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Changes in Patterns of Excessive Alcohol Consumption in 25 Years of High Security Hospital Admissions From England and Wales

NCJ Number
Criminal Behaviour and Mental Health Volume: 13 Issue: 1 Dated: 2003 Pages: 17-31
Celia McMahon; Martin Butwell; Pamela J. Taylor
Date Published
15 pages
This study tested the hypothesis that for people with a major mental disorder that involves a high risk for violent behavior, the likelihood of excessive alcohol consumption in the period prior to a violent or dangerous act has increased over time.
The study participants were all of the 3,625 first admissions (2,995 men and 630 women) to an English high-security hospital between January 1, 1975, and December 31, 1999. For consenting patients, a full search of the clinical records and a comprehensive research interview were conducted. For nonconsenting patients, only basic demographic and official criminal data were recorded, together with their Mental Health Act classification of disorder. Offending data up to and including the index offense were obtained from the Home Office Criminal Records Office. Interviews focused on patients' personal history and a detailed account of their use of alcohol and illicit drugs. Problem drinkers were defined as those patients whose alcohol intake had exceeded 21 units per week during the 12 months prior to the index offense. Regarding illicit substances, addiction or regular use over 3 months or more was classified as abuse for the purposes of the research. The study found a linear increase in the proportion of patients in 5-year admission cohorts who had engaged in excessive alcohol consumption during the year prior to their index offense or act. The increase was steeper among women than men, but for both genders the increase cut across all diagnosis and offending groups. It was strongly associated with an increasing tendency to abuse illicit drugs. The increased trend may reflect similar trends in alcohol use in the general population; however, it may also be associated with a lack of services or current consensus about the appropriate treatment for patients whose mental illness is compounded by excessive alcohol use. Regardless, the trend suggests a growing need for dual diagnosis services both within and outside hospitals. 1 table, 1 figure, 28 references, and appended alcohol and drug-use questions asked during the interview