Substance-Use Disorders and Violence

Abstract

Substance use seems to be associated with increased prevalence levels of violent behaviour in both general population and psychiatric patients, with 'dual diagnosis' clients showing high rates of risky and criminal behaviour and worse therapy compliance. Cases of drug-related aggressiveness mostly involve a number of molecules, e.g. ethanol, stimulants, cannabinoids, opiates, benzodiazepines, synthetic cannabinoids and synthetic cathinones. Consumers of the virtually few hundreds, and up to a few thousands substances currently available may present to the emergency departments without providing information about the substances(s) ingested and it is likely that standard drug tests will show negative results. An appropriate treatment/management plan to cope with the related acute behavioural and psychopathological disturbances is here discussed. Because of the complex behavioural and medical toxicity issues associated with drug intake, raising awareness and education of health care professionals on drugs' health harms, interventions, harm reduction techniques, and referral pathways are here deemed of particular relevance.

Social Skills Acquisition in Virtual Reality-Based Interventions for People with Mental Health and Substance Use Disorders: A Qualitative Exploration (Preprint)

“…Adverse childhood experiences are one of the most robust predictors of substance use and are commonly found among people with MHD and SUD [51,52]. The participants' reports of violence and intimidation in substance use environments are also in line with previous research [53,54]. It is also well known that adverse childhood experiences can disrupt physiological pathways and the development of body systems.…”

Pharmacotherapeutic management of insomnia and effects on sleep processes, neural plasticity, and brain systems modulating stress: A narrative review

“…Z-drugs (zolpidem, zaleplon, zopiclone, eszopiclone) were introduced in the 1980s for the treatment of insomnia with the aim of overcoming some of the disadvantages of benzodiazepines, such as next-day sedation and daytime sleepiness, as well as dependence and withdrawal syndrome. Although initially seen as safer alternatives to benzodiazepines, concern related to the abuse and dependency of Z-drugs has arisen over the past three decades (Schifano et al, 2019).…”

“…Common zolpideminduced delirium and sleep-related complex behavior include accidents, falls, overdoses as well as risks to others included assaults, vehicular accidents, various crimes, and civil actions that occurred during zolpidem-induced delirium and sleep related complex behaviors (Greenblatt and Zammit, 2012;Park et al, 2016;FDA, 2019a;Harbourt et al, 2020;Westermeyer and Carr, 2020). Recently and increased concern has been developed regarding its misuse and risk of abuse (Schifano et al, 2019).…”

“…Although meta-analyses have confirmed the clinical efficacy of short-and intermediate-acting benzodiazepines and Z-drugs for the short-term treatment (≤4 weeks) of insomnia (Pillai et al, 2017;Lynch et al, 2020;Chiu et al, 2021), many concerns have reported during the last few years about the use of Z-drugs, originally marketed as a safe alternative to benzodiazepines (Schifano et al, 2019). Accordingly, the aim of this review was to focus at a physiological level on the effect of benzodiazepines and Z-drugs on sleep regulation, brain plasticity, and the stress system, which are altered in chronic insomnia.…”

Extreme emotional disturbance: Legal frameworks and considerations for forensic evaluation

“…Substance use is another important factor to consider when assessing a potentially emotion‐fueled act. A clear relationship exists between risk of violence and substance use disorders, especially when coupled with a co‐occurring mental illness (Schifano et al., 2020; Van Dorn et al., 2012). Substance intoxication also tends to have an additive effect with the symptoms of preexisting mental health conditions.…”