Brief report Criminal recidivism in offenders with personality disorders and substance use disorders over 8 years of time at risk Marc Walter ⁎, Gerhard A. Wiesbeck, Volker Dittmann, Marc Graf Psychiatric Hospital of the University of Basel, Basel, Switzerland abstract article info Article history: Received 12 December 2009 Received in revised form 10 August 2010 Accepted 12 August 2010 Keywords: Addiction Personality disorder Psychopathy Personality disorders (PD) and substance use disorders (SUD) lead to high violent criminality. The influence of co-morbidity on recidivism remains unclear. Recidivism of 379 offenders was assessed at 8 years of follow-up. Sixty-nine percent of PD + SUD, 45% of SUD- and 33% of PD- subjects showed any recidivism. However, violent recidivism was highest in the PD- group. © 2010 Elsevier Ireland Ltd. All rights reserved. 1. Introduction There is a high risk of violent recidivism in offenders in many countries (Grann et al., 2008). It is well known that clinical data, particularly the diagnosis of either personality disorder (PD) or substance use disorder (SUD), are associated with an increased risk of recidivism in criminals (Asnis et al., 1997). However, less is known about the influence of the common co-morbidity of these two disorders on general and violent criminal recidivism. Prior studies have shown that half or more individuals with Cluster B PDs, mainly antisocial and borderline personality disorders, have co- occurring alcohol use disorder or drug use disorder (Verheul, 2001; Walter et al., 2009). However, it is not clear whether the co- occurrence of both disorders is also related to higher recidivism in criminals. It has been argued that particularly the psychopathic traits increase the risk of violent behavior and recidivism (Dolan and Doyle, 2000). Psychopathic traits including impulsive–aggressive behavior, affective shallowness, and social maladjustment are associated with a high risk of violent behavior (Kiehl, 2006) and with violent recidivism in long-term outcome studies measured by Hare's Psychopathy Checklist (PCL) (Stone, 2002). This is the first study that investigates specific recidivism rates in criminals with PDs and co-occurring SUD, compared to other diagnostic groups with PDs and SUDs only. This study used reliable and independent diagnostic assessments, and prospectively collected data over 8 years of follow-up to investigate the risk of criminal recidivism in these different diagnostic groups, and to analyze the simple recidivism as well as the violent recidivism. A priori we expected the highest simple and violent recidivism rate in criminals with PDs and co-occurring SUD. 2. Methods 2.1. Subjects All 379 defendants were included who were subject to court orders for forensic psychiatric evaluation from the Forensic Psychiatry Clinic of the University of Basel for criminal responsibility, risk assessment and the need for forensic treatment, between 1989 and 2000. Two hundred sixty-seven were diagnosed as suffering from personality disorders (PD-), substance use disorders (SUD-), and 112 offenders had other psychiatric diagnoses. Eighty-five percent were males and the median age was 33.4 (range 18–86) years. For the purpose of this study, subjects were divided into the following four groups: those diagnosed with personality disorders and current substance use disorders (PD + SUD) (n = 84), those with personality disorders without current substance use disorders (PD-) (n = 86), and those with current substance use disorders without personality disorders (SUD-) (n = 97), and a control group diagnosed with other psychiatric disorders (n = 112). 2.2. Baseline assessments Sociodemographic and forensic data were obtained using the Basel Catalogue for Risk Assessment (Dietiker et al., 2007). The groups did not differ significantly at baseline data except with respect to age (p b 0.01). The PD + SUD group were the youngest (median 27.7 years) and control subjects the oldest offenders (median 35.7 years). Clinically experienced forensic psychiatrists conducted the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I/P) (First et al., 1996) and for DSM-IV Axis II Disorders (SCID-II) (First et al., 1997) during the forensic assessment. SCID-I and SCID-II have shown adequate to excellent internal consistency and interrater reliability for PD and SUD diagnoses (Maffei et al., 1997; Zanarini and Frankenburg, 2001). The Psychopathy Checklist-screening version (PCL:SV) (Hart et al., 1995) was used to screen for psychopathic traits in forensic patients. The PCL:SV correlates highly with the original (Psychopathy Checklist-Revised) PCL-R and has Psychiatry Research 186 (2011) 443–445 ⁎ Corresponding author. Psychiatric Hospital, University of Basel, Wilhem Klein- Strasse 27, CH-4025 Basel, Switzerland. Tel.: +41 61 325 5112; fax: +41 61 325 5583. E-mail address: marc.walter@upkbs.ch (M. Walter). 0165-1781/$ – see front matter © 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.psychres.2010.08.009 Contents lists available at ScienceDirect Psychiatry Research journal homepage: www.elsevier.com/locate/psychres