HaCKeRz Kr0nlcKLeZ 1/HaCKeRz Kr0nlcKLeZ.iso/drugs/violence

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Date: Tue, 7 Mar 1995 20:18:13 -0800
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From: [e-mail] (Clifford Schaffer)
Subject: DOJ Report text - Psychoactive Substances and Violence
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OK folks, by popular demand, here it is:

Menu TITLE:Psychoactivs Substances and Violence
Series: Research in Brief
Published: February 1994
19 pages
39,660 bytes

Psychoactive Substances and Violence

by Jeffrey A. Roth

-----------------------------------------------
Issues and Findings


Discussed in the Research in Brief: The current
status of research on the links connecting
violence to alcohol and illegal psychoactive
drugs, and evaluations of interventions to prevent
violence related to these substances.

Key issues:  Correlations between violence and
psychoactive substances; the social, economic,
cultural, psycho-social, neurobehavioral, and
other factors that explain the correlations; and
prevention strategies for reducing the violence
associated with these substances.

Key findings:

o Research has uncovered strong correlations
between violence and psycho-active substances,
including alcohol and illegal drugs, but the
underlying relationships differ by type of drug.

o The links between violence and psychoactive
substances involve broad social and economic
forces, the settings in which people obtain and
consume the substances, and biological processes
that underlie all human behavior.  These factors
interact in chains of events that may extend back
from an intermediate triggering event such as an
argument to long-term predisposing processes that
begin in childhood.

o Of all psychoactive substances, alcohol is the
only one whose consumption has been shown to
commonly increase aggression.  After large doses
of amphetamines, cocaine, LSD, and PCP, certain
individuals may experience violent outbursts,
probably because of preexisting psychosis.
Research is needed on the pharmacological effects
of crack, which enters the brain more directly
than cocaine used in other forms.

o Alcohol drinking and violence are linked through
pharmacological effects on behavior, through
expectations that heavy drinking and violence go
together in certain settings, and through patterns
of binge drinking and fighting that sometimes
develop in adolescence.

o The most promising strategies for reducing
alcohol-related violence are to reduce underage
drinking through substance abuse preventive
education, taxes, law enforcement, and peer
pressure.

o Illegal drugs and violence are linked primarily
through drug marketing:  disputes among rival
distributors, arguments and robberies involving
buyers and sellers, property crimes committed to
raise drug money and, more speculatively, social
and economic interactions between the illegal
markets and the surrounding communities.

o The most promising strategy for reducing
violence related to illegal drugs appears to be
reducing the demand that fuels violent illegal
markets.  Promising tactics include preventive
education, pretrial monitoring of arrestees
through urinalysis and, for convicted violent
offenders, in-prison therapeutic communities
integrated with postrelease treatment followup.

o In the future, medications may reduce violence
by reducing cocaine craving and by blocking the
aggression-promoting effects of opiate withdrawal
and alcohol consumption.

Target audience:  State and local policymakers,
court administrators, law enforcement and juvenile
justice practitioners, and drug treatment program
staff.
--------------------------------------------



As noted by the Panel on the Understanding and
Control of Violent Behavior, the character of
violence presents simultaneous challenges to
understanding and opportunities for prevention.
First, violence is diverse. Acts as different as
spontaneous drive-by shootings and met-iculously
planned serial killings, for example, are both
included in the legal and statistical category of
murder. Second, the causes of violence are
complex, involving a very wide variety of factors.
The panel found it useful to classify these
factors in terms of four levels of analysis at
which they are usually studied:

o Broad social and economic forces (macrosocial).

o Encounters between people in particular settings
(microsocial).

o Individual behavioral development from childhood
through adulthood (psychosocial).

o Neurobehavioral and other biological processes
that underlie all human behavior
(neurobehavioral).

Factors at these four levels operate and interact
in chains of events that may begin long before the
violent event that results. Therefore, the panel's
classification framework also categorized causal
factors in terms of their temporal proximity to
the violent event itself: from the immediate
triggering mechanism (for example, a response to
an insult), back through the situation that led up
to the triggering event, to predisposing factors
that months or years earlier increased the risk of
a future violent event.

This diversity and complexity might at first
glance seem to discourage efforts to prevent
violence. In fact, however, they create promising
opportunities. Merely acknowledging the diversity
breaks the overall "violence problem" into
separate problems that may be preventable through
interventions by different public agencies.
Recognizing the causal complexity expands the list
of options for preventing a particular violence
problem by highlighting all the points at which
chains of events leading to it may be breakable.
Problem-solving initiatives--programs that involve
design and evaluation of preventive interventions
at various links in these chains of events, that
revise these interventions in light of the
evaluation findings, and that replicate the
evaluations--have the potential to simultaneously
reduce violence and increase the understanding of
its causes.

Many chains of causal events for violence include
links to alcohol or to illegal psychoactive drugs.
The panel found these links worth exploring in
depth for at least three reasons. First,
statistics consistently demonstrate correlations
between violent events and involvement with
alcohol and other psychoactive drugs. Second, the
variety of potential causal links between violence
and different psychoactive substances--alcohol,
opiates, cocaine in smokable and powdered form,
amphetamines, hallucinogens, and other illegal
drugs--presents an especially rich example of the
panel's classification framework. Third,
preliminary evidence from research and evaluations
suggests that certain interventions related to
psychoactive substances should be considered in
developing strategies for controlling violence.

Correlations between violence and psychoactive
substances

Research supported by the National Institute of
Justice and other organizations has repeatedly
found strong correlations between violence and
psychoactive substances:

o For at least the last several decades, alcohol
drinking--by the perpetrator of a crime, the
victim, or both--has immediately preceded at least
half of all violent events, including murders, in
the samples studied by researchers.

o Chronic drinkers are more likely than other
people to have histories of violent behavior.

o Criminals who use illegal drugs1 commit
robberies and assaults more frequently than do
nonuser criminals, and they commit them especially
frequently during periods of heavy drug use.

o In a study of New York City murders in 1988,
researchers classified more than half the
homicides (53 percent) as drug-related: 39 percent
in the course of drug distribution, 8 percent
through pharmacological effects on the offender, 2
percent while the offender was obtaining money to
buy drugs, and 4 percent through more than one of
these links.2

Data from the National Institute of Justice Drug
Use Forecasting (DUF) program, which tests for
drug use among booked arrestees in 24 sites
nationwide, showed the following patterns in 1989:

o Most males and females who were interviewed
after arrest for a violent crime reported drinking
alcohol within 72 hours before the crime for which
they were arrested.

o About 60 percent of arrestees booked for violent
crimes were confirmed by laboratory test to have
used at least one illegal drug3 in the hours
before arrest.

Explaining the correlations

While these statistical patterns strongly suggest
that psychoactive substances play significant
roles in acts of violence, they do not explain the
nature of those relationships. In trying to sort
out links between violence and psychoactive
substances, the panel categorized potential links
in terms of the four levels noted above:

o Social and economic forces (macrosocial):
Processes that affect large social units such as
nations or communities. Examples include cultural
practices related to alcohol use and, in the
United States, economic and social processes
surrounding the illegal markets in which
psychoactive drugs other than alcohol are sold.

o Encounters between people (microsocial):
Characteristics of encounters between people.
Examples include group drinking in settings where
violence is expected and socially acceptable;
arguments that are begun or aggravated because the
participants are under the influence of drugs or
alcohol; and disputes involving organizations,
buyers, and sellers in illegal drug markets.

o Psychosocial: Influences on individuals'
behavior patterns, which begin developing in early
childhood and continue to evolve throughout
adulthood. Examples include patterns of heavy
drinking and aggression that develop during
adolescence and psychoses that predispose a few
individuals toward violent psychotic episodes
while under the influence of certain drugs.

o Neurobehavioral: Processes in the brain that
underlie all human behavior and that may be
altered by pharmacological effects of alcohol and
other drugs. Examples include effects of substance
abuse during pregnancy on fetal development,
effects of chronic substance abuse on brain
functioning, and temporary neurological effects of
being "high" or "blue."

These and other examples of links at all four
levels between violence and alcohol or other drugs
are displayed in table 1. Much of the evidence for
specific links is suggestive rather than
conclusive. One challenge in understanding and
verifying the links is the complexity of
interactions among factors at different levels. It
would be difficult at best to sort out such
interactions. What makes the challenge even
greater is that most studies measure factors at
only one or two levels at a time, so that the full
range of interactions is rarely observed in a
single study. In addition, it is difficult to
study violent events using methods that yield
generalizable conclusions. Controlled experiments
under laboratory conditions produce the strongest
confirmation of factors that influence behavior,
but practical and ethical constraints generally
limit those methods to studies of behaviors that
are far milder than the potentially lethal
violence that occurs in homes and communities. At
present, therefore, there are only fragments of
scientific evidence providing partial support for
the existence of many causal links between
psychoactive substances and violence. These
findings neither explain definitively how the
links interact nor provide a basis for ranking
them in order of importance in explaining
variation in violence related to alcohol or other
drugs.

Neurobehavioral explanations

Research on humans and many animal species
suggests there are several neurobehavioral links
between violence and psychoactive substances:

o Expectant mothers' use of psychoactive
substances during pregnancy adversely affects
fetal development. The resultant damage causes
learning and communication problems that, in turn,
increase the risk of early grade school failure, a
well-documented precursor of violent behavior.

o Alcohol is the only psychoactive drug that in
many individuals tends to increase aggressive
behavior temporarily while it is taking effect.
However, factors at other levels--behavior patterns
when people are not drinking, the setting in which
people drink, and local drinking customs, for
example--influence the strength of this
relationship.

o Among alcohol abusers, those who also abuse
other psychoactive substances, who are diagnosed
with antisocial personality disorder, and whose
parents have been diagnosed as alcohol abusers are
at especially high risk of chronic violent
behavior. Some researchers have suggested that a
genetic process may contribute to this relatively
rare pattern.

o Marijuana and opiates temporarily inhibit
violent behavior, but withdrawal from opiate
addiction tends to exaggerate both aggressive and
defensive responses to provocations.

Individual humans and animals deviate widely from
these "average" behaviors. For example, the
aggression-promoting effects of alcohol are
strongest in animals having high blood levels of
testosterone, the principal male hormone that
distinguishes males from females; humans may or
may not exhibit the same pattern. A study of
violent Finnish alcohol abusers suggests that the
alcohol-violence link may be associated with
abnormally low levels of blood sugar (that is,
hypoglycemia) and of metabolites of the brain
chemical serotonin. Another study suggests that
the alcohol-violence link is especially strong in
people who exhibit certain abnormal brain wave
patterns, both at rest and while responding to
outside stresses.

On the other hand, several common assumptions
about connections between drugs and violence are
called into question by research findings:

o There is no evidence to support the claim that
snorting or injecting cocaine stimulates violent
behavior. However, research is urgently needed on
the behavioral effects of smoking cocaine in crack
form, which affects the brain more directly.

o Anecdotal reports notwithstanding, no research
evidence supports the notion that becoming high on
hallucinogens, amphetamines, or PCP stimulates
violent behavior in any systematic manner. The
anecdotes usually describe chronic users with
histories of psychosis or antisocial behavior,
which may or may not be related to their chronic
use of drugs.

o Occasional anecdotes about " 'roid
rages"--violent outbursts by men who use anabolic
steroids to accelerate muscle growth--appear to
describe isolated coincidences rather than any
common, systematic effect.

Psychosocial links

Evidence from research on animals and humans
indicates that patterns of substance abuse and
aggressive behavior reinforce each other. It
cannot be said that one "causes" the other. For
example, alcohol may trigger violent episodes in
aggressive animals and people, but rarely in
submissive ones.

Patterns of aggressive behavior and substance
abuse often become intertwined starting in
childhood. Early childhood aggression is a
predictor of later heavy drinking, and the
combination is associated with an above-average
risk of adult violent behavior, especially among
those who also abuse other psychoactive drugs.

Research suggests at least four possible
explanations for the link between substance abuse
and violent behavior in adolescents. First,
adolescents may chronically use psychoactive
substances to help them temporarily escape from
such feelings as rage, guilt, worthlessness, or
depression--emotions that often precede aggressive
behavior. Second, repeated family arguments over
teenage substance abuse may eventually take on a
violent character. Next, underlying family
problems or socially expected responses may lead
some adolescent males to patterns of heavy
drinking and fighting as ways to demonstrate their
masculinity. Last, boys who regularly observe
older males fighting while drinking may learn to
expect that violent behavior accompanies alcohol
use. All of these processes may be at work, but
their roles, interactions, and importance as
explanations have not yet been sorted out.

Preexisting psychosis appears to account for
occasional violent outbursts by people who are
under the influence of amphetamines or
hallucinogens, especially PCP. While these drugs
are well known to cause disorganized, bizarre
behavior, they trigger violence in very few people
who are not also psychotic. In studies of
laboratory mice and monkeys, bizarre behavior on
the part of animals under the influence of PCP
fairly commonly provokes violent attacks by others
in the group. Anecdotal information and newspaper
accounts report similar attacks on humans using
alcohol, amphetamines, powdered cocaine, or LSD,
but this relationship has not been systematically
studied in humans.

Encounters between people

In a variety of ways, alcohol and drugs modify
encounters between people in ways that make these
substances greater hazards for violence. In the
case of alcohol, these hazards tend to be related
to use, while for illegal psychoactive drugs they
tend to be related to distribution and purchase.

Alcohol use and sexual violence. Some therapists
who treat violent sex offenders have reported that
their patients tend to have both histories of
alcohol abuse and high blood levels of
testosterone. Without comparisons to men who are
not violent sex offenders, these clinical
observations cannot demonstrate that alcohol abuse
or high testosterone levels cause sexual violence.
Studies of many animal species suggest a causal
connection--that alcohol reduces testosterone
levels but has stronger aggression-promoting
effects in individual high-testosterone animals.
However, that relationship has not yet been tested
in humans. The frequent involvement of alcohol in
acquaintance rapes suggests that social
expectations may also be at work; that is, young
men who expect to have sex after drinking may try
to satisfy their expectations, sometimes forcibly
if they encounter resistance.

Illegal drug markets. Illegal drug markets operate
outside the world of contract law, courts and
mediators for resolving disputes, and business
customs that distinguish socially acceptable from
unac- ceptable approaches to buying and selling.
Illegal markets often develop substitute
mechanisms that involve the threat or actual use
of violence. Examples include:

o Violence by drug distributors in the course of
territorial disputes between rival organizations,
threats of violence to make "staff" obey
organizational rules, violent punishment of
rulebreakers to keep the threats credible, battles
with police, and protection of sellers or drugs on
the street.

o Violence between buyer and seller during a drug
transaction, caused, for example, by attempted
robbery of one or the other, failure to hand over
drugs or money, or "honest" misunderstandings of
local rules of the game on the part of buyers and
sellers.

o Violence involving people other than buyers and
sellers who are found around drug markets--third
parties such as innocent bystanders and people
operating in related illegal markets for
"protection," guns, or prostitution.

As places where violence tends to occur for the
reasons listed above, illegal drug markets may
also serve as "magnets." As such, they attract
valuable drugs and cash, weapons, and people who
are accustomed to violence. The mix of these
ingredients creates hazardous conditions for
robberies and other forms of violence that may not
be directly related to drugs.

Obtaining drug purchase money. In some settings,
the need for money to buy drugs also increases the
chance of a violent encounter. A taxi driver
carrying a passenger late at night, for example,
is presumably at greater risk of being robbed if
the passenger wants to buy drugs but lacks the
cash to do so. While robbery is still a common way
to obtain money to buy drugs, it has been replaced
by drug selling in some large cities.

Using alcohol and drugs. If alcohol caused
violence only by making individuals behave more
aggressively, violence would be equally common in
all places where drinking occurs. In fact,
however, most drinking places are rarely scenes of
violence. A few acquire reputations as "animal
houses" or "fighting bars," where people expect
drinking and violence to go hand in hand.

Just what characteristics of a drinking place make
it a hazard for violence are not precisely known,
but there is supporting evidence for several
possible explanations. People who drink in
fighting bars may behave violently in order to
"fit in" or to advance socially. People who
experience anger or frustration may seek out such
settings, because they believe that drinking in
these types of establishments means social
permission to engage in violent behavior. One
study of a group of young men who were observed
during an evening of drinking illustrates this by
suggesting that behavior patterns and situational
influences may play off each other. As the evening
progressed, the group began both to behave more
aggressively and to move on to establishments
where aggressive behavior was more socially
acceptable.

Connections between drinking and violence have
been identified by researchers in many countries
with predominantly European cultures. But they
have not been found in many tribal and folk
societies, even where binge drinking is common.
For reasons not yet known, expectations that
violence follows drinking have failed to develop
in those cultures.

Finally, it seems likely that substance abuse is
indirectly related to violence in ways that are
difficult to identify and count. Examples of
indirect relationships include robberies committed
to replace household money spent on drugs or
alcohol, or spouse assaults arising from disputes
over money or time spent away from home drinking
or taking drugs.

Violence is related to the distribution, purchase,
and use of illegal drugs or alcohol in a wide
variety of human interactions. Unfortunately, the
difficulty of counting such interactions makes it
also difficult to rank them in order of
importance. Better counts would help in focusing
violence prevention strategies on the most common
interactions in which drug- and alcohol-related
violence occurs.

Social and economic forces

If the patterns of behavior discussed above were
the only links between illegal drug distribution
and violence, every city that experienced a crack
epidemic in the 1980's would also have seen a
substantial increase in homicide at the same time.
Indeed, policymakers have occasionally claimed a
"uniform, straight line relationship" between
illegal drug use and murder.4

The reality is more complex. The murder rate
increased 350 percent in Washington, D.C., and by
a smaller amount in New York City as their crack
epidemics unfolded. However, during the crack
epidemics in Detroit and Los Angeles these cities
experienced decreases in the murder rate. This
suggests that the relationships between illegal
drug market activity and lethal violence are
intertwined with social and economic processes in
the surrounding community.

What are these processes? Because causal patterns
at the social level are especially difficult to
establish, the answers are necessarily
speculative. Fragments of evidence suggest that
some or all of the following factors may influence
the relationship between levels of violence and
illegal drug market activity:

o Stability of drug market control: Situations
that produce violent encounters--fights over
territorial allocations or misunderstandings
between buyers and sellers, for example--arose
relatively infrequently in markets controlled by
old, stable organizations that had developed
operating rules decades ago and enforced them
through a standing threat to punish violators
violently. Where the spread of crack manufacturing
technology encouraged new organizations to enter
the markets, the resulting destabilization may
temporarily have increased the frequency of
violent encounters.

o Community access to legitimate economic
opportunities: Where the rise of crack markets
followed the exodus of legitimate economic
opportunities from central cities, economic
rewards shifted away from skills valued by
legitimate employers to those valued by crack
distribution organizations; these included the
ability to threaten and use violence.

o Strength of informal violence controls: Where
the exodus of legitimate economic opportunities
from urban communities took with it many people
committed to legal, nonviolent values, those
people were no longer available for roles in
preventing drug-related violence. They were not
available, for example, as nonviolent role models
for adolescents, as passers-by who might
discourage drug buyers or intervene in emerging
violent events, or as concerned individuals who
might inform parents if their children began
drifting toward involvement in drug markets.

o Social status and moral authority: During crack
epidemics in some communities, successful young
drug entrepreneurs either supplanted or
intimidated neighborhood "old heads"--unofficial
community leaders who upheld traditional values
and had exercised moral authority in the
neighborhood. Where this occurred, it tended to
weaken cultural restraints against violence in all
contexts, including drug markets.

Because such relationships are difficult to
verify, evidence supporting their influence is
only suggestive and fragmentary, and new research
is needed to explore them more fully.

Preventive interventions

A number of intervention strategies for preventing
violence related to psychoactive substances have
been proposed:

o Police disruption of illegal drug markets.

o Selectively longer incarceration of violent
drug-using criminals.

o Reducing teenagers' access to alcohol.

o Substance abuse prevention.

o Drug abuse treatment.

o Pharmacological therapies to reduce drug craving
and aggressive tendencies associated with alcohol
use and heroin addiction.

Some of these strategies have been evaluated to
test their effectiveness in reducing violence.
Only a few have demonstrated success under any
conditions; none have shown universal
effectiveness. Developing better interventions
will require collaborative problem-solving
initiatives that involve representatives of
criminal justice agencies, providers of substance
abuse treatment and other social services, and
evaluation researchers. These initiatives are
needed to turn promising ideas into workable
programs, to evaluate the programs, and to refine
them in light of the evaluation results. The
findings of evaluations conducted thus far are
summarized in the following sections.

Disrupting illegal drug markets. Police attack
illegal drug markets through a number of tactics:
undercover investigations leading to dealers'
arrests; cooperation with community antidrug
efforts; and large-scale, high-visibility
crackdowns. Evaluations of these tactics in
Birmingham, Alabama; Lawrence and Lynn,
Massachusetts; New York City; Oakland, California;
Philadelphia, Pennsylvania; and Washington, D.C.,
present a mixed picture. Perhaps the strongest
supportable statement is that their chance of
success is improved by intervening early in
emerging markets, by creating a highly committed
police force, and by generating community
receptivity and cooperation in advance. NIJ's Drug
Market Analysis (DMA) program is helping with the
first prerequisite--early detection of drug
markets. Specific techniques for creating
supportive climates in police departments and the
surrounding communities are less well understood,
although many approaches are now being tested as
part of community policing initiatives.

Incarcerating violent drug-using criminals.
Researchers have generally found that compared to
other violent offenders, those who use drugs tend
to have higher average frequencies of violent
crimes such as robbery and assault. This finding
raises the possibility that sentencing
drug-involved offenders who are convicted of these
crimes to longer prison terms might reduce
violence. However, analyses suggest that this
strategy of "selective incapacitation" would
reduce violent crime levels very little unless it
were accompanied by massive increases in prison
populations.

A related strategy--monitoring pretrial releasees'
drug use through urinalysis--showed rather
surprising effects in a Washington, D.C.,
evaluation. Although positive drug test results
did not predict significantly higher pretrial
rearrest rates, failure to show up for the test
was a strong predictor of subsequent new crimes
leading to rearrest.

Reducing teenagers' access to alcohol. Evidence is
fairly clear that increases in tax rates and other
measures that reduce the availability of alcohol
to adolescents (social pressure and enforcement of
underage drinking laws) in turn reduce drinking
and certain associated problems such as death
rates due to auto collisions. Therefore, these
strategies may also reduce adolescents'
disproportionate share of violence. That
conjecture remains to be tested, however.

Substance abuse prevention. By reducing the demand
that fuels violent, illegal drug markets,
substance abuse prevention should, in theory,
reduce violence levels. Many substance abuse
prevention programs have been evaluated, including
the Drug Abuse Resistance Education (DARE), which
brings police officers into classrooms as
instructors. Evaluations of prevention programs
have generally found them effective in delaying
the onset of tobacco, alcohol, and marijuana use.
Ev