It is both a pleasure and an honor to be asked to write a preface for a book - particularly when the book is excellent and that is the case with the present volume edited by Dr. Baltieri. This is not just another book on drugs, sex, and crime. This book confirms many of the current international findings in the Brazilian context, but more importantly, it also expands the international knowledge base about these issues. For example, there is ample international evidence that alcohol and drug misuse are commonly related to many types of crime - and this is confirmed in the present book. However, this book clearly shows that substance misuse is also intimately connected to sexual crimes and even more interestingly, that different patterns of substance misuse are related to different types of sexual offenders. This latter finding is very important and new, making this book an important contribution to the international forensic literature.
This is ambitious and compelling book - there are three chapters which focus sexual offending: male adult (both against children and adults) sexual offenders, juvenile sexual offenders, and pedophilic children molesters. These three chapters examine patterns of substance misuse, and how these patterns are linked to particular sorts of sexual criminal behavior and diagnostic entities. But the book first sets the scene for these chapters by providing an international overview of the issues, plus a focus on epidemiological data on substance misuse in Brazil, including noting the gaps in the knowledge base.
The three chapters on sexual offenders are tremendously important for both diagnostic and treatment purposes. I realize from my conversations over the years with Professor Lippi of the University of Sao Paulo and Dr. Baltieri of ABC Medical School that sex offender assessment and treatment is still developing in Brazil. However, these three chapters provide a great amount of information that is related to effective treatment of these offenders. For example, if certain types of offenders misuse alcohol more often than drugs (e.g., child molesters), then alcohol misuse is likely to be more commonly part of the offence pathway for such offenders - and a focus of any good multi-modal treatment program. Further, if non-pedophilic child molesters differ from pedophilic child molesters in terms of the dimensions of their substance misuse, then again the focus of treatment in this regard will be somewhat different. Certainly, the evidence presented shows that substance misuse is risk-relevant and one ignores the role of substances in the patients' offence pathways with perilous potential. That is, if substance misuse (not necessarily addiction) is part of an offender's crime pathway, addressing and eliminating the factor will decrease the likelihood that the offender will reoffend.
The ambitious nature of the book really comes out with the scope of the remaining chapters: female violent offenders, filicide/parricide, AIDS and sexual crimes - and how these phenomena may be linked to differing patterns of substance misuse. Admittedly, some of the topics are speculative - but only by informed speculation and discussion can new hypotheses and research be initiated on route to finding effective assessment and intervention strategies. In this regard, these chapters are excellent. The final chapter addresses the important issue of the treatment of substance misuse in the context of the Brazilian legal system.
Substance misuse is a common criminogenic (crime-causing) factor that is unlike almost any other criminogenic factor - it is relatively easily and effectively treated and monitored to ensure compliance. It is not possible for the criminal justice system to address systemic issues such as poverty, over-population, AIDS, or unemployment. However, the criminal justice system can address education, job-skills, sexual disease knowledge, and substance misuse. If the Brazilian prison system wants to save money, it should look abroad to Canada and other countries that provide substance abuse to all inmates who are willing to participate. The evidence shows that this factor alone, if addressed, helps to dramatically decrease the relapse and reconviction rates of substance misusing offenders, saving a great deal of personal anguish and public money.
In closing, this is an important book that sets a challenge for forensic mental health providers in Brazil, the Brazilian criminal justice system, and the country's political leaders. This book states: here is the problem, here are some of the dimensions of the problem, and here are some suggested means of dealing with it.
Can Brazil meet the challenge put forth by this book? With professionals like Dr. Baltieri and his colleagues leading the discussion, there is every reason to be optimistic.
Douglas P. Boer, Ph.D., R.Clin.Psych.
Associate Professor of Psychology
The University of Waikato
Hamilton, New Zealand
This book is about crime and drugs. It also is about sex, with special emphasis on sexually offensive behavior. However, this book does not suggest that crime simply leads to drug misuse, wich in turn leads to crimes. The chapters will show that alcohol and drug misuse can be more intimately related to some types of crimes even when we are not considering those crimes properly associated with drug sale or possession with intention to sell. Furthermore, considering a same type of crime, such as rape, different patterns of alcohol / drug abuse can be observed in different types of perpetrators in accordance with the choice of victims.
The co-occurrence of criminal behaviors and substance misuse has frequently affected the public perceptions of the influence of alcohol and drug usage on criminal demeanours. In fact, substance abuse can perform different roles in diverse types of crimes. The idea that violent crimes, such as rapes, homicides and robberies are more commonly committed by delinquent drug users cannot be generalized for all of these crimes; however, some violent crimes are more frequently associated with drug abuse than others. This finding should help to improve the development of more specific and individualized correctional treatments. However, multiple other variables interact and cumulate to lower the violence threshold and must also be considered during all evaluations. For example, drug-dependent people who are known to commit crimes tend to be clustered in areas that are socio-economically deprived, in the same way as people known to commit crimes without drug usage. Thus, the connection between drugs and crime is far too complicated to be summarized as a straightforward relationship.
Anyway, it would be impossible to describe all types of crimes and their connections with substance abuse here. Thus, we provide ten manuscripts that describe different aspects of the relationship between drugs and crimes, always focusing on Brazilian reality.
Brazil is the largest and the most populous country in Latin America and the fifth largest in the world in both area and population. It covers over 3.3 million square miles (8.5 million square kilometers) and spans some 2,700 miles from north to south and roughly the same distance from east to west. Thus, an enormous and rich cultural diversity is observed in different points of this country. However, some ‘common denominators’ can be noted here. We lived in a phallocentric society, where virility is sometimes viewed as synonymous with power. Men are characterized by strength, virility, activity, potential for violence, and the legitimate use of force. Thus, machismo stresses diametrically opposed male / female roles. Male must be tough, aggressive, and worldly, and destined to rule family, community and nation. Some of these ‘internalized concepts’ can influence criminal demeanors and even the psychosocial management for inmates.
The chapters are organized by a number of phenomena that are known (or supposed) to link drugs and crime. In three out of ten chapters, we emphasized the study on sexual offenders because this is one of the main research lines of the editor. I have also pointed out that the assessment and the management of these types of offenders in Brazil is in its first infancy still and many controversies about an adequate medical treatment for paraphilic sexual offenders have risen. Sometimes, different members of our society reveal intense prejudice and misunderstandings with respect to the medical treatment for sexual offenders in general.
It is opportune to report that Brazilian Sexual Crime Law has changed since August 2009 and established an increase in the penalties, especially for those offenders that perpetrate any sexual acts against children. I believe that many policy actions against sexual crimes have been motivated primarily by the need for policy makers and policy making to be seen to be doing something that looks to the public, particularly the media, to be likely to work. Often, policy simply panders to cruel and naïve opinions on sexual crimes, which sells newspapers and satisfies society’s most punitive urges, at least in public. The application of punishment under the guise of deterrence, despite its ineffectiveness, has been preferred to a more adequate management for some types of these offenders. It is our contention that a partnership between specialized mental health professionals, lawyers and policy makers is urgent with respect to this subject in Brazil and other countries.
In chapter 1, we report that the relationship between drug consumption and criminal activities is recognized as a serious social problem around the world. In fact, drugs may cause crime directly (by desinhibition; cognitive impairment); drugs and crime may be linked through a shared third factor (personality; social disadvantage); crime may lead to drug usage; or the relationship may be absolutely spurious. In many different countries, the penal system does not punish the individuals who at the moment of the crime do not have the capacity to understand the unlawfulness of their acts or to behave in accordance with this understanding. However, voluntary or culpable drunkenness does not exclude imputability which should only occur in cases that drunkenness results from accidents or force majeure. Therefore, an adequate knowledge of the laws is essential to psychiatrists involved with clinical and forensic evaluations who should provide the juridical authority with conclusive and good prognostic elements for consideration of penal liability. Besides, the recognizing of the different criminological aspects associated with the genesis of crime is an essential subject in the clinical and forensic contexts.
In chapter 2, we present data on the realities of alcohol, tobacco and illicit drug consumption in Brazil. In fact, epidemiologic studies on drug use may improve our understanding about patterns of usage, changes in these patterns, the impact of hazardous use, abuse and dependence as well as special issues associated with the use of these substances, such as risk consumption and violent behavior.
In chapter 3, we analyse the role of alcohol and drug consumption among adult sexual offenders. In fact, according to different published researches, substance misuse can be an important factor that sets apart rapists from children molesters. The severity of alcohol misuse seems to be higher among children molesters; on the other hand, sexual offenders against adults seem to have more serious problems with drug usage. This difference must deserve more adequate attention by health and law professionals, aiming at delineating effective proposals of management for this complex population.
In chapter 4, we talk about the juvenile sexual offenders, in terms of alcohol and drug abuse and dimensional personality traces. Although this population is also tremendously heterogeneous, some psychosocial and criminological aspects can be used to distinguish some groups of adolescent sexual aggressors. Also, there seems to be some different personality characteristics between the juvenile sexual offenders who acknowledge and those that deny the crime, in terms of adherence to our treatment programme.
In chapter 5, we discuss a medical condition that has been extremely stigmatized, known as Pedophilia. The socially sensitive nature of this disorder and the stigma associated with it has harmed the active involvement of mental health professionals in its treatment. Pedophilia is a serious disorder and, sometimes, other psychiatric problems may co-occur, such as alcoholism, personality disorders and mood disorders. Unfortunately, many different law and health professionals have questioned whether Pedophilia is a disease or simply a criminal activity. Rarely has a medical condition been so stigmatized as Pedophilia. The socially sensitive nature of this disorder as well as the stigma associated with it has harmed the active involvement of mental health professionals in its treatment. In this chapter, we compare pedophilic with nonpedophilic children molesters in terms of alcohol and drug misuse, victims involved, impulsiveness and other aspects and we report some problems related to the adequate medical and psychological treatment in our country.
In chapter 6, we point out that, among women condemned to prison for violent crimes (Homicide and Robbery), a longer criminal career is verified in those that initiated the street drug consumption more precociously. We have verified that the majority of robberies committed by women are economically driven. Furthermore, the vast majority of these women who are financially motivated have revealed that the money would support their drug usage. Also, the women with early-onset drug usage have most likely resided in areas with high concentration of poverty and frequently have family histories of psychiatric problems. In truth, for many women, the own victimization is associated with the involvement in delinquent or criminal demeanors. Although female inmates consist of a highly heterogeneous population, some common crime-related factors have been seen among many of them, such as pressure to commit a crime, lack of social opportunities and necessity of retaliation against an abusive partner.
In chapter 7, we studied alcohol and drug problems among male prostitutes. Male sex work is not a unitary phenomenon but, rather, a multifaceted one. Despite this, we have classified these sex workers into two different groups: those with and those without gender identity disorders. Actually, the motivations, rationales, and life patterns of our respondents vary to such an extent that we could divide them into more than these two categories. However, our sample size has not permitted this yet. Some preliminary differences between both groups that have been found may help us develop more effective proposals of management for this population.
In chapter 8, we reviewed some studies on different psychiatric and criminological aspects of filicides and parricides. Brazilian research on family crimes is very scarce, although several cases of filicides and parricides have been reported by the communication means. The role of alcohol and drug use in filicides and parricides is also unclear, but it is analysed in this chapter.
In chapter 9, we present possible relationships between AIDS and sexual crimes. Certainly, sexual acts without consent increase the risk of HIV infection. In the same way, alcohol and drug misuse before or during sexual act increases the risk of unprotected sex, multiple partners, oral and vaginal non-protected sex and not allowed sex practice. Unfortunately, statistics are not yet available on the rates of HIV transmission during rape and other sexual offences, in part because the prevalence of HIV among sexual offenders is unknown. Also, AIDS can be a consequence of diverse behaviors associated with drug misuse and can also be a “side effect” of forced behaviors inside prisons. Although this theme has been seriously neglected by criminological research, we have pointed out it as an important aspect to be considered during forensic and clinic evaluations.
In chapter 10, we comment on the treatment for addicts with justice problems. Unfortunately, medical and psychological treatments inside prisons have not been carried out in our country adequately. However, proposals of management for inmates with drug problems should be developed and installed as a way to prevent criminal recidivism. Anyway, the current correctional practice must decidedly be evidence-based and public resources should be provided to treat offenders and not only to arrest them. The assessment of criminogenic needs is essential for the provision of appropriate case-based correctional intervention. Although poverty, social victimization and lack of job opportunities or skills are associated with crimes in general, frequently are not treatable medical and psychological factors. With respect to these relevant social needs, intensive efforts of the governments will be necessary as soon as possible.
This book was written to address the following issues:
Are violent crimes related to alcohol and drug consumption ?
Have pedophilic children molesters demonstrated higher alcohol or drug problems than nonpedophilic children molesters ?
How are researches on crime-related factors being carried out in Brazil ?
Despite the high prevalence of alcohol and drug misuse in Brazil, have inmates received adequate medical and psychological treatment for this serious problem?
There are multiple criminological factors associated with the perpetration of violent crimes. Has this been considered in political, medical and psychological contexts ?
It is our position that legal, medical and political sciences need to reach a consensus on what to do with offenders in general and particularly sexual offenders. Thus, an adequate, just and viable management could be effectively carried out in our country.
Danilo Antonio Baltieri
List of Contributors
Danilo A. Baltieri
Department of Psychiatry
ABC Medical School
Psychiatrist, Master of Public Health (University of Illinois at Chicago). Professor of the Department of Psychiatry – Medical School
University of São Paulo, Coordinator of GREA – Group of Studies on Alcohol and Drugs
Arthur Guerra de Andrade
Psychiatrist, Associate Professor, Department of Psychiatry, School of Medicine,
University of Sao Paulo,
Cíntia de Azevedo Marques Périco
Psychiatrist, Assistance Branch Coordinator of the Department of Psychiatry of ABC Medical School
Fernanda Cestaro Prado Cortez
Psychiatrist, Medical Researcher, Ambulatory for the Treatment of Sexual Disorders
ABC Medical School
Psychiatrist, Medical Researcher, Interdisciplinary Group of Studies on Alcohol
Drugs of the Clinical Hospital of the Psychiatric, Institute of the University of São Paulo
Gabriela Arantes Wagner
Pharmacist, PhD student, Department of Psychiatry
School of Medicine, University of São Paulo
Luciana Roberta Donola Cardoso
Psychologist, Master of Sciences Catholic University
Institute of Psychiatry – Hospital das Clinicas – Medical School – University of São Paulo
Lucio Garcia de Oliveira
Psychologist, Post-doctoral student, Department of Psychiatry
School of Medicine, University of Sao Paulo
Psychiatrist, PhD student, Department of Psychiatry
School of Medicine, University of São Paulo