Abstract

BackgroundOpioid maintenance treatment (OMT) is regarded as a crime control measure. Yet, some individuals are charged with violent criminal offenses while enrolled in OMT. This article aims to generate nuanced knowledge about violent crime among a group of imprisoned, OMT-enrolled individuals by exploring their understandings of the role of substances in violent crime prior to and during OMT, moral values related to violent crime, and post-crime processing of their moral transgressions.MethodsTwenty-eight semi-structured interviews were undertaken among 12 OMT-enrolled prisoners. The interviews were audio recorded and transcribed verbatim. An exploratory, thematic analysis was carried out with a reflexive and interactive approach.FindingsPrior to OMT, substances and, in particular, high-dose benzodiazepines were deliberately used to induce ‘antisocial selves’ capable of transgressing individual moral codes and performing non-violent and violent criminal acts, mainly to support costly heroin use. During OMT, impulsive and uncontrolled substance use just prior to the violent acts that the participants were imprisoned for was reported. Yet, to conduct a (violent) criminal act does not necessarily imply that one is without moral principles. The study participants maintain moral standards, engage in complex moral negotiations, and struggle to reconcile their moral transgressions. Benzodiazepines were also used to reduce memories of and alleviate the guilt associated with having committed violent crimes.ConclusionsSubstances are used to transgress moral codes prior to committing and to neutralize the shame and guilt experienced after having committed violent crimes. Being simultaneously enrolled in OMT and imprisoned for a (violent) crime might evoke feelings of ‘double’ shame and guilt for both the criminal behavior prior to treatment and the actual case(s) one is imprisoned for while in OMT. Treatment providers should identify individuals with histories of violent behavior and, together with them, explore concrete episodes of violence and their emotional reactions. Particular attention should be given to potential relationships between substance use and violence and treatment approaches tailored accordingly. What appears as severe antisocial personality disorder may be partly explained by substance use.

Highlights

  • Opioid maintenance treatment (OMT) is regarded as a crime control measure

  • Substances are used to transgress moral codes prior to committing and to neutralize the shame and guilt experienced after having committed violent crimes

  • What appears as severe antisocial personality disorder may be partly explained by substance use

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Summary

Introduction

Opioid maintenance treatment (OMT) is regarded as a crime control measure. Yet, some individuals are charged with violent criminal offenses while enrolled in OMT. Previous research identifies the following as among important factors associated with increased violence risk: earlier violent crime [4], ‘history of problems with other antisocial behavior’ [3], severe personality disorders [5,6,7], and substance abuse [8,9]. Most psychoactive substance use occurs among individuals who do not behave violently [8]. Heavy and frequent use of amphetamines is related to violence [17]. Disinhibitory benzodiazepine reactions, such as hostility, agitation, and loss of impulse control, have been reported [21,22], and high-dose benzodiazepine use is found to be a high risk factor for interpersonal violent crime [23]. Physical discomfort and agitation can result in violent behavior [8]

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