The age-crime curve, increasing to a peak in the teenage years and then decreasing, is well-known. Less well-known is that it seems to reflect variations in prevalence (the proportion of persons who are offenders) rather than incidence (the rate of offending by offenders). Age-crime curves for individuals do not resemble the aggregate curve since incidence does not change consistently between the onset and the termination of criminal careers. This has major implications for criminal justice policy since the greatest residual length of criminal careers, and hence the greatest potential incapacitative effect, may be between ages thirty and forty, not at the peak age. Different types of offenses peak at different ages; this probably reflects crime switching rather than the replacement of one group of offenders by another. There is little specialization in offending, but specialization does increase with age. Age effects need to be separated from period and cohort effects. The age-crime curve probably reflect...

Age and Crime

This article presents a new instrument with which to assess the effects of opiate treatment. The Opiate Treatment Index (OTI) is multi-dimensional in structure, with scales measuring six independently measured outcome domains: drug use; HIV risk-taking behaviour; social functioning; criminality; health; and psychological adjustment. Psychometric properties of the Index are excellent, suggesting that the OTI is a relatively quick, efficient means of obtaining reliable and valid data on opiate users undergoing treatment over a range of relevant outcome domains.

Development and validation of a multidimensional instrument for assessing outcome of treatment among opiate users: the Opiate Treatment Index

In a three-year field study of methadone maintenance programs in New York City, Philadelphia, and Baltimore, treatment was found to be effective in reducing IV drug use and needle sharing among most heroin addicts. Of 388 patients who remained in treatment for one year or more, 71 percent had ceased IV use. Conversely, 82 percent of patients who left treatment relapsed rapidly to IV drug use. Marked differences in the effectiveness of various programs were observed: current IV use varied from less than 10 percent to over 57 percent of patients in particular treatment programs. This differential effectiveness was related both to length of patient's stay and to the quality of treatment provided. HIV seropositivity among high-risk drug users is related to frequency of injections and needle-sharing contacts. Effective methadone treatment can stop these practices, but a widespread impact on the AIDS epidemic will require improvement of treatment in many programs.

Reducing the risk of AIDS through methadone maintenance treatment.

The major drug-treatment modalities-methadone maintenance, therapeutic communities, outpatient drug-free programs, and some criminal justice system-based treatments such as civil commitment-have all been shown to be successful by most outcome criteria. Programs with flexible policies, goals, and philosophies produce better results than inflexible programs, especially when they adopt combinations of treatment components that are suited to individual clients' problems and needs. Patients' lengths of time in treatment are highly correlated with positive outcomes, but dropout rates are high for most modalities. Clients entering treatment under legal coercion do as well by most outcome criteria as volunteer clients and may stay in treatment longer. The evidence on treatment effectiveness suggests a social policy of expanded treatment capacities and options and increased attention to adequate implementation of treatment programs.

Treatment of Drug Abuse

Within the past decade, there has been increasing recognition that glia are far more than simply “housekeepers” for neurons. This review explores two recently recognized roles of glia (microglia and astrocytes) in: (a) creating and maintaining enhanced pain states such as neuropathic pain, and (b) compromising the efficacy of morphine and other opioids for pain control. While glia have little-to-no role in pain under basal conditions, pain is amplified when glia become activated, inducing the release of proinflammatory products, especially proinflammatory cytokines. How glia are triggered to become activated is a key issue, and appears to involve a number of neuron-to-glia signals including neuronal chemokines, neurotransmitters, and substances released by damaged, dying and dead neurons. In addition, glia become increasingly activated in response to repeated administration of opioids. Products of activated glia increase neuronal excitability via numerous mechanisms, including direct receptor-mediated actions, upregulation of excitatory amino acid receptor function, downregulation of GABA receptor function, and so on. These downstream effects of glial activation amplify pain, suppress acute opioid analgesia, contribute to the apparent loss of opioid analgesia upon repeated opioid administration (tolerance), and contribute to the development of opioid dependence. The potential implications of such glial regulation of pain and opioid actions are vast, suggestive that targeting glia and their proinflammatory products may provide a novel and effective therapy for controlling clinical pain syndromes and increasing the clinical utility of analgesic drugs.

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Glia as the “bad guys”: Implications for improving clinical pain control and the clinical utility of opioids

The reduction of intravenous heroin use, non-opiate abuse and crime during methadone maintenance treatment: further findings

Admissions to methadone maintenance: Comparisons between programs and implications for treatment

Medical services provided to 2,394 patients at methadone programs in three states.

Incidence and Estimated Prevalence of Recorded Delinquency in a Metropolitan Area

Postaddiction crime rates among narcotic (principally heroin) addicts in five different areas (theft, violence, dealing, confidence games, and other crime) were found to be substantially related to a number of pre-addiction characteristics, especially criminal activity and drug and alcohol use prior to addiction to narcotics. Early family influences such as lack of religious training, history of parent's arrest, and use of drugs and alcohol by other family members also appear to play an important role. Early identification of extremely crime-prone individuals followed by intensive intervention efforts might reduce the amounts of crime such persons might otherwise commit.

John C. Ball

Papers

The reduction of intravenous heroin use, non-opiate abuse and crime during methadone maintenance treatment: further findings

Admissions to methadone maintenance: Comparisons between programs and implications for treatment

Medical services provided to 2,394 patients at methadone programs in three states.

Incidence and Estimated Prevalence of Recorded Delinquency in a Metropolitan Area

The relationship of preaddiction characteristics to the types and amounts of crime committed by narcotic addicts.