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3.3 Forensic psychology > Problem 6: Mental health and criminal behavior > Flashcards

Problem 6: Mental health and criminal behavior Flashcards

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1
Q

Why is alcohol use separated from other drug use in offender evaluations?

A
  1. The relationship between alcohol abuse and crime is generally weaker than with illegal drugs.
  2. The criminal justice system is less tolerant of drug use compared to alcohol abuse.
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2
Q

How is alcohol abuse defined?

A

Use in hazardous situations (e.g., impaired driving).

Leads to physical, social, work, or psychological problems.

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3
Q

What are the prevalence rates of alcohol abuse in the general population?

A

30.4% for men.

16.0% for women.

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4
Q

What are the advantages of using risk/need scales for assessing alcohol abuse?

A
  1. Routine administration by staff provides regular data.
  2. Drives treatment service delivery in criminal justice.
  3. Allows investigation of criminogenic needs and predictive validity.
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5
Q

What are the key findings on alcohol abuse and crime?

A

Alcohol abuse is significantly higher in offenders than the general population.

37% of homicide offenders were intoxicated during their offense.

Meta-analyses show only a small correlation between alcohol abuse and violence (effect size ~.10-.15).

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6
Q

What mediates alcohol’s influence on aggression?

A

Individual factors such as:
* Perceived provocation.
* Perceived personal benefits of aggression.

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7
Q

What are the primary pharmacological treatments for alcohol abuse?

A
  1. Disulfiram (Antabuse): Triggers aversive reactions when alcohol is consumed.
  2. Naltrexone and Acamprosate: Reduce alcohol cravings.
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8
Q

What is the Alcoholics Anonymous (AA) model?

A

Focuses on admitting powerlessness over alcohol and reliance on a higher power.

12-step recovery process, supported by a sponsor who maintains sobriety.

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9
Q

What contributes to AA’s potential success?

A

Incorporates cognitive-behavioral elements: sponsors model and reinforce abstinence.

Alters social networks, promoting relationships with non-drinkers.

Group dynamics provide motivation and coping skills.

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10
Q

What is the prevalence of drug use and dependency in the U.S.?

A

9.2% of Americans (12+) used illicit drugs in 2012, with marijuana leading.

2.0%-7.9% of the population has diagnosable drug abuse or dependency.

Among offenders, substance abuse ranges from 20%-79%.

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11
Q

Which drugs are most commonly used by offenders?

A
  1. Marijuana: 82.9%
  2. Methamphetamines: 62.9%
  3. Opiates: 50.0%
  4. Cocaine: 38.2%
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12
Q

Why does drug abuse have a closer relationship to crime than alcohol abuse?

A

Illicit nature of drugs increases criminal associations.

Addiction drives illegal activities to sustain use.

Substance abuse is a strong risk factor for crime.

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13
Q

What are therapeutic communities, and why are they effective?

A

Programs within prison settings where inmates support each other in abstinence and prosocial behavior.

Success attributed to aftercare, belongingness, and a supportive social network.

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14
Q

What is Relapse Prevention (RP)?

A

A cognitive-behavioral intervention focusing on:
1. Identifying high-risk situations that trigger substance use.
2. Teaching alternative responses (e.g., refusal skills, healthier activities).

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15
Q

What are the theoretical components of Relapse Prevention (RP)?

A

Alters reinforcement contingencies to favor sobriety.

Encourages family, employers, and friends to reinforce sobriety.

Teaches cognitive and behavioral skills to cope with high-risk situations.

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16
Q

What are the shared elements of effective addiction and offender treatment programs?

A

Positive therapist-client relationships.

Structured, cognitive-behavioral interventions.

Community support and Relapse Prevention training.

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17
Q

Why are behavioral changes challenging for substance abusers?

A

Substance use is habitual and often automatic.

Rooted in long histories of frequent use and reinforcement.

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18
Q

What is Motivational Interviewing (MI)?

A

MI is a client-centered approach designed to increase motivation and move clients from contemplation to action.

It fosters a non-threatening and supportive relationship, often serving as a preparatory phase for structured treatments.

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19
Q

What are the stages of readiness to change in MI?

A
  1. Pre-contemplation: Denial of a problem.
  2. Contemplation: Considering the possibility of change.
  3. Action: Taking steps toward change.
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20
Q

How effective is MI in non-criminal contexts?

A

Meta-analyses report positive effects for areas like addiction, with effect sizes ranging from r = .13 to r = .25.
* Less effective for smoking cessation.
* Promotes treatment adherence and problem-solving attitudes.

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21
Q

What is the role of mandated treatment in the criminal justice system?

A

Involves court-mandated programs or parole conditions requiring treatment.

Operates on a continuum of coercion: from compulsory mandates to subtle pressures (e.g., family influence).

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22
Q

What are drug courts, and how do they function?

A

Community-based treatment programs with regular drug testing and court monitoring.

Completing the program may help offenders avoid custodial sentences.

Average recidivism reduction: ~12%.

Challenges: Low completion rates (48%) and methodological weaknesses.

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23
Q

What is the “worst of both worlds” hypothesis in substance abuse?

A

Proposed by Walters (2015a).

Offenders with both substance misuse and criminal behavior exhibit:
* Higher antisocial traits (APP).
* Greater risk of reoffending.
* More severe substance abuse.

24
Q

Why is substance abuse linked to recidivism?

A

Substance abuse correlates with other criminogenic needs:
* Procriminal peers.
* Disrupted family relationships.
* Employment struggles.
* Policies addressing only substance use overlook its broader social and behavioral impacts.

25
Q

What are key critiques of mandated treatment and drug courts?

A

Mandatory treatment is less effective than voluntary treatment.

Drug courts face:
* Low completion rates.
* Lack of rigorous experimental evaluation.
* Effectiveness depends on addressing client motivation and criminogenic needs.

26
Q

What is the public perception of mentally disordered offenders (MDOs)?

A

Often seen as highly prevalent and inherently violent due to media portrayals.

No universal definition for MDO exists, leading to debates between legal and mental health systems.

27
Q

What are Axis I and Axis II disorders in the context of MDOs?

A

Axis I: Clinical syndromes (e.g., schizophrenia, bipolar disorder) often linked to evaluations like NGRI pleas.

Axis II: Personality disorders (e.g., Antisocial Personality Disorder (APD)), with APD being highly prevalent among offenders.

28
Q

What are the three key findings on mental disorders among criminal populations?

A
  1. 80-90% of offenders are diagnosed with a mental disorder.
  2. Major Axis I disorders (e.g., schizophrenia) are rare, except in pretrial settings.
  3. APD is the most common diagnosis, far exceeding general population rates (~3.6%).
29
Q

How does substance abuse interact with mental illness in predicting violence?

A

Substance abuse amplifies the risk of violence more than mental illness alone.

Mental illness is a weak predictor unless combined with substance abuse.

Factors like criminal history and juvenile detention are stronger predictors of violence.

30
Q

What is Threat/Control-Override (TCO) symptomatology?

A

Refers to delusions involving harm or mind control, increasing violent responses.

Studies show mixed results on the relationship between TCO symptoms and violence.

Substance abuse is a more significant risk factor than TCO symptoms.

31
Q

Do MDOs have higher recidivism rates than non-disordered offenders?

A

Meta-analysis findings: MDOs are no more likely to reoffend than non-disordered offenders.
* General recidivism: r = .01.
* Violent recidivism: r = -0.03.

Central Eight risk/need factors predict recidivism effectively in both groups.

32
Q

What are the limitations of traditional treatments for MDOs?

A

Focus on symptom management (e.g., medication, CBT) rather than criminogenic needs.

Neglect of Risk-Need-Responsivity (RNR) principles leads to limited effects on recidivism.

Substance abuse, a key criminogenic need, is often inadequately addressed.

33
Q

What is the Reasoning and Rehabilitation (R&R) program, and how is it adapted for MDOs?

A

A cognitive-behavioral intervention targeting criminogenic needs.

Modified version R&R2MHP for MDOs improves coping skills, reduces violent thoughts, and addresses disruptive behaviors.

Recidivism outcomes are not yet reported.

34
Q

What are the challenges of post-release treatment for MDOs?

A

Specialty probation/parole units improve treatment adherence but focus on mental health rather than criminogenic needs.

Lack of integration with RNR principles limits their impact on recidivism.

35
Q

What do studies show about the relationship between psychosis and violence in MDOs?

A

Psychosis alone is a weak predictor of violence.

Substance abuse, criminal history, and impulsivity are stronger predictors.

Some studies link chronic mental illness with higher violence rates but emphasize external mediators.

36
Q

What are key gender differences in psychopathy prevalence and PCL-R scores?

A

Women score lower on the PCL-R (Mean: 16.5) compared to men (Mean: 21.3).

Psychopathy is less prevalent in women, but using a gender-sensitive cut-off (23 for women, 30 for men), rates are similar (Women: 19.3%, Men: 20.8%).

37
Q

How does psychopathy manifest differently in women compared to men?

A

Women show more manipulative, relational, and self-destructive behaviors.

Men exhibit more physical aggression, visible dominance, and ward transfers.

Women’s motivations often involve relational frustration (e.g., jealousy, revenge), while men are driven by power or sexual dominance.

38
Q

What diagnoses are more common in women vs. men with psychopathy?

A

Women: Borderline Personality Disorder (BPD) and comorbid Axis I disorders.

Men: Antisocial Personality Disorder (ASPD) and Narcissistic Personality Disorder (NPD).

39
Q

What behavioral tendencies are observed in psychopathic women during treatment?

A

Women display manipulative and self-destructive behaviors.

Men exhibit more physical violence and are transferred between wards more frequently.

40
Q

How do early life experiences differ between psychopathic men and women?

A

Both genders report unstable childhoods and fewer biological parents.

Women experience higher rates of prostitution, young pregnancy, and victimization after childhood.

Men report younger age at first violent incident.

41
Q

How do PCL-R Factor 1 and Factor 2 differ in predictive validity for violence in women vs. men?

A

Factor 1 (Interpersonal-Affective) predicts violence more strongly in women.

Factor 2 (Lifestyle-Antisocial Behavior) is more predictive in men.

Including verbal violence improves predictive validity for women.

42
Q

What is the “mask of maternalism” in psychopathic women?

A

Women with psychopathy may appear empathetic and caring, using these behaviors as tools for manipulation.

43
Q

How do criminological characteristics differ between psychopathic men and women?

A

Women: Older at first conviction, fewer prior convictions, more fraud offenses, fewer sexual offenses.

Men: More sexual and power/dominance-related motivations for crimes.

44
Q

How does psychopathy’s overlap with BPD impact understanding in women?

A

Women with psychopathy often show traits of emotional instability and unstable self-concept, aligning with BPD.

Further research is needed to differentiate psychopathy from BPD while acknowledging overlap.

45
Q

What are societal and relational influences on psychopathy in women?

A

Women often use subtler tactics like verbal manipulation and relational strategies (e.g., seduction).

Gender-role socialization and societal norms shape relationally focused expressions of psychopathy.

46
Q

What proportion of violence is attributable to mental illness in the U.S.?

A

Only 4% of violence in the U.S. is attributable to mental illness, with other factors like past violence and substance abuse being stronger predictors.

47
Q

What percentage of violent incidents among psychiatric patients are preceded by psychosis?

A

Only 11% of violent incidents among psychiatric patients are preceded by psychosis, indicating a limited role of psychosis in violence.

48
Q

What are the key findings about psychosis-preceded violence in high-risk patients?

A
  1. 12% of violent incidents were psychosis-preceded.
  2. 80% of individuals exhibited only non-psychosis-preceded violence.
  3. Only 5% of individuals engaged exclusively in psychosis-preceded violence.
49
Q

What factors are stronger predictors of violence than psychosis?

A
  • Substance abuse
  • Past violence
  • Anger control issues
  • Antisocial behavior and conduct problems
50
Q

How consistent is violence type (psychosis-preceded vs. non-psychosis-preceded) among high-risk individuals?

A

Fair consistency overall (ICC = 0.42).

For individuals with mixed violence types, no clustering was observed (ICC = 0).

51
Q

What characterizes individuals with mixed violence types (psychosis- and non-psychosis-preceded)?

A

Higher rates of bipolar disorder and schizophrenia.
Slightly lower verbal intelligence.
Greater social deviance.
Similar levels of antisocial personality disorder and conduct problems.

52
Q

How does substance abuse interact with psychosis in predicting violence?

A

Substance abuse substantially amplifies the risk of violence and often overshadows the influence of psychotic symptoms like hallucinations or delusions.

53
Q

What are the implications for treating psychosis-related violence?

A

Psychosis-targeted treatment is critical for individuals whose violence is tied to psychosis.

For most high-risk individuals, addressing anger, antisocial behavior, and substance abuse is more effective.

54
Q

What are the main findings of the MacArthur Violence Risk Assessment Study?

A

Only 11% of violence among psychiatric patients involved psychosis.

Psychosis-related violence is rare and inconsistent, with other factors like substance abuse playing a larger role.

55
Q

What intervention strategies are recommended for high-risk individuals?

A
  1. Treat psychosis in individuals whose violence is psychosis-driven.
  2. Focus on anger management, substance abuse treatment, and social deviance reduction for others.
  3. Combine psychosis treatment with broader violence-prevention strategies.
56
Q

How does the observation period affect consistency in violence type?

A

Narrowing the observation period increases consistency:
* ICC = 0.48 for incidents without hospitalization/arrest.
* ICC = 0.50 for violence repeated within a single 10-week period.

57
Q

Why is it critical to differentiate between psychosis-preceded and non-psychosis-preceded violence?

A

Differentiating allows for targeted interventions:
* Psychosis-preceded violence requires symptom management.

  • Non-psychosis-preceded violence benefits from addressing general risk factors like substance abuse and antisocial behavior.

3.3 Forensic psychology (9 decks)

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