Drugs of abuse and the elicitation of human aggressive behavior

Intra- and extra-familial child homicide in Sweden 1992-2012: A population-based study

Previous studies have shown decreasing child homicide rates in many countries - in Sweden mainly due to a drop in filicide-suicides. This study examines the rate of child homicides during 21 years, with the hypothesis that a decline might be attributable to a decrease in the number of depressive filicide offenders (as defined by a proxy measure). In addition, numerous characteristics of child homicide are presented. All homicide incidents involving 0-14-year-old victims in Sweden during 1992-2012 (n = 90) were identified in an autopsy database. Data from multiple registries, forensic psychiatric evaluations, police reports, verdicts and other sources were collected. Utilizing Poisson regression, we found a 4% annual decrease in child homicides, in accordance with prior studies, but no marked decrease regarding the depressive-offender proxy. Diagnoses from forensic psychiatric evaluations (n = 50) included substance misuse (8%), affective disorders (10%), autism-spectrum disorders (18%), psychotic disorders (28%) and personality disorders (30%). Prior violent offences were more common among offenders in filicides than filicide-suicides (17.8% vs. 6.9%); and about 20% of offenders in each group had previously received psychiatric inpatient care. Aggressive methods of filicide predominated among fathers. Highly lethal methods of filicide (firearms, fire) were more commonly followed by same-method suicide than less lethal methods. Interestingly, a third of the extra-familial offenders had an autism-spectrum disorder. Based on several findings, e.g., the low rate of substance misuse, the study concludes that non-traditional risk factors for violence must be highlighted by healthcare providers. Also, the occurrence of autism-spectrum disorders in the present study is a novel finding that warrants further investigation.

The Elusive Goal of Drug-Free Prisons

BACKGROUND

Although there is a need for well-designed evaluations, international evidence shows that drugs frequently enter prisons and enforcement efforts are said to be linked to adverse events.

OBJECTIVES

This study sought to examine drug enforcement within a federal prison system, overseen by the Correctional Service of Canada (CSC), and to detail competing perspectives.

METHODS

Three main sources of data were used in this qualitative study: 16 interviews conducted between 2010 and 2012 with former CSC senior officials, former frontline staff, and external stakeholders; CSC research publications and other documents; and transcripts from a relevant House of Commons Standing Committee public study. All texts were coded and compared to examine emergent themes of interest.

RESULTS

Six key themes are described as contested effects of enhanced in-prison drug enforcement: (1) continued and creative efforts to bring in drugs; (2) climate of tensions and violence; (3) prisoners switching their drug use; (4) health-related harms; (5) deterrence of visitors; and (6) staff involvement in the in-prison drug trade.

CONCLUSIONS/IMPORTANCE

Urgently needed are rigorous evaluations of in-prison drug enforcement, along with closer scrutiny of policy recommendations that uphold the goal of drug-free prisons. Studying similar prison systems as complex risk-managing organizations may offer new information about drug enforcement policy and practice resistance despite detrimental effects.

Subjective aggression during alcohol and cannabis intoxication before and after aggression exposure

RATIONALE

Alcohol and cannabis use have been implicated in aggression. Alcohol consumption is known to facilitate aggression, whereas a causal link between cannabis and aggression has not been clearly demonstrated.

OBJECTIVES

This study investigated the acute effects of alcohol and cannabis on subjective aggression in alcohol and cannabis users, respectively, following aggression exposure. Drug-free controls served as a reference. It was hypothesized that aggression exposure would increase subjective aggression in alcohol users during alcohol intoxication, whereas it was expected to decrease subjective aggression in cannabis users during cannabis intoxication.

METHODS

Heavy alcohol (n = 20) and regular cannabis users (n = 21), and controls (n = 20) were included in a mixed factorial study. Alcohol and cannabis users received single doses of alcohol and placebo or cannabis and placebo, respectively. Subjective aggression was assessed before and after aggression exposure consisting of administrations of the point-subtraction aggression paradigm (PSAP) and the single category implicit association test (SC-IAT). Testosterone and cortisol levels in response to alcohol/cannabis treatment and aggression exposure were recorded as secondary outcome measures.

RESULTS

Subjective aggression significantly increased following aggression exposure in all groups while being sober. Alcohol intoxication increased subjective aggression whereas cannabis decreased the subjective aggression following aggression exposure. Aggressive responses during the PSAP increased following alcohol and decreased following cannabis relative to placebo. Changes in aggressive feeling or response were not correlated to the neuroendocrine response to treatments.

CONCLUSIONS

It is concluded that alcohol facilitates feelings of aggression whereas cannabis diminishes aggressive feelings in heavy alcohol and regular cannabis users, respectively.

Does Marijuana Use Contribute to Intimate Partner Aggression? A Brief Review and Directions for Future Research

Marijuana users are more likely to perpetrate intimate partner aggression (IPA) than non-users, yet the mechanism responsible for this association is unknown. Recent studies considering the association between episodes of marijuana use and episodes of IPA have failed to find evidence consistent with an acute effect of marijuana. Research gaps are highlighted and a heuristic model of marijuana's potential effects on IPA is presented. Research priorities include consideration of mediating mechanisms, moderating variables at the individual and couple level, and examination of acute effects of marijuana using daily report and EMA designs.

Cannabinoid Ligands and Alcohol Addiction: A Promising Therapeutic Tool or a Humbug?

The vast therapeutic potential of cannabinoids of both synthetic and plant-derived origins currently makes these compounds the focus of a growing interest. Although cannabinoids are still illicit drugs, their possible clinical usefulness, including treatment of acute or neuropathic pain, have been suggested by several studies. In addition, some observations indicate that cannabinoid receptor antagonists may be useful for the treatment of alcohol dependence and addiction, which is a major health concern worldwide. While the synergism between alcohol and cannabinoid agonists (in various forms) creates undesirable side effects when the two are consumed together, the administration of CB1 antagonists leads to a significant reduction in alcohol consumption. Furthermore, cannabinoid antagonists also mitigate alcohol withdrawal symptoms. Herein, we present an overview of studies focusing on the effects of cannabinoid ligands (agonists and antagonists) during acute or chronic consumption of ethanol.

Early Maladaptive Schemas and Aggression in Men Seeking Residential Substance Use Treatment

Social-cognitive theories of aggression postulate that individuals who perpetrate aggression are likely to have high levels of maladaptive cognitive schemas that increase risk for aggression. Indeed, recent research has begun to examine whether early maladaptive schemas may increase the risk for aggression. However, no known research has examined this among individuals in substance use treatment, despite aggression and early maladaptive schemas being more prevalent among individuals with a substance use disorder than the general population. Toward this end, we examined the relationship between early maladaptive schemas and aggression in men in a residential substance use treatment facility (N = 106). Utilizing pre-existing patient records, results demonstrated unique associations between early maladaptive schema domains and aggression depending on the type of aggression and schema domain examined, even after controlling for substance use, antisocial personality, age, and education. The Impaired Limits domain was positively associated with verbal aggression, aggressive attitude, and overall aggression, whereas the Disconnection and Rejection domain was positively associated with physical aggression. These findings are consistent with social-cognitive models of aggression and advance our understanding of how early maladaptive schemas may influence aggression. The implications of these findings for future research are discussed.

Reciprocal longitudinal associations between substance use and child-to-parent violence in adolescents

Child-to-parent violence (CPV) is a type of violence that has received little attention despite its increasing rates in Western countries. Several models state that substance abuse constitutes a risk factor for aggressive behavior and that relationships among these variables can be reciprocal. In this study, the temporal relationships among substance use and physical and psychological CPV were examined. A sample of 981 adolescents (mean age = 15.22 years, SD = 1.2 years) completed measures of substance use and CPV at three time points (T1, T2, and T3) spaced 6 months apart. The results indicated that T1 levels of substance use predicted an increase in psychological CPV at T2 and that T2 levels of substance use predicted an increase in physical CPV at T3. Additionally, several mediational mechanisms emerged between substance use at T1 and CPV at T3. Neither physical nor psychological CPV predicted an increase in substance use at any time. Multiple comparisons indicated that the predictive association between substance use and physical aggression against parents was significant only in boys. These findings suggest that preventive programs for CPV should include specific components for reducing substance use.

Assessment of Pharmacokinetic and Pharmacodynamic Interactions Between Albumin-Fused Mutated Butyrylcholinesterase and Intravenously Administered Cocaine in Recreational Cocaine Users

Cocaine dependence presents a major public health issue, and to date, no pharmacotherapies are approved for its treatment. TV-1380 is a novel recombinant albumin-fused mutated butyrylcholinesterase (Albu-BChE) that has increased catalytic efficiency for cocaine compared with wild-type BChE and therefore has the potential to facilitate abstinence in cocaine-dependent subjects by decreasing exposure to cocaine and its reinforcing effects.

METHODS

This randomized, double-blind, placebo-controlled, parallel-group study in nondependent cocaine users was conducted to evaluate the effect of a single intramuscular dose of Albu-BChE (50, 100, and 300 mg) on the pharmacokinetic and metabolic profile of intravenous cocaine infusions (40 mg) administered at baseline and at 24, 96, and 168 hours after Albu-BChE dosing, to assess safety of coadministering Albu-BChE and cocaine, and to explore the subjective responses to cocaine infusions after Albu-BChE dosing.

RESULTS

Administration of Albu-BChE resulted in significant dose-dependent reductions in cocaine exposure (maximum concentration, area under the curve) and half-life. Effects were greatest at 24 hours after Albu-BChE dose, but were sustained up to 168 hours. Spearman correlations indicated a significant negative relationship between Albu-BChE concentration and cocaine clearance and exposure. Consistent with its mechanism of action, Albu-BChE also shifted cocaine metabolism toward preferential formation of ecgonine methyl ester. Administration of Albu-BChE was associated with modest decreases in subjective reports of feeling high and willingness to take cocaine again after cocaine infusion. Coadministration of Albu-BChE and cocaine was safe and well tolerated.

CONCLUSIONS

Administration of Albu-BChE at single doses of 50, 100, and 300 mg safely resulted in long-lasting decreases in cocaine exposure in recreational cocaine users.

Discrepant effects of acute cocaine on impulsive choice (delay discounting) in female rats during an increasing- and adjusting-delay procedure

RATIONALE

The relationship between impulsive choice and cocaine use in humans has been well established, although the causal role between these variables is complex. To disentangle this relationship, studies using rats have focused on how acute or chronic cocaine alters impulsive choice. A predominance of studies has focused on chronic cocaine regimens, but few have assessed acute cocaine's effects on impulsive choice.

OBJECTIVE

The current study assessed if acute cocaine administrations alter delay discounting of rats in two common impulsive choice procedures.

METHOD

Baseline delay discounting rates were determined in female rats using both an increasing- and adjusting-delay procedure. Once stable, a range of acute cocaine injections (2, 5, and 15 mg/kg i.p.) was administered prior to both procedures.

RESULTS

Baseline delay discounting rates were positively correlated between the increasing- and adjusting-delay procedures. Acute administrations of cocaine produced a dose-dependent decrease in preference for the large alternative in the increasing-delay procedure but had no effect in the adjusting-delay procedure.

CONCLUSIONS

The concordance of delay discounting rates across the two choice procedures suggests that both quantify the same underlying components of impulsive choice. However, manipulations that disrupt large alternative preference may not be readily detected under the adjusting-delay procedure unless control conditions are employed.

The relationship between spirituality and aggression in a sample of men in residential substance use treatment

There is a robust literature documenting that aggression perpetration is increased among individuals in treatment for substance use. Although aggression decreases with successful substance use treatment, a substantial number of patients continue to engage in aggression following treatment. Thus, continued research is needed on potential protective factors for aggression that could be enhanced during substance use treatment. The current study examined the relationship between spirituality and aggression among men in residential treatment for substance use (N = 398), as many substance use treatment programs employ spirituality-based interventions. Findings demonstrated that spirituality was negatively associated with attitudinal, physical, and verbal aggression, as well as a composite aggression score. Moreover, spirituality remained negatively associated with aggression after controlling for age, alcohol use and problems, and drug use and problems. These findings provide preliminary evidence for the association between spirituality and aggression among men in treatment for substance use. Continued research is needed in this area, particularly longitudinal and treatment outcome research.

Adolescent homicide victimization in Johannesburg, South Africa: incidence and epidemiological characteristics (2001-2009)

This study describes the incidence and epidemiological characteristics of adolescent homicides (15-19 years) in Johannesburg, South Africa. A retrospective population-based study was conducted on cases drawn from the National Injury Mortality Surveillance System. A total of 590 adolescent homicides were registered for 2001-2009 corresponding to an average annual homicide rate of 23.4/100,000. The average annual rate was 39.8/100,000 for males and 7.9/100,000 for females. Black and coloured adolescents had the highest homicide rates. There was a considerable decline in the firearm homicide rates over the study period. In contrast, sharp instrument and blunt force homicides increased. Public places were the predominant scenes for male deaths, while female homicides occurred primarily in residential locations. Most male homicides took place over weekend nights. Alcohol was a prominent feature of homicides. The high homicide rates reported in this study underscore the need to develop interventions directed specifically at adolescents. Prevention efforts are required to pay particular attention to black and coloured adolescent males, and to address the availability of weapons and alcohol use among adolescents.

Adolescent Substance Misusers with and without Delinquency: Death, Mental and Physical Disorders, and Criminal Convictions from Age 21 to 45

Little is known about adult outcomes of males who as adolescents sought treatment for alcohol misuse or drug use, and who additionally were engaging or not engaging in other forms of delinquency. Since the rates of negative outcomes vary in the general population, the study determined whether the sub-groups of clinic attendees fared differently as compared to males of the same age who had not sought treatment for substance misuse from age 21 to 45. Adolescent males who consulted the only substance misuse clinic in a Swedish city between 1968 and 1971 were divided into four groups: ALCOHOL no drug use, no criminal offending (n=52); ALCOHOL+D no drug use, plus criminal offending (n=105); DRUG use, no criminal offending (n=92); and DRUG+D plus criminal offending (n=474). These four groups were compared to a general population sample (GP) of males matched on age and birthplace, who did not seek treatment for SM in adolescence. National Swedish registers provided data on death, hospitalizations for substance misuse (SM), mental and physical disorders, and criminal convictions. Compared to the GP, and after controlling for co-occurring adult outcomes, ALCOHOL showed elevated risks for SM hospitalization and convictions for violent crimes, and DRUG showed elevated risks for SM hospitalization, convictions for non-violent crimes, and hospitalization for psychosis. ALCOHOL+D and DRUG+D showed increased risk for SM hospitalization, violent and non-violent convictions, and DRUG+D additionally, for death, and hospitalizations for psychosis and physical illness. Misuse of alcohol without drug use or other delinquency in adolescence was associated with increased risk for convictions for violent crimes during the subsequent 25 years, in addition to SM, while adolescent drug use without other forms of delinquency was associated with increased risks for convictions for non-violent crimes, hospitalizations for SM, and non-affective psychosis. Cannabis use, with and without delinquency, was associated with subsequent hospitalization for non-affective psychosis. Consistent with contemporary studies, most adolescents treated for SM from 1968-1971 presented delinquency that was associated with an increase in risk of all adverse outcomes to age 45.

The relation between trait mindfulness and aggression in men seeking residential substance use treatment

There has been an abundance of research in recent years on mindfulness, including mindfulness within individuals seeking substance use treatment. However, to date, there has been no research on whether trait mindfulness is associated with increased aggression among individuals seeking substance use treatment. Past research has demonstrated that individuals in substance use treatment evidence higher levels of aggression than non-substance abusers, and preliminary research has shown that trait mindfulness is inversely associated with aggression in non-substance-use treatment-seeking populations. The current study examined whether trait mindfulness was associated with aggression among men seeking residential substance use treatment (N = 116). Results demonstrated that lower trait mindfulness was associated with increased aggression (physical, verbal, and aggressive attitude). Moreover, this relation held for both verbal aggression and aggressive attitude after controlling for alcohol use, drug use, and age, all known predictors of aggression. Findings provide the first evidence that mindfulness is negatively associated with aggression among men in substance use treatment, which could have important implications for intervention. That is, mindfulness-based interventions may prove helpful for the treatment of both substance use and aggression.

Motivations, substance use and other correlates amongst property and violent offenders who regularly inject drugs

OBJECTIVE

To examine the prevalence, correlates and motivations for the commission of property and violent crime amongst a sample of people who inject drugs (PWID).

METHOD

Data were obtained from the 2013 Illicit Drug Reporting System (IDRS), which includes a cross-sectional sample of 887 PWID.

RESULTS

Eighteen percent of PWID had committed a property offence and 3% had committed a violent offence in the month preceding interview. Opioid dependence (AOR 2.57, 95% CI 1.29-5.10) and age (AOR 0.96, 95% CI 0.93-0.99) were found to be the strongest correlates of property crime. The majority of property offenders (75%) attributed their offending to financial reasons, however those under the influence of benzodiazepines were proportionately more likely to nominate opportunistic reasons as the main motivation for their last offence. Stimulant dependence (AOR 5.34, 95% CI 1.91-14.93) was the only significant correlate of past month violent crime, and the largest proportion of violent offenders (47%) attributed their offending to opportunistic reasons. The majority of both property (71%) and violent offenders (73%) reported being under the influence of drugs the last time they committed an offence; the largest proportion of property offenders reported being under the influence of benzodiazepines (29%) and methamphetamine (24%), whilst violent offenders mostly reported being under the influence of heroin and alcohol (32% respectively).

CONCLUSION

Criminal motivations, substance use and other correlates vary considerably across crime types. This suggests that crime prevention and intervention strategies need to be tailored according to individual crime types, and should take into account self-reported criminal motivations, as well as specific risk factors that have been shown to increase the likelihood of offending.

Safety, pharmacokinetics, and pharmacodynamics of TV-1380, a novel mutated butyrylcholinesterase treatment for cocaine addiction, after single and multiple intramuscular injections in healthy subjects

Human plasma butyrylcholinesterase (BChE) contributes to cocaine metabolism and has been considered for use in treating cocaine addiction and cocaine overdose. TV-1380 is a recombinant protein composed of the mature form of human serum albumin fused at its amino terminus to the carboxy-terminus of a truncated and mutated BChE. In preclinical studies, TV-1380 has been shown to rapidly eliminate cocaine in the plasma thus forestalling entry of cocaine into the brain and heart. Two randomized, blinded phase I studies were conducted to evaluate the safety, pharmacokinetics, and pharmacodynamics of TV-1380, following single and multiple administration in healthy subjects. TV-1380 was found to be safe and well tolerated with a long half-life (43-77 hours) and showed a dose-proportional increase in systemic exposure. Consistent with preclinical results, the ex vivo cocaine hydrolysis, TV-1380 activity clearly increased upon treatment in a dose-dependent manner. In addition, there was a direct relationship between ex vivo cocaine hydrolysis (kel ) and TV-1380 serum concentrations. There was no evidence that TV-1380 affected heart rate, the uncorrected QT interval, or the heart-rate-corrected QTcF interval. TV-1380, therefore, offers a safe once-weekly therapy to increase cocaine hydrolysis.

Benzodiazepine use among mothers of small children: a register-based cohort study

AIMS

To compare benzodiazepine (BZD) purchases in different groups of mothers of small children.

DESIGN

Prospective population-based cohort study based on the Finnish social and health care registers.

SETTING

Finnish women of child-bearing age.

PARTICIPANTS

All women who gave birth in 2002 in Finland (n = 54 519).

MEASUREMENTS

Latent class analysis (LCA) was used to create a typology of mothers according to their substance abuse status, psychiatric disorders and socio-demographic characteristics. The mothers were followed-up yearly for purchases of benzodiazepines, starting 4 years before the child's birth and continuing up to the child's 7th birthday. BZD purchases in different mother groups were compared using negative binomial hurdle models.

FINDINGS

The five mother types identified by LCA were mothers with substance abuse (1%), mothers with psychiatric disorders (1%), mothers with a risk of social marginalization (11%), mothers with minor social problems (18%) and mothers with no identified problems (69%; the comparison group). Mothers with substance abuse problems had the highest odds of purchasing BZDs [odds ratio OR = 27.5, 95%CI = 22.9-33.0; RR = 20.2, 95%CI = 14.9-27.3. The change in time was similar in all groups: the probability of purchasing and the number of purchases were lowest during pregnancy and the year of the child's birth.

CONCLUSIONS

In Finland, among mothers of young children, prevalence of benzodiazepine use is reduced during pregnancy and the child's first year, and then increases as the child grows older. Mothers with substance abuse and psychiatric disorders are at particularly high risk of benzodiazepine use.

Alcohol consumption in adolescent homicide victims in the city of Johannesburg, South Africa

AIMS

To describe the blood alcohol concentration (BAC) of adolescent homicide victims in Johannesburg, South Africa and to identify the victim and event characteristics associated with a positive BAC at the time of death.

DESIGN

Logistic regression of mortality data collected by the National Injury Mortality Surveillance System (NIMSS).

SETTING

Johannesburg, South Africa.

PARTICIPANTS

A total of 323 adolescent (15-19 years) homicide victims for the period 2001-9 who had been tested for the presence of alcohol.

MEASUREMENTS

Data on the victims' BAC level, demographics, weapon or method used, scene, day and time of death were drawn from NIMSS.

FINDINGS

Alcohol was present in 39.3% of the homicide victims. Of these, 88.2% had a BAC level equivalent to or in excess of the South African limit of 0.05 g/100 ml for intoxication. Multivariate logistic analysis showed that a positive BAC in homicide victims was associated significantly with the victim's sex [male: odds ratio (OR) = 2.127; 95% confidence interval (CI) = 1.012-4.471], victim's age (18-19 years: OR = 2.364; CI = 1.343-4.163); weapon used (sharp instruments: OR = 2.972; CI = 1.708-5.171); and time of death (weekend: OR = 3.149; CI = 1.842-5.383; night-time: OR = 2.175; CI = 1.243-3.804).

CONCLUSIONS

Excessive alcohol consumption is associated with a substantial proportion of adolescent homicides in Johannesburg, South Africa, and is more prevalent among male and older adolescent victims and in victims killed with sharp instruments over the weekends and during the evenings.

Anabolic androgenic steroids and violent offending: confounding by polysubstance abuse among 10,365 general population men

BACKGROUND AND AIMS

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.

DESIGN

Cross-sectional study of a population-based sample.

SETTING

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%).

PARTICIPANTS

A total of 10,365 male survey participants with information on AAS use.

MEASUREMENT

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.

FINDINGS

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.

CONCLUSION

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.

Benzodiazepine use and aggressive behaviour: a systematic review

CONTEXT

The relationship between benzodiazepine consumption and subsequent increases in aggressive behaviour in humans is not well understood.

OBJECTIVES

The current study aimed to identify, via a systematic review, whether there is an association between benzodiazepine consumption and aggressive responding in adults.

METHOD

A systematic review was conducted and reported in line with the PRISMA statement. English articles within MEDLINE, PsycARTICLES, PsycINFO, Academic Search Complete, and Psychology and Behavioural Sciences Collection databases were searched. Additional studies were identified by searching reference lists of reviewed articles. Only articles that explicitly investigated the relationship between benzodiazepine consumption and subsequent aggressive behaviour, or a lack thereof, in human adults were included.

RESULTS

Forty-six studies met the inclusion criteria. It was not possible to conduct a meta-analysis due to the heterogeneity of study design and benzodiazepine type and dose. An association between benzodiazepine use and subsequent aggressive behaviour was found in the majority of the more rigorous studies, although there is a paucity of high-quality research with clinical or forensic populations. Diazepam and alprazolam have received the most attention. Dose-related findings are inconsistent: therapeutic doses may be more likely to be associated with aggressive responding when administered as a once-off, whereas higher doses may be more risky following repeated administration. Trait levels of anxiety and hostility may indicate a vulnerability to the experience of benzodiazepine-related aggression.

CONCLUSIONS

There appears to be a moderate association between some benzodiazepines and subsequent aggressive behaviour in humans. The circumstances under which aggressive responding may be more likely to follow benzodiazepine use remain unclear, although some evidence suggests dose and/or personality factors may influence this effect.

Acute influence of alcohol, THC or central stimulants on violent suicide: A Swedish population study

Alcohol and substance abuse in general is a risk factor for suicide, but very little is known about the acute effect in relation to suicide method. Based on information from 18,894 medico-legal death investigations, including toxicological findings and manner of death, did the present study investigate whether acute influence of alcohol, tetrahydrocannabinol (THC), or central stimulants (amphetamine and cocaine) was related to the use of a violent suicide method, in comparison with the nonviolent method self-poisoning and alcohol-/illicit drug-negative suicide decedents. Multivariate analysis was conducted, and the results revealed that acute influence of THC was related to using the violent suicide method–– jumping from a height (RR 1.62; 95% CI 1.01–2.41). Alcohol intoxication was not related to any violent method, while the central stimulant-positive suicide decedent had a higher, albeit not significant, risk of several violent methods. The study contributes with elucidating suicide methods in relation to acute intoxication.

Toxicities associated with NBOMe ingestion-a novel class of potent hallucinogens: a review of the literature

BACKGROUND

A new class of synthetic hallucinogens called NBOMe has emerged as drugs of abuse.

OBJECTIVE

Our aim was to conduct a systematic review of published reports of toxicities associated with NBOMe ingestion.

METHODS

We searched PubMed for relevant English-language citations that described adverse effects from analytically confirmed human NBOMe ingestion. Demographic and clinical data were extracted.

RESULTS

A total of 10 citations met the criteria for inclusion, representing 20 individual patients. 25I-NBOMe was the most common analogue identified, followed by 25B-NBOMe and 25C-NBOMe. Fatalities were reported in 3 (15%) cases. Of all the patients, 7 (35%) were discharged after a period of observation, whereas 8 (40.0%) required admission to an intensive care unit. The most common adverse effects were agitation (85.0%), tachycardia (85.0%), and hypertension (65.0%). Seizures were reported in 8 (40.0%) patients. The most common abnormalities reported on laboratory tests were elevated level of creatinine kinase (45.0%), leukocytosis (25.0%), and hyperglycemia (20.0%).

CONCLUSION

NBOMe ingestion is associated with severe adverse effects. Clinicians need to have a high index of suspicion for NBOMe ingestion in patients reporting the recent use of hallucinogens.

The effects of acute alcohol administration on the human brain: insights from neuroimaging

Over the last quarter century, researchers have peered into the living human brain to develop and refine mechanistic accounts of alcohol-induced behavior, as well as neurobiological mechanisms for development and maintenance of addiction. These in vivo neuroimaging studies generally show that acute alcohol administration affects brain structures implicated in motivation and behavior control, and that chronic intoxication is correlated with structural and functional abnormalities in these same structures, where some elements of these decrements normalize with extended sobriety. In this review, we will summarize recent findings about acute human brain responses to alcohol using neuroimaging techniques, and how they might explain behavioral effects of alcohol intoxication. We then briefly address how chronic alcohol intoxication (as inferred from cross-sectional differences between various drinking populations and controls) may yield individual brain differences between drinking subjects that may confound interpretation of acute alcohol administration effects. This article is part of the Special Issue Section entitled 'Neuroimaging in Neuropharmacology'.

Effects of acute alcohol consumption and processing of emotion in faces: Implications for understanding alcohol-related aggression

The negative consequences of chronic alcohol abuse are well known, but heavy episodic consumption ("binge drinking") is also associated with significant personal and societal harms. Aggressive tendencies are increased after alcohol but the mechanisms underlying these changes are not fully understood. While effects on behavioural control are likely to be important, other effects may be involved given the widespread action of alcohol. Altered processing of social signals is associated with changes in social behaviours, including aggression, but until recently there has been little research investigating the effects of acute alcohol consumption on these outcomes. Recent work investigating the effects of acute alcohol on emotional face processing has suggested reduced sensitivity to submissive signals (sad faces) and increased perceptual bias towards provocative signals (angry faces) after alcohol consumption, which may play a role in alcohol-related aggression. Here we discuss a putative mechanism that may explain how alcohol consumption influences emotional processing and subsequent aggressive responding, via disruption of orbitofrontal cortex (OFC)-amygdala connectivity. While the importance of emotional processing on social behaviours is well established, research into acute alcohol consumption and emotional processing is still in its infancy. Further research is needed and we outline a research agenda to address gaps in the literature.

Violence and aggression in the Drug Treatment Centre Board

Objectives: We sought to determine the prevalence of and the factors associated with violent and aggressive incidents among clients attending an out-patient methadone stabilisation and detoxification programme in Dublin.

Methods: We retrospectively examined all incident report forms over a two-year period. We also obtained information on demographics, main drug of abuse, timing and location of the incident as well as psychiatric and physical comorbidity among the perpetrators from case note review.

Results: Two hundred and ninety-five incidents occurred over the study period. The overall rate of violence and aggression was 85 per 1,000 clients attending the centre per year. Most incidents involved verbal abuse. Females were significantly more likely to be involved in assaults compared to males. A high proportion of clients (80%) who were physically aggressive tested positive for benzodiazepine medication.

Conclusions: Levels of recorded violence have remained stable however racial abuse has increased in recent years. The relatively low overall rate of violence suggests that existing measures have helped reduce the number of aggressive and violent incidents in the centre. Most of the victims were either doctors, nursing staff or general assistants. This finding reflected their respective roles in the centre, which included limit setting and dealing with positive drug screens among clients.

Correlates of Recent and Lifetime Aggression among Veterans with Co-Occurring PTSD and Substance Use Disorders

OBJECTIVE

Aggressive behavior is strongly associated with both posttraumatic stress disorder (PTSD) and substance use disorders (SUD) among civilians. However, little research has examined correlates of aggression among Veterans with co-occurring PTSD and SUD.

METHODS

This exploratory study examined the prevalence and correlates of recent (i.e., past 30 days) and lifetime aggressive behavior among a sample of U.S. Veterans (N=97) enrolled in a study examining integrated psychosocial treatment of co-occurring PTSD/SUD.

RESULTS

The findings revealed high rates of recent and lifetime aggressive behaviors (39.2% and 57.7%, respectively). Participants who endorsed recent aggressive behaviors were younger, had less education, more severe PTSD numbing and hyperarousal symptoms, were more likely to report recent suicidal ideation, more frequent alcohol and marijuana use, had higher rates of physical and sexual abuse, greater combat exposure, and more severe aftermath of battle experiences. Participants who endorsed lifetime aggression were younger, reported more total PTSD symptom severity, PTSD re-experiencing severity, depression severity, and fewer post-deployment stressors compared to those who did not. Logistic regression analyses indicated that education and number of drinking days were correlated with recent aggression while depression and post-deployment stressors were correlated with lifetime aggression.

CONCLUSIONS

The findings demonstrate high rates of aggressive behaviors among Veterans with PTSD/SUD, as well as clinically relevant correlates of aggressive behaviors. Although preliminary, the findings suggest potential targets for improving assessment and treatment of Veterans with PTSD/SUD.

Associations between substance use, post-traumatic stress disorder and the perpetration of violence: A longitudinal investigation

AIM

Substance use disorder (SUD) and post-traumatic stress disorder (PTSD) commonly co-occur. This is of significant concern, given the increased risk for violence perpetration among individuals with this comorbidity. Limited research, however, has examined relationships between SUD, PTSD and violence among individuals longitudinally. Such an investigation is warranted given that substance use and PTSD symptoms can fluctuate over time. This study therefore aims to examine how changes in substance use and PTSD symptom severity are associated with the perpetration of violent crime over time among individuals with comorbid SUD and PTSD.

METHOD

One-hundred and two men and women who met criteria for SUD and PTSD were interviewed four times over a 9-month period. These interviews included measures of past-month violent crime perpetration, substance use and dependence, PTSD symptom severity, and depression and state anxiety symptoms. Generalised estimating equations (GEE) modelled associations between substance use, PTSD and violence.

RESULTS

Increased substance use, more severe substance dependence and more severe PTSD symptomology were consistently associated with violent crime over time. Multivariate GEE analyses, however, revealed that the PTSD hyperarousal symptoms, specifically, were independently associated with violence over time.

CONCLUSIONS

This longitudinal study found that PTSD hyperarousal symptoms were consistently associated with the perpetration of violent crime, further highlighting the potentiating role of PTSD hyperarousal in relation to violence among individuals with SUD. These findings indicate that interventions addressing hyperarousal symptoms have the potential to reduce the susceptibility for violence among individuals with this common comorbidity.

Cannabis use and violence: Is there a link?

Background: While several studies suggest that cannabis users are at increased risk of interpersonal violence, it is not clear to what extent the association is causal. Our paper aims to assess the association between cannabis use and violence by using a method that diminishes the risk of confounding. Methods: We analysed data on cannabis use and violent behaviour from the second (1994) and third (1999) waves of the Young in Norway Longitudinal Study (cumulative response rate: 68.1%, n = 2681). We applied fixed-effects modelling to estimate the association between these behaviours, implying that changes in the frequency of violence were regressed on changes in the frequency of cannabis use. The effects of time-invariant confounders were hence eliminated. In addition, we included two time-varying covariates. Results: The elasticity estimate implies that a 10% increase in cannabis use frequency is associated with a 0.4% increase in frequency of violence ( p=.024). Conclusions: Analyses of panel data on Norwegian youths reveals a statistically significant association between cannabis use and violence.

The Role of Executive Function Deficits in Domestic Violence Perpetration

Of the probable psychological or neuropsychological vulnerabilities or risks in domestic violence perpetration, deficits in executive function may be one of the least explored. This integrative review contains overviews of domestic violence theory, the literature on psychological and neuropsychological risk for violence, the literature on executive function, and the literature on coping. The neuropsychology and neuroanatomy of violence typically involves deficits in the frontal lobes and their role in cognition and impulse control and/or excessive activation of the limbic structures with their role of mediating primary emotions and drive-related behavior. Domestic violence perpetration can be understood as maladaptive and destructive coping, symptomatic of disorders of impulsivity, neuropsychological impairment, and emotional dysfunction activated within the context of intimacy or primary relationships, often (if not usually) exacerbated by substance abuse or dependency. Conceptualizing domestic violence perpetration as maladaptive coping, impaired by executive deficits, psychopathology, often worsened by substance abuse, opens up a wide range of alternative intervention strategies. Instead of assuming (often incorrectly) that a perpetrator’s intentions are only patriarchal domination, careful assessment of neuropsychological vulnerability and coping abilities can lead to both a more accurate picture of risk as well as guided change strategies. Assessment of executive function can provide a framework for understanding and improving both the cognitive capabilities of perpetrators to form and use adaptive strategies as well as their abilities to manage or inhibit affective arousal to violence.

Phenomenology of borderline personality disorder: the role of race and socioeconomic status

Little is known about racial differences in borderline personality disorder (BPD) that may influence etiology, phenomenology, and treatment of women with BPD. A total of 83 women with BPD participated in this cross-sectional study: n = 41 white and n = 42 African-American women. Structured interviews were used to assess Axis I and II disorders, and a series of interviews and questionnaires captured internalizing and externalizing symptoms. The white women with BPD reported more severe internalizing symptoms, whereas the African-American women reported more severe externalizing symptoms. Except for the association between race and number of suicide attempts, the relationship between race and internalizing/externalizing symptoms was mediated by socioeconomic status. In conclusion, African-American women with BPD may present with more severe symptoms of lack of anger control and fewer suicidal behaviors than those of white women with BPD, raising the possibility that they are misdiagnosed and receive treatments that are not optimal for BPD.

Integrated Treatment for Substance Abuse and Partner Violence (I-StoP)

Substance use disorders and intimate partner violence (IPV) perpetration frequently co-occur, and it has been hypothesized that alcohol use and IPV perpetration are causally related. This led to the development of an Integrated treatment for Substance abuse and Partner violence (I-StoP). This case study describes the treatment of Henry, who repeatedly abused his partner and was diagnosed with alcohol and cannabis dependence. Treatment with I-StoP was highly successful with respect to IPV: At posttreatment and 6 months follow-up, no IPV had taken place. However, Henry had not changed substance use. This can be explained by the spurious model that states that a third variable, such as inadequate problem-solving skills (which was addressed in I-StoP), may be responsible for both IPV and substance abuse. In addition, Henry’s partner was involved in treatment and became more assertive and, in contrast, he did change substance use. This case study illustrates that IPV is a very complex problem and that it is important to involve the partner.

Intimate partner violence victimization and cigarette smoking: a meta-analytic review

The current meta-analytic review represents the first comprehensive empirical evaluation of the strength of the relationship between intimate partner violence (IPV) victimization and cigarette smoking. Thirty-nine effect sizes, drawn from 31 peer-reviewed publications, determined the existence of a small to medium composite effect size for the victimization-smoking relationship (d = .41, 95% confidence interval = [.35, .47]). Results indicate that victims of IPV are at greater smoking risk than nonvictims. Subsequent moderator analyses indicated that the association between victimization and smoking is moderately stronger among pregnant compared to nonpregnant victims. The strength of the victimization-smoking relationship did not differ by relationship type or ethnicity. More research is needed on the smoking behavior of male victims, victims of psychological violence, and victims who identify as Latino/Latina. It would be useful for professionals working with IPV victims to assess for smoking and incorporate smoking prevention and cessation skills in intervention settings.

Marijuana withdrawal and aggression among a representative sample of U.S. marijuana users

BACKGROUND

Previous laboratory-based research suggests that withdrawal from marijuana may cause increased aggression. It is unclear whether this finding extends beyond the laboratory setting to the general population of marijuana users. The purpose of this study was to test a cross-sectional association between marijuana withdrawal symptoms and aggression among a representative sample of U.S. adult marijuana users, and to test whether this association was moderated by previous history of aggression.

METHODS

Data were analyzed from the National Epidemiologic Survey on Alcohol and Related Conditions. Wave Two data (2004-2005) were used for all variables except for history of aggression, which was assessed during the Wave One interview (2001-2002). Two outcomes were examined: self-report general aggression and relationship aggression. Odds ratios for aggression based on withdrawal symptoms and the interaction between withdrawal symptoms and history of aggression were calculated using logistic regression, adjusting for covariates and accounting for the complex survey design.

RESULTS

Among marijuana users with a history of aggression, marijuana withdrawal was associated with approximately 60% higher odds of past year relationship aggression (p<0.05). There was no association between withdrawal symptoms and relationship aggression among those without a history of aggression, and no association with general aggression regardless of history of aggression.

CONCLUSIONS

The findings from this study support the notion that laboratory-based increases in aggression due to marijuana withdrawal extend to the general population of marijuana users who have a previous history of aggression.

Psychedelics and mental health: a population study

Background

The classical serotonergic psychedelics LSD, psilocybin, mescaline are not known to cause brain damage and are regarded as non-addictive. Clinical studies do not suggest that psychedelics cause long-term mental health problems. Psychedelics have been used in the Americas for thousands of years. Over 30 million people currently living in the US have used LSD, psilocybin, or mescaline.

Objective

To evaluate the association between the lifetime use of psychedelics and current mental health in the adult population.

Method

Data drawn from years 2001 to 2004 of the National Survey on Drug Use and Health consisted of 130,152 respondents, randomly selected to be representative of the adult population in the United States. Standardized screening measures for past year mental health included serious psychological distress (K6 scale), mental health treatment (inpatient, outpatient, medication, needed but did not receive), symptoms of eight psychiatric disorders (panic disorder, major depressive episode, mania, social phobia, general anxiety disorder, agoraphobia, posttraumatic stress disorder, and non-affective psychosis), and seven specific symptoms of non-affective psychosis. We calculated weighted odds ratios by multivariate logistic regression controlling for a range of sociodemographic variables, use of illicit drugs, risk taking behavior, and exposure to traumatic events.

Results

21,967 respondents (13.4% weighted) reported lifetime psychedelic use. There were no significant associations between lifetime use of any psychedelics, lifetime use of specific psychedelics (LSD, psilocybin, mescaline, peyote), or past year use of LSD and increased rate of any of the mental health outcomes. Rather, in several cases psychedelic use was associated with lower rate of mental health problems.

Conclusion

We did not find use of psychedelics to be an independent risk factor for mental health problems.

Police custody following driving under the influence of cannabis: a prospective study

Traffic offences are a common cause of detention in police custody. We hypothesized that drug intoxication while driving could correspond to specific medical conditions of the detainees. Our objective was to evaluate medical features and addictive behaviours of suspected drug drivers and to collect data regarding assaults or injuries in these individuals. We conducted a prospective study (April 2010-December 2011) of suspected drug driving arrestees, who were compared to drink drivers or persons aged over 18 detained for other reasons. Data collected concerned persons' characteristics, reported assaults, and observed injuries. A total of 205 drivers were tested positive for drugs in blood, 116 were either positive for drugs in urine or saliva and negative in blood, or negative in urine. Cannabis-only users accounted for 201 of 205 drug drivers (98%). Suspected drug driving arrestees had good overall health rating. Drug drivers were younger than controls and requested more rarely medical examination (12% vs. 44%, P<0.0001). They were rarely involved in addiction treatment (3%) and reported assaults or presented traumatic injuries less often than drink drivers and controls (8% vs. 38% and 25%, P<0.0001). Drug drivers were less often alcohol abusers than controls. Their opinion on custody was better than that of controls and they were considered unconditionally fit for detention more frequently (99% vs. 77%, P<0.0001). We conclude that arrested drug drivers were young, healthy, and infrequently reported assaults or presented traumatic injuries, which does not put them in a high risk medical condition. Medical care could include brief interventions on addictive behaviours.

The triggering effect of alcohol and illicit drugs on violent crime in a remand prison population: a case crossover study

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.

MAIN OUTCOME MEASURE

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.

CONCLUSION

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.

The mediator roles of trait anxiety, hostility, and impulsivity in the association between childhood trauma and dissociation in male substance-dependent inpatients

The aim of this study was to investigate the mediator roles of negative affect, aggression, and impulsivity in the association between childhood trauma and dissociation in male substance-dependent inpatients. In addition, the effect of some variables that may be related with childhood trauma and dissociation among treatment-seeking substance dependents, such as substance of choice (alcohol/drug), mean of current age, and age at regular substance use was controlled. Participants were consecutively admitted 200 male substance-dependent inpatients. Patients were investigated with the Dissociative Experiences Scale, the Childhood Trauma Questionnaire, the Barratt Impulsiveness Scale, the Buss-Perry Aggression Questionnaire, the Beck Depression Inventory, and the Spielberger State-Trait Anxiety Inventory. Seventy-seven patients (38.5%) with pathologic dissociation were compared with 123 nondissociative patients (61.5%) classified by dissociative taxon membership. The dissociative group had lower age, age at regular substance use, duration of education, and higher rate of drug dependency rather than alcohol dependency. Beside higher scores on anxiety, depression, childhood trauma, aggression, and impulsivity, a larger proportion of dissociative group reported suicide attempts and self-mutilation than did the nondissociative group. Results of regression analyses suggest that severity of chronic anxiety, aggression (particularly hostility), and impulsivity were found to be mediators of association between childhood trauma and dissociation. Results suggest that, to reduce the risk of dissociation and related behavior such as suicide attempt and self-mutilation among substance dependents, chronic anxiety together with the feelings of hostility and impulsivity must be the targets of evaluation and treatment among those with history of childhood trauma.

Trait aggression, depression and suicidal behavior in drug dependent patients with and without ADHD symptoms

The objective of this study was to investigate trait-aggression, depression and suicidal behavior of drug dependent patients with and without ADHD symptoms. The cross sectional survey was conducted in outpatient drug centers in Hungary. The Adult Self-Report Scale (ASRS), the Buss-Perry Aggression Questionnaire (AQ), the European Version of the ADolescent Assessment Dialogue (EuroADAD), and the Beck Depression Inventory (BDI) were used for measures. GLM analyses, adjusting for age and gender, indicated that patients who screened positive for ADHD (ADHD+ group) had significantly higher severity of overall trait aggression, as well as physical and verbal aggression than patients who did not (ADHD negative group). The highest severity of aggression was observed when the ADHD+ status co-occurred with heroin use, while the lowest severity of aggression was detected when ADHD- status co-occurred with the use of marijuana. ADHD+ patients showed a marked increase in depression symptoms, suicidal ideation, suicidal attempts as well as self-injuries associated with suicidal attempts. Considering the substantial costs of aggression and suicide from a societal perspective and from the point of view of the individual sufferer, our results highlight the importance of the diagnostic investigation of ADHD in the treatment of drug dependent patients.

Substance use disorders in forensic psychiatry: differences among different types of offenders

This is the first study that compared different types of offenders in forensic outpatient treatment (i.e., offenders of general violence [GV], intimate partner violence [IPV], sex crimes, and "other offenses" such as drug smuggling and property crimes) regarding the prevalence of substance use disorders at the time of the offense. In total, 35.8% of participants (n = 187) were diagnosed with any substance use disorder. Specifically, 61.5% of GV perpetrators, 30.9% of IPV perpetrators, 9.1% of sex offenders, and 26.7% of "other offenders" were diagnosed with substance abuse or dependence. More GV offenders and less sex offenders fulfilled diagnostic criteria for a substance use disorder. Furthermore, 29.9% of the offenders were intoxicated by substances at the moment they committed the offense (48.5% of GV perpetrators, 25.0% of IPV perpetrators, 17.4% of sex offenders, and 21.0% of other offenders). More GV perpetrators were intoxicated during the offense. As there is a clear association between substance abuse and criminal behavior, substance abuse in offenders should be assessed and, if present, be treated.

The multiple systems model of angry rumination

Angry rumination is perseverative thinking about a personally meaningful anger-inducing event and is a risk factor for aggression. This article presents a new model for understanding angry rumination across five levels of analysis: cognitive, neurobiological, affective, executive control, and behavioral. The type of rumination that occurs at the cognitive level moderates affective responding and neurobiological activation, which influences executive control and aggression. Angry rumination recruits brain regions implicated in cognitive control, emotion regulation, negative affect, physiological arousal, social cognition, and self-reflection on emotional states. Moreover, angry rumination temporarily reduces self-control, which can increase aggression. The article suggests a functional account of angry rumination, identifies gaps in our knowledge, and proposes future research directions based on hypotheses derived from the model.

Injection drug users' and their risk networks' experiences of and attitudes towards drug dealer violence in Baltimore, Maryland

BACKGROUND

A large portion of violence associated with drug use is due to drug dealing. These analyses sought to examine injection drug users' attitudes and experiences of drug dealer violence.

METHODS

The current study used the 18-month follow up data of STEP into Action (STEP) study, an HIV prevention intervention among drug injectors and their risk network members conducted in Baltimore, Maryland. Four scales assessed acceptability of drug dealer violence, willingness to talk to drug users about avoiding drug dealer violence, social norms about reporting drug dealer violence and intentions to report drug dealer violence to the police.

RESULTS

Many (44%) of the 373 participants reported witnessing drug dealers' acts of violence within the prior 6 months. Although the majority of participants disagreed with statements on the acceptability of dealers using violence, only a minority indicated that they would call the police if they observed dealer violence. Most participants indicated that they would be interested in talking to drug users about how to avoid violent dealers. Males were more likely to report that violence was acceptable, whereas African Americans were less likely to condone violence. Those who were homeless and had higher incomes were more likely to report witnessing drug dealer violence.

CONCLUSIONS

These results suggest that it may be feasible to train current and former drug users and their risk network members in methods to promote violence reduction among drug dealers.

A behavioral test of accepting benefits that cost others: associations with conduct problems and callous-unemotionality

Background

Youth with conduct problems (CP) often make decisions which value self-interest over the interests of others. Self-benefiting behavior despite loss to others is especially common among youth with CP and callous-unemotional traits (CU). Such behavioral tendencies are generally measured using self- or observer-report. We are unaware of attempts to measure this tendency with a behavioral paradigm.

Methods/Principal Findings

In our AlAn's (altruism-antisocial) game a computer program presents subjects with a series of offers in which they will receive money but a planned actual charity donation will be reduced; subjects decide to accept or reject each offer. We tested (1) whether adolescent patients with CP (n = 20) compared with adolescent controls (n = 19) differed on AlAn's game outcomes, (2) whether youths with CP and CU differed significantly from controls without CP or CU, and (3) whether AlAn's game outcomes correlated significantly with CP and separately, CU severity. Patients with CP and CU compared with controls without these problems took significantly more money for themselves and left significantly less money in the charity donation; AlAn's game outcomes were significantly correlated with CU, but not CP.

Conclusions/Significance

In the AlAn's game adolescents with conduct problems and CU traits, compared with controls without CP/CU, are disposed to benefit themselves while costing others even in a novel situation, devoid of peer influences, where anonymity is assured, reciprocity or retribution are impossible, intoxication is absent and when the “other” to be harmed is considered beneficent. AlAn's game outcomes are associated with measures of CU. Results suggest that the AlAn's game provides an objective means of capturing information about CU traits. The AlAn's game, which was designed for future use in the MRI environment, may be used in studies attempting to identify the neural correlates of self-benefiting decision-making.

The psychopharmacology of aggressive behavior: a translational approach: part 1: neurobiology

Patients with mental disorders are at an elevated risk for developing aggressive behavior. In the last 19 years, the psychopharmacological treatment of aggression has changed dramatically because of the introduction of atypical antipsychotics into the market and the increased use of anticonvulsants and lithium in the treatment of aggressive patients.Using a translational medicine approach, this review (part 1 of 2) examines the neurobiology of aggression, discussing the major neurotransmitter systems implicated in its pathogenesis, namely, serotonin, glutamate, norepinephrine, dopamine, and γ-aminobutyric acid, and also their respective receptors. The preclinical and clinical pharmacological studies concerning the role of these neurotransmitters have been reviewed, as well as research using transgenic animal models. The complex interaction among these neurotransmitters occurs at the level of brain areas and neural circuits such as the orbitoprefrontal cortex, anterior cortex, amygdala, hippocampus, periaqueductal gray, and septal nuclei, where the receptors of these neurotransmitters are expressed. The neurobiological mechanism of aggression is important to understand the rationale for using atypical antipsychotics, anticonvulsants, and lithium in treating aggressive behavior. Further research is necessary to establish how these neurotransmitter systems interact with brain circuits to control aggressive behavior at the intracellular level.