David A. Deitch, PhD
Professor of Clinical Psychiatry
University of California, San Diego
Addiction Training Center

Overview
• A picture of current problems
• A brief look at what’s coming
• How we develop crime & drug taking
• Types of substance abusing offenders

• Of the $620 billion total the states spent, $81.3 billion (13.1%)
- was used to deal with substance abuse and addiction
• The states spend 113 times as much to clean up the devastation substance abuse and addiction visit on children as they do to prevent and treat it
• Each American paid $277 per year in state taxes to deal with the burden of substance abuse and addiction in their social programs and only $10 a year for prevention and treatment
• Of the $453.5 billion states spent in the 16 budget categories of public programs, $81.3 billion —(17.9%) percent--was linked to substance abuse and addiction
The National Center of Addiction and Substance Abuse, 2000

5.6
5.9
2.6
3.4
0.7
9.6
Drug Offenses
Extortion
Immigration
60.2
Robbery
Property Offenses
White Collars
Firearms, Explosives
Violent

The Number of Inmates Released
Federal and States Prisons
635,000
473,300
1995 2001
Bureau of Justice Statistics, 2001

(FBI Crime Reports)
70%
60%
50%
40%
30%
20%
10%
0%
7.9%
1941-50
0.3%
1951-60
0.7%
1961-70
36.9%
1971-80
54.2%
1981-90
63.7%
1990-1999

Natural Innate Drives
Inherited Parts of Physical and Psychological Well-being
Hunger
Thirst
Shelter
Sex
( Physical Survival )
Altered Consciousness

Disease Concept of Alcoholism
 Know Etiology
 Know Progression
 Know Outcome
Genetic Model
 Adoption and Twin Studies
 Receptor Genes
 Son of Alcoholics and Tolerance
 Twin Studies

Psychological Models
 Addictive Personality
 Psychological Vulnerability
 Self Medicating
 Personality Issues (anti-social, C.D., etc..)
 Self Esteem
 Risk Taking
Psychoanalytic Models
 Oral
 Oral Longing
 Maternal-Depravation
 Sexual Adequacy
 Sexual Identity
 Structural Deficit in Object Relations

Defective Stimulus Barriers (Krystal-Raskin)
 Inability to Desomatise Emotions
Mal-adaptive Narcissism (Wursmer)
 Defense Against Overwhelming Feelings of Rage and Loneliness

Impoverished Self Esteem (Khamtzian)
 Lack of Capacity for Self Care and Poor Emotional
Regulation

Tension and Stress Reduction Model
 Low Tolerance for Tension
 Stimulus Augmenting
 Drugs ( CNS, D) ) Reduce Tension = People Use it and Get this
Response = Reinforcement
Socio-Cultural Models
 Cultural Circumstances - Tension
 Attitude Toward Drug Taking
 Cultural; Substitutes as Means of Satisfaction
 Alienation – Anomie
Neurotransmitters Brain Pleasure Centers
 Dopamine
 Re uptake
 Inhibition

• 1.9 Million juvenile arrests, up 35.4% from
1987
• 93,000 Juveniles arrested for FBI Violent
Index Crimes, up 59.9% from 1987 murder, rape, robbery, aggravated assault
• 480,000 Juveniles arrested for FBI Property
Index Crimes, up 7.9% from 1987 burglary, larceny-theft, motor vehicle theft, arson
Source: FBI Crime in the United States, 1996 – Table 32

28
18
Age 7 13
Normal bell curve
If drugs come into play

Role of Biology and Environment
Non Antisocial
Parent/
Psychological
Illness or
Antisocial
Environment
Criminal Parent/
Non Criminal
Adoptee
Antisocial
Parent/
Antisocial
Adoptive
Environment
R.J. Cadoret, 1978, Archives of General Psychiatry

Birth Complications & Maternal Rejection
50
45
25
20
15
10
40
35
30
5
0
No Rejection / No
Complication
N=1750
Rejection Only
N=256
Birth Complication
Only
N=2064
Rejection and Birth
Complication
N=191
A. Raine, 1994, Archives of General Psychiatry

•
•
•
Psychiatric
Abusive/violent family
Drug use environment
Socialization Factors
•
•
•
Episodic Symptoms
Neuro/Limbic dysfunction
Cognitive impairments
External
Vulnerabilities
Inherent
Vulnerabilities

How We Develop: Risk Factors Cascading
Across Domains of Development &Time
Age <1 Difficult to soothe infant
Age 2
Age 3
Age 4
Age 5
Age 6
Age 7
Coercive parent-child relationship
Poor self-regulation & control
Child rejected by pro-social peers
Child rejected by teacher
Child bonds to other rejected peers
Poor school bonding

How We Develop Risk Factors Cascading
Across Domains of Development & Time
Age 8
Age 9
Age 10
Age 11
Age 12
Age 13
Age 14
Poor academic achievement
Minor infractions: lying, petty stealing
Cigarette smoking
Alcohol use
Marihuana use, arrests
Risky sexual behavior
Crack cocaine

• Remember: Social bonding is
– Attachment to others in social unit
– Investment in lines of action consistent with social unit
– Belief in values of the unit

Bonding & Environment
For example:
– Abandonment
– Foster care
– Group homes
– Juvenile detention
– Prison

All advance an education
A sense of social definition…
Their notion of the world and how to handle it -“might is right” -- etc.

 Integration
 Inner Voices / Conscience
 Culture, atmosphere & reference points become deeply integrated
 It is our definition of self
 These become our inner voices
 These voices influence our attitudes and behavior

PRO-SOCIAL
OR
ANTI-SOCIAL
 Depends on predominant behaviors
 Values & norms of those to whom we are bonded

Criminal Personality Prototypes
Psychopaths
ASPDs
Sociopaths
Perpetrators with criminal records
All perpetrators of illegal, criminal and destructive acts
Henry Richards, PhD, U Wash

The person who comes to us bonded, attached and has powerful inner voices.

 Substance abusing offenders are not a homogenous group.
 A classification model:
The Early Stage Substance Abuser
The Addict
The Dually Diagnosed Substance Abuser
The Criminogenic Substance Abuser

Early stage refers to experimental and recreational substance abusers whose crimes result from impaired judgment or disinhibition while under the influence of drugs and/or alcohol

Addicts are those for whom daily life is dedicated to drug-seeking behavior.
Petty crime has become their primary means to support their addiction.
Serious or violent crime is less prevalent in this group than in the criminogenic substance abuser .

The mentally ill substance abuser, often referred to as dually diagnosed, has a concurrent mental illness and substance abuse problem .

Criminogenic substance abusers are those who do not wish to be part of mainstream society and have chosen to be members of outlaw subcultures.
Their substance abuse is incidental to their criminal behavior.