title: The triggering effect of alcohol and illicit drugs on violent crime in a remand prison population: a case crossover study.
abstract: BACKGROUND
  The association between substance abuse, particularly alcohol abuse, and violence has been well established. However, since substance abuse co-occurs with several other risk factors for violence, the causal link between substance abuse and violence and the extent to which the acute influence of alcohol, illicit drugs, benzodiazepines, and anabolic androgenic steroids have a triggering effect on violent behavior are more uncertain.
  
  
  METHODS
  Case-crossover design was used based on data from structured face to face interviews with remand prisoners (n=194; 172 men, 22 women) suspected of violent crimes.
  
  
  METHODS
  odds ratio (OR 95% CI) for a violent crime, 24h after exposure to different substances, compared to periods of no exposure was calculated using conditional logistic regression and a Mantel-Haenszel estimator with confidence intervals for sparse data.
  
  
  RESULTS
  Intake of alcohol (OR 6.41 CI 4.24-9.67) and large doses of benzodiazepines (OR 36.32 CI 7.14-183.65) triggered interpersonal violence. Stratified analyses of possible effect modifiers were sex, conduct/behavioral problems, trauma experiences; psychiatric vulnerability did not reveal any substantial differences.
  
  
  CONCLUSIONS
  Influences of alcohol and unusually high doses of benzodiazepines are proximal risk factors for violent crime. Improved knowledge of short-term (and dose-related) risk factors may contribute to treatment planning and risk assessment of violence.
authors.affiliation: Department of Surgical Sciences, Forensic Medicine Uppsala University, Dag Hammarskölds väg 17, SE-752 37 Uppsala, Sweden. lena.lundholm@surgsci.uu.se
authors.forename: Lena
authors.initials: L
authors.lastname: Lundholm
authors.forename: Ulrika
authors.initials: U
authors.lastname: Haggård
authors.forename: Jette
authors.initials: J
authors.lastname: Möller
authors.forename: Johan
authors.initials: J
authors.lastname: Hallqvist
authors.forename: Ingemar
authors.initials: I
authors.lastname: Thiblin
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000523:psychology*; D045930:Anabolic Agents; D001569:Benzodiazepines; D018592:Cross-Over Studies; D003627:Data Interpretation, Statistical; D017831:Diagnosis, Dual (Psychiatry); D004522:Educational Status; D005260:Female; D006801:Humans; D013287:Illicit Drugs; D007182:Income; D008297:Male; D001523:Mental Disorders / Q000150:complications; D011329:Prisoners / Q000523:psychology*; D012959:Socioeconomic Factors; D013256:Steroids; D019966:Substance-Related Disorders / Q000523:psychology*; D014754:Violence / Q000523:psychology*; D014947:Wounds and Injuries / Q000523:psychology
chemical_list: D045930:Anabolic Agents; D013287:Illicit Drugs; D013256:Steroids; D001569:Benzodiazepines