles of Risk-Need-Responsivity (Andrews &Bonta, 1990, 2007, 2010)

49. Forensic addiction treatment
Risk assessment
Risk management with relapse prevention and signaling plan
Treatment of addiction
Treatment of comorbid disorders
Improvement of life areas (finance, work, housing, free time, relationships)
Restoration of roles

50. Further information