title: Anabolic androgenic steroids and violent offending: confounding by polysubstance abuse among 10,365 general population men.
abstract: OBJECTIVE
  Anabolic androgenic steroid (AAS) use is associated with aggressive and violent behaviour, but it remains uncertain if this relationship is causal in humans. We examined the link between AAS use and violent crime while controlling for polysubstance abuse and additional suggested risk factors for violence.
  
  
  METHODS
  Cross-sectional study of a population-based sample.
  
  
  METHODS
  In 2005, all Swedish-born male twins aged 20-47 years were invited to participate in the Swedish Twin Adults: Genes and Environment (STAGE) survey of the Swedish Twin Register (response rate = 60%).
  
  
  METHODS
  A total of 10,365 male survey participants with information on AAS use.
  
  
  METHODS
  Data on self-reported use of AAS, alcohol and other substances, attention deficit hyperactivity disorder (ADHD) and personality disorder symptoms were linked to nation-wide, longitudinal register information on criminal convictions, IQ, psychological functioning and childhood socio-economic status (SES) covariates.
  
  
  RESULTS
  Any life-time use of AAS was associated strongly with conviction for a violent crime [2.7 versus 0.6% in convicted and non-convicted men, respectively; odds ratio (OR) = 5.0, 95% confidence interval (CI) = 2.7-9.3]. However, this link was substantially reduced and no longer significant when controlling for other substance abuse (OR = 1.6, 95% CI = 0.8-3.3). Controlling for IQ, psychological functioning, ADHD, personality disorder symptoms and childhood SES did not reduce the risk further.
  
  
  CONCLUSIONS
  In the general population, co-occurring polysubstance abuse, but not IQ, other neuropsychological risks or socio-economic status, explains most of the relatively strong association between any anabolic androgenic steroid use and conviction for a violent crime.
authors.affiliation: Swedish Prison and Probation Service, R&D, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Lundholm
authors.forename: Thomas
authors.initials: T
authors.lastname: Frisell
authors.forename: Paul
authors.initials: P
authors.lastname: Lichtenstein
authors.forename: Niklas
authors.initials: N
authors.lastname: Långström
mesh_terms: D000328:Adult; D000374:Aggression / Q000187:drug effects; D045930:Anabolic Agents / Q000009:adverse effects*; D000728:Androgens / Q000009:adverse effects*; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology; D003415:Crime / Q000706:statistics & numerical data; D057237:Criminals / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010554:Personality Disorders / Q000453:epidemiology; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D013548:Sweden / Q000453:epidemiology; D014754:Violence / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D045930:Anabolic Agents; D000728:Androgens
keywords: Anabolic androgenic steroids; general population; polysubstance abuse; psychiatry; survey; violent crime