Sroecial Article Substance Abuse and Criminality Rajita Sinha, PhD, and Caroline Easton, PhD Substance abuse issues and the law have become intricately linked over the years. This article reviews the current research underlying the association be- tween substance abuse and crime, and provides an overview of the pertinent issues in conducting a substance abuse evaluation in the forensic context. The epidemiology of substance abuse and crime is reviewed, exploring the associa- tion between crime and specific psychoactive substances. Clinical considerations underlying the association are discussed, with specific attention paid to the pharmacological effects of psychoactive substances and to the role of substance use in individuals with serious associated psychopathology. Diagnostic and eti- ological issues that are important in differentiating substance abuse from crimi- nality are considered in the context of conducting forensic evaluations. Finally, key components of a forensic substance abuse evaluation are presented. Substance abuse increases the likelihood of involvement with the law, and the link between substance abuse and criminal be- havior is well-documented.'~~ In recent years, the rise in use of illicit substances has led to a growing number of drug- related arrests and convictions, with greater punitive consequences for drug- related charges.' The rise in the number of drug-involved offenders has resulted in the overcrowding of prisons, a need for more jails, higher costs of maintaining arrestees, delays in processing court Dr. Sinha and Dr. Easton are affiliated with the Depart- ment of Psychiatry, Yale University School of Medicine, New Haven, CT. Address correspondence to: Rajita Sinha, PhD, Associate Professor and Program Director, Substance Abuse Treatment Unit, Connecticut Mental Health Center, Department of Psychiatry, Yale Univer- sity School of Medicine, 1 Long Wharf, Box 18, New Haven, CT 0651 1. E-mail: rajita.sinha@yale.edu cases, and greater demand for treatment services. One of the predominant beliefs in the legal world is that criminals, because of their disregard of societal rules. become involved in the business of selling and using drugs and, therefore, need to be punished.3 The laws resulting from such views have been partially responsible for the higher rates of incarceration of drug- involved offenders. In contrast, the pre- dominant view in the addictions field is that a majority of drug-involved offenders are drug abusers who become involved with the law because of their addiction. One of the key features of substance use disorders is the lack of responsibility of role obligations, be it family, work, or other social re~~onsibilities.~ Greater chronicity of substance abuse, as evi- J Am Acad Psychiatry Law, Vol. 27, No. 4, 1999