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1/3

A n a b o l i c S t e r o i d s a n d V i o l e n t C r i m e - - A n E p i d e m i o l o g i c a l

S t u d y a t a J a i l i n S t o c k h o l m S w e d e n

G6 ran Isacsson, Ma ts Gar le, Else-B r i t t L jung , UI f , ,sg~rd, and U I f Be rgm an

V i o l e n t c r i m e h a s b e e n a s s o c i a t ed w i t h t h e a b u s e o f

a n a b o l i c - a n d r o g e n i c s t e r o i d s A A S ) in s e v e r a l r e p o r ts .

S p e c u l a t i o n s c o n c e r n i n g s u c h a s s o c i a t i o n s h a v e b e e n

r a i s e d w i t h r e g a r d t o s e v e r a l r e c e n t c r i m e s c o m m i t t e d

i n S w e d e n . T o t e s t t h i s h y p o t h e t i c a l r e l a t i o n s h i p ,

i n d i v i d u a l s i n a S t o c k h o l m j a i l w h o h a d b e e n a r r e s t e d

f o r v i o l e n t c r i m e s w e r e s c r e e n e d f o r A A S i n t h e u r i n e .

N o A A S w e r e d e t e c t e d i n t h e u r i n e s a m p l e s o f 50

p r i s o n e r s w h o h a d v o l u n t e e r e d f o r t h e s t u d y . H o w -

e v e r , 1 6 p r i s o n e r s r e f u s e d t o p a r t i c i p a t e . A A S a b u s e

w a s a d m i t t e d b y t w o o f t h e p a r t i c ip a t i n g s u b je c t s.

A l t h o u g h t h e r e i s a g r e a t n e e d f o r e p i d e m i o l o g i c a l

s t u d i e s t o o b j e c t i v e l y c o n f i r m t h e a s s o c i a t i o n o f A A S

a b u s e a n d v i o l e n c e , i t s e e m s t h a t s u c h s t u d i e s w i l l b e

i m p o s s i b l e t o c o n d u c t a s l o n g a s t h e y , f o r l e g a l r e a -

s o n s , d e p e n d o n v o l u n t a r y p a r t i c i p a t i o n .

C o p y r i g h t © 1 9 98 b y W B S a u n d er s C o m p a n y

N A B O L I C - A N D R O G E N I C S T E R O I D S A A S )

include synthet ic analogues to the male sexual

hor mo ne testosterone, as well as tes tos terone and other

endogenous androgen ic horm ones . Endog enous t es tos -

terone influences the m ale fe tus in the develo pm ent of

m ale characteristics, including bra in anatom y. 1 Exp eri-

mental s tudies in animals sugges t that psychological

t rai ts such as aggress ion a nd sexual drive are tes tos ter-

one-mediated.l,2

A A S h a v e b e e n u s e d f o r d e c a d es b y a t h le t es t o

i m p r o v e t h e i r p e r f o r m a n c e . A n e c d o t a l r e p o r t s o n

p e r s o n a l i t y c h a n g e s w i t h a t e n d e n c y t o w a r d i n -

c r e a s e d i m p u l s i v e - a g g r e s s i v e b e h a v i o r h a v e b e e n

m o r e c o m m o n a s t h e u se o f A A S i n S w e d e n h a s

s p r e a d to b r o a d e r g r o u p s o f y o u n g e r m a l e s a b u s i n g

A A S a s a s h o r t - c u t t o a t t a i n i n g a n a t h l e t i c b o d y

im ag e . 34

C a s e r e p o r t s o n v i o l e n t c r i m e s c o m m i t t e d b y

a b u s e r s o f A A S h a v e b e e n p u b l i s h e d i n s c i e n t if i c

l i te r a t u r e, 6 a s h a v e r e p o r t s o n p s y c h o t i c e p i s o d e s 7

a n d d e p e n d e n c e . 8,9 R e t r o s p e c t i v e s u r v e y s o f b o d y -

b u i l d e r s h a v e a l s o s u g g e s t e d a s u b s t a n t i a l p r o p o r -

t i o n o f p s y c h i a t r i c d i s o r d e r s a m o n g t h o s e a b u s i n g

A A S . 1° A b o v e a ll , t h e r e p o r t s h a v e c o n c e r n e d

a f f e c t i v e s y m p t o m s , w i t h m a n i c s t a t e s d u r i n g a b u s e

and dep res s ive s t a te s d ur ing abs t inence . =,11 Th ese

p r e l i m i n a r y r e s u l t s h a v e b e e n s u p p o r t e d b y a n

e x p e r i m e n t a l s t u d y o f h e a l t h y v o l u n t e e r s . 12 V i o -

l e n c e to w a r d w o m e n w h e n u s i n g A A S w a s r e p o r te d

i n a r e t r o s p e c t i v e s t u d y c o n c l u d i n g t h a t p a r tn e r s o f

A A S u s e r s m a y r u n t h e r i s k o f s e r i o u s i n j u r y f r o m

u s e r s w h i l e t h e y a r e o n A A S . 13 I n v e s t i g a t i o n s u s i n g

p s y c h o m e t r i c t e s t s h a v e a l s o b e e n a b l e t o d e m o n -

s t r a t e i n c r e a s e d a g g r e s s i o n a n d h o s t i l i t y a m o n g

A A S u s e r s a n d a m o n g v o l u n t e e r s t a k i n g A A S

under experimental condit ions . 14,15

S p e c u l a t i o n a s t o a n a s s o c i a t i o n b e t w e e n A A S

a b u s e a n d v i o l e n t c r i m e h a s b e e n r a i s e d w i t h r e g a r d

t o s e v e r a l v i o l e n t c r i m e s c o m m i t t e d i n S w e d e n ?

H o w e v e r , n o n e o f t h es e c a s e s h a v e b e e n c o n f i r m e d

b y o b j e c t i v e s u c h as u r i n e a n a ly s i s ) m e a s u r e m e n t s

o f A A S . 4,16 F u r t h e r m o r e , t h e c a u s a l i t y b e t w e e n

A A S a b u s e a n d v i o le n c e m a y b e c o m p l e x . 4,15,17

T h e e p i d e m i c o f i n t r a v e n o u s a b u s e o f n a r c o t i c s

i n S w e d i s h s o c i e t y w a s s u c c e s s f u l l y m o n i t o r e d b y

i n s p e c t i n g a r r e s t e d p e o p l e a t th e S t o c k h o l m j a i l f o r

n e e d l e s t i g m a s a s m a r k e r s o f s u c h a b u s e . T In th i s

e p i d e m i o l o g i c a l s t u d y , o u r a i m w a s t o u s e s c r e e n -

i n g t e st s o f A A S i n u r in e a s m a r k e r s f o r s u c h a b u s e

i n p e r p r e t a t o r s o f v i o l e n t c ri m e s . T h i s a p p r o a c h

w a s a l s o c a l l e d f o r i n a r e c e n t s t u d y i n w h i c h

p r i s o n e r s w e r e i n t e r v i e w e d r e g a r d i n g A A S a bu se .1 9

M ET HOD

W e s c r e e n e d 5 0 v i o l e n t o f fe n d e r s f o r t r ac e s o f A A S i n t h e i r

u r i n e . P e r s o n s a r r e s te d f o r t h e f o l l o w i n g c r i m e s w e r e i n c l u d e d

a s v i o l e n t o f f e nde r s : un l a w f u l t h r e a t , a s sa u l t a nd ba t t e r y , ma n-

s l a ugh t e r , mur de r , r obbe r y , a nd r a pe . O ne pe r son a r r e s t e d f o r

k i d n a p p i n g w a s a l s o i n c l u d e d i n t h e s t u d y . P e r s o n s a l r e a d y

s e n t e n c e d w e r e e x c l u d e d a s t o o l o n g a t i m e h a d e l a p s e d s i n c e

t h e c r i m e h a d b e e n c o m m i t t e d . A l l i n c l u d e d s u b j e c t s w e r e

a r r es t e d w i t h i n 1 d a y o f t h e c r i m e , a n d u r i n e s a m p l e s w e r e l e f t

b y 3 5 o f t h e s u b j e c ts (7 0 ) w i t h i n 2 d a y s a n d w i t h i n 6 d a y s b y

t he r e ma i n i ng 15 ( me d i a n f o r a l l sub j e c t s , 2 da ys ) .

T h e a r r e st e d i n d i v i d u a l s w e r e a s k e d w h e t h e r t h e y w a n t e d t o

From the Departmen t of Clinical Neuroscience and Fa mily

Medic ine , Div ision o f Psychiatry; Depa rtment of Medical

Laboratory Sciences and Technology , the Doping Control

Laboratory, Division o f Clinical Pharmacology, K arolinska

Institute, Huddinge University Hospital, Huddinge, Sweden;

and the Stockholm Jail, Stockholm, Sweden.

Suppor te d by a grant f rom the Swe dish Ins t i tu te for Publ ic

Health Folkhiilsoinstitutet).

Address reprint requests to Grran lsacsson, M.D., Ph.D.,

Ch ie f Physic ian, D epartmen t of Clinical Neuroscience and

Fa mily Medicine, D ivision o f Psychiatry, Karo[inska Institute,

Huddinge University Hospital, S-141 86 Huddinge, Sweden.

Copyright © 1998 by W.B. Saunders Compa ny

0010-440X/98/3904-0009503.00/0

Com prehensive Psychiatry Vol . 39, No. 4 July /A ugu st ) , 1998: pp 203-205 203

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2/3

2 4 I S A C S S O N f iT A L

pa r t i c ipa te a nonym o us ly . A s ubs a m ple o f thos e who vo lu n te e re d

to g ive u r ine s a m ple s we re a l s o a s ke d i f the y we re w i l l ing to

unde rgo a pe r s ona l i ty in te rv ie w . W e us e d the S t ruc tu re d C l in ic a l

In te rv ie w fo r DSM -I I I -R SCID- I I ) a nd l im i te d i t to i t e m s fo r

h i s t r ion ic , na rc i s s i s t i c , bo rde r l ine , a nd a n t i s oc ia l pe r s ona l i ty

d i s o r d er s , b a s ed o n o u r a s s u m p t i o n t h a t t h e s e w e r e o f p r i m a r y

in te re s t} ° W he the r the s ub je c t s we re a s ke d to be in te rv ie we d o r

no t de pe n de d on our l im i te d in te rv ie wing c a pa c i ty .

T o g e t s o m e i d e a o f t h e c o m p o s i t i o n o f t h e n o n p a r t i c i p an t

g roup , r e le va n t no te s we re m a de by the j a il p s yc h ia t r i s t r e ga rd -

ing the na tu re o f the c r im e , h i s to ry o f a bus e , a nd body

c ons t i tu t ion fo r a l l pe r s ons a s ke d to pa r t i c ipa te . T he 50 pa r t i c i -

pa n ts ga ve a u r ine s a m ple the s a m e da y , a nd th i s wa s a na lyz e d a t

the Dop ing Con t ro l L a bora to ry a c c re d i te d by the In te rna t iona l

O l y m p i c C o m m i t t e e ), H u d d i n g e U n i v e r s i ty H o s p i t al , b y m e a n s

o f g a s ch r o m a t o g r a p h y a n d m a s s s p e c t r o m e t r y G C - M S ) . T h e

SCID - I I in te rv ie w wa s c onduc te d a s s oon a s pos s ib le . App rox i -

m a te ly 50 o the r ind iv idua l s w ho fu l f i l l e d the inc lus ion c r it e r ia

we re no t a s ke d to pa r t i c ipa te , a s the y ha d le f t the j a i l be fo re the y

c ou ld be a pproa c he d . T h is oc c ur re d m os t ly dur ing we e ke nds .

T h e s t u d y w a s a p p r o v e d b y t h e C o m m i t t e e o f E t h i c s a t

Hud d inge Unive r s i ty Hos p i ta l 930830 :HS 90 /93) a nd by the

Natio na l Pr iso ns Bo ard 930526: 1339-9305-0683).

RESULTS

T o o b t a i n 5 0 v o l u n t e e r s t o p r o v i d e a u r i n e

s a m p l e t o t es t f o r A A S , i t w a s n e c e s s a r y t o

a p p r o a c h 6 6 i n d i v i d u a l s f u l f i l l i n g t h e i n c l u s i o n

c r i te r i a. T h i s t o o k p l a c e b e t w e e n O c t o b e r 1 , 1 99 3

a n d M a r c h 1 4 , 1 99 4. T h e n o n p a r t i c i p a t io n r a t e w a s

2 4 % . T h e m e d i a n a g e w a s 2 7 y e a r s ( r a n g e , 1 6 t o

5 2 ) . I n t e r m s o f c r i m e s f o r w h i c h t h e y h a d b e e n

a r r e s t e d , t h e g r o u p c o n s i s t e d o f t w o u n l a w f u l

t h r e a t s , 2 0 a s s a u l t a n d b a t t e r i e s , t w o m u r d e r s a n d

o n e a t t e m p t e d m u r d e r , 2 0 r o b b e r i e s , f o u r r a p e s , a n d

o n e k i d n a p p i n g . A A S w a s n o t d e t e c t e d i n a n y o f th e

5 0 u r i n e s a m p l e s .

O n e s u b j e c t r e p o r t e d a b u s e o f A A S i n a c y c l ic

o n - o f f p a t t e r n . A t t h e t i m e o f t h e a ll e g e d c r im e ,

h e w a s i n a n o f f p h a s e . A n o t h e r s u b j e c t a d m i t t e d ,

d u r i n g a s u b s e q u e n t s t a y a t t h e j a i l, h e a c t u a l l y h a d

u s e d A A S o n t h e p r e v i o u s ( i n d e x ) v i si t . H e w a s

s u r p r i s e d a b o u t t h e n e g a t i v e u r i n e t e s t a s h e w a s

c o n v i n c e d t h a t h i s u r i n e s a m p l e w o u l d h a v e c o n -

t a i n e d A A S . T h r e e s u b j e c t s h a d a b o d y c o n s t i tu t i o n

( b o d y - b u i l d e r s ) th a t g a v e a n im p r e s s i o n o f A A S

a b u s e , a l t h o u g h t h e y d e n i e d s u c h a b u s e a n d t h e r e

w e r e n o o t h e r c i r c u m s t a n c e s t h a t s u p p o r t e d t h e

s u s p i c io n s . A b u s e o f o t h e r s u b s t a n c e s w a s r e p o r t e d

b y 1 8 ( 3 6 % ) o f t h e s u b j e ct s i n c l u d e d i n t h e s t u d y .

O f the 12 in te rv ie we d sub jec t s , 10 fu l f i l l ed the

c r i t e r i a fo r a t l ea s t one , usua l ly th ree , pe rsona l i ty

d i s o r d e r s ( P D ) a c c o r d i n g t o D S M - I I I - R . T h u s , t h e

c r i t e r i a f o r H i s t r i o n i c P D w e r e m e t b y f o u r s u b -

j e c t s , A n t i s o c i a l P D b y s i x , N a r c i s s i st i c P D b y f o u r ,

B o r d e r l i n e P D b y s e v e n , a n d P D - N o t O t h e r w i s e

S p e c i f i e d b y t w o s u b j e c ts . O n l y t w o o f t h e se 1 2 h a d

g i v e n a n o v e r t i m p r e s s i o n o f h a v i n g a P D . T h e

s u b j e c t w h o a d m i t t e d A A S a b u s e f u l f i ll e d th e

c r i t e r i a fo r a l l four P D s .

A m o n g t h e 1 6 w h o r e f u s e d t o p a r t i c i p a t e , t h e

m e a n a g e w a s 3 1 y e a r s . T h e c r i m e s w e r e u n l a w f u l

th rea t (n = 2 ) , a s sau l t and ba t t e ry (n = 7 ) , m urde r

(n = 2 ) , robbe ry (n = 2 ) , and rape (n = 3 ) . Three

g a v e a c l i n i c a l i m p r e s s i o n o f h a v i n g a n a n t i s o c i a l

P D , a n d t w o a p p e a r e d t o b e p a r a n o i d . T w o w e r e

s u s p e c te d o f b e i n g a b u s e rs o f A A S , a n d f o u r w e r e

p r o b a b l y a b u s e r s o f o t h e r s u b s t a n c e s .

DIS USSION

T h i s s t u d y w i t h a l a r g e , p r o b a b l y s y s t e m a t i c ,

n o n p a r t i c i p a t i o n r a t e d o e s n o t a l l o w a n y c o n c l u -

s i o n s t o b e d r a w n r e g a r d i n g t h e r e l a t i o n b e t w e e n

a b u s e o f A A S a n d v i o l e n t c ri m e . H o w e v e r , i t

c l e a r l y d e m o n s t r a t e s t h e d i f fi c u l ti e s i n e s t a b l i s h i n g

s u c h a r e l a t io n s h i p a n d g i v e s s o m e h i n ts f o r f u r t h e r

re sea rch .

O n e s u b j e c t a d m i t t e d a b u s i n g A A S , a n d o t h e r s

g a v e a n i m p r e s s i o n o f s u c h a b u s e . S u b s e q u e n t l y

i m p r i s o n e d a f t e r t h e s t u d y , o n e o f t h e i n c l u d e d

s u b j e c t s a d m i t t e d h e h a d d e n i e d a c u r r e n t A A S

a b u s e w h e n i n t e r v ie w e d . S o m e A A S a r e cl e a r ed

f r o m t h e b o d y f l u i d s r a p i d l y a n d m a y , t h u s , b e

a b s e n t i n t h e u r i n e a n a l y s i s i f s o m e d a y s h a v e

e l a p s e d s i n c e t h e l a s t i n t a k e . O n t h e o t h e r h a n d ,

s o m e A A S , s u c h a s n a n d ro l o n e d e c a n o a t e g i v e n

i n t r a m u s c u l a r l y , m a y b e d e t e c t e d 4 t o 1 2 m o n t h s

a f t e r th e i n j e c t io n . F u r t h e r m o r e , s e v e r a l v a r i e t ie s o f

f a k e A L AS a r e k n o w n t o b e a v a i l a b l e c o n t a i n i n g

o n l y s e s a m e o i l f o r i n j e c t i o n o r c a f f e i n e i n t a b l e t

f o r m . T h e f r e q u e n t l y o c c u r r i n g c y c l i c o n - o f f

p a t t e r n o f i n ta k e m a y a l s o g i v e ri s e t o m e t h o d o l o g i -

c a l p r o b l e m s . T h e r e s u l t o f t h e p e r s o n a l i t y i n t e r -

v i e w s i s i n l i n e w i t h t h a t e x p e c t e d f o r a j a i l

p o p u l at i on . T h e s u b j ec t w h o a d m i t t e d A A S a b u s e

a t the in te rv iew fu l f i l l ed the c r i t e r i a fo r a l l pe rso na l -

i t y d i s o r d e r s f o r w h i c h h e w a s t e s t e d . H e w a s

a g g r e s s i v e a l s o w h i l e i n ja i l a n d h a d b e e n i n c a r c e r -

a t e d f o r t r y i n g t o s h o o t s o m e o n e . I n a g r e e m e n t w i t h

t h e f in d i n g s o f v i o l e n c e t o w a r d s w o m e n p r e v i o u s l y

repor ted , 13 th i s sub jec t spon taneo us ly adm i t t ed tha t

h e h a d b e a t e n h i s g i r l f r i e n d . P r o v i d e d t h e r e i s a

r e l at i on b e t w e e n A A S a b u s e a n d t h is t y p e o f

agg res s iv e be hav ior , 21 a t l ea s t one ques t ion re -

m a i n s - - - d o e s A A S a b u s e i n d u c e s u c h b e h a v i o r , o r

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ANABOLIC STEROIDS AND VIOLENT CRIME 2 5

i s i t a n u n d e r l y i n g p e r s o n a l i t y d i s o r d e r t h a t i n -

c r e a s e s t h e r i s k f o r A A S a b u s e a s w e l l a s f o r v i o l e n t

ou tbu rs t s ? a5,17 P resu m ab ly , the re i s a m u l t i fac to r ia l

c a u s a l i t y b e h i n d v i o l e n t c r i m e s . T h e r e i s , h o w e v e r ,

i n c r e a s i n g e v i d e n c e f r o m e x p e r i m e n t a l s t u d ie s t h a t

A A S m i g h t b e o n e s u c h f a c t o r i n s u s c e p t i b l e

individuals.12,14

O u r r e s u l t i s c o n s i s t e n t w i t h a n A m e r i c a n i n v e s -

t i g a t i o n i n w h i c h 1 3 3 p r i s o n e r s w e r e i n t e r v i e w e d ,

a n d t w o c a s e s o f a p p a r e n t A A S i n d u c e d c r i m e s

we re foun d . 19 Bo th s tud ies su gge s t tha t AA S i s a

f a c t o r i n c r i m i n a l b e h a v i o r , a l t h o u g h i n f r e q u en t l y .

I n t h e A m e r i c a n i n t e r v i e w s t u d y , t h e d r o p o u t r a t e

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i n s e q u e n t i a l o f f e n d e r s , e s p e c i a l l y v i o l e n t o f f e n d -

e r s , c o u l d o f f e r a g r e a t e r d e g r e e o f o b j e c t i v i t y i n

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w a s n o t a b l e t o f i n d a n y A A S i n t h e u r i n e t e s t s ,

a l t h o u g h w e f o u n d c i r c u m s t a n t i a l e v i d e n c e i n d i c a t-

i n g t h a t a f e w v i o l e n t o f f e n d e r s d i d a b u s e A A S .

I n c o n c l u s i o n , t h e r e i s r e a s o n t o s u s p e c t t h a t

a b u s e o f A A S d o e s i n c r e a s e t h e r i s k o f v i o l e n t

outb urs ts am on g susc ept i ble indiv idua ls . 2,12,19 A

S w e d i s h G o v e r n m e n t a l C o m m i s s i o n D o p i n g i n a

P u b l i c H e a l t h P e r s p e c t i v e p r o p o s e d i n 1 9 9 6 t h a t

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as op ia te s , e t c . 4 In the Un i ted S ta te s , AA S a re

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