Patterns of delinquency among British heroin addicts

Sections

I. Introduction
II. Heroin addicts in prison
TABLE 3 Pattern of drug abuse in 66 female heroin addicts
III. Discussion Differences among the sexes
Delinquency patterns
IV. Summary and conclusions
Acknowledgements

Details

Author: I. PIERCE JAMES, , P. T. D'ORBAN,
Pages: 13 to 19
Creation Date: 1970/01/01

Patterns of delinquency among British heroin addicts

M.A., M.B., M.A.N.Z.C.P., D.P.M., I. PIERCE JAMES, *
M.B., D.P.M. P. T. D'ORBAN, **

I. Introduction

The picture of narcotic addiction in Britain has dramatically changed in recent years. Prior to 1960 the bulk of narcotic addiction was of iatrogenic or "therapeutic ' origin or else occurred among professional people who had access to drugs [ 1] . Since the early 1960s there has been a rapid increase in the number of "non-therapeutic' addicts, and it is justifiable to talk of an epidemic of heroin addiction which began in London but which by 1965 had spread to other parts of the country. Table I shows the number of addicts known to the Home Office in the years 1959-1968. During this period heroin addiction has spread to an increasingly younger age group, whilst the social class distribution of the addict population has changed to include young people of lower social class origin. As a consequence of the increasingly widespread use of heroin among adolescents, the addict population as a whole now appea largely composed of extremely unstable and maladjusted young people who had been unable to achieve any satisfactory social adaptation prior to heroin use, and whose subsequent social adjustment has been even more impaired by their addiction population delinquency is a fairly common feature of adolescent maladjustment, it is not surprising that with the changes in the composition of the addict population delinquency has become a prominent characteristic of heroin addicts in this country.

Medical Officer H.M. Prison, Brixton, London S.W.2.

Medical Officer, H.M. Prison, Holloway, London N.7.

A review of recent studies on heroin addiction in Britain shows a high incidence of delinquency among British heroin addicts. The extent of delinquency depends on the particular sample of addicts selected for study, and is no doubt correlated with such factors as age, social class and the degree of involvement in heroin use. One method of study has been the epidemiological survey of heroin users in a circumscribed geographical area. De Alarc6n and Rathod [ 2] in a survey carried out in Crawley (a new town), found no evidence that young heroin users aged 15 to 20 formed part of a delinquent subculture. However, only a small proportion were daily users of heroin, all were living with their parents and 74 % were in regular employment. Nevertheless in a group of 33 boys and 6 girls who formed part of the Crawley survey, Rathod [ 3] reported marked antisocial behaviour patterns: 60% had run away frequently from school, whilst 75 % had a history of court appearances. Kosvinier et al. [ 4] carried out a survey in a provincial university town. They found that of 31 male and 6 female heroin users (mean age 20.6 years), 54% had a record of convictions, and of these half had been convicted before they began using heroin. However, they also comment that their sample did not constitute a drifting criminal subculture, but was of a high social origin, and 17 of the 37 subjects were not regular heroin users. Hines [ 5] , in a study of heroin addicts from predominantly lower social class origins in the East End of London, reported a high incidence of delinquency prior to heroin addiction. The boys had usually embarked on a delinquent career in their early teens, and many had appeared in juvenile courts and had been in approved schools. The girls were a more deprived and emotionally disturbed group; many were engaged in casual prostitution or were lesbians. Hines felt that his heroin addicts were basically delinquents and that their addiction was part of the wider problem of juvenile delinquency. After becoming addicted to heroin, there was little change in the pattern of their delinquency and most continued to indulge in petty crime.

TABLE 1

Narcotic addicts known to the Home Office 1959-1968

Year

1959

1960

1961

1962

1963

1964

1965

1966

1967

1968

Total number
454 437 470 532 635 753 927 1 349
1729
2782
Taking heroin
68 94 132 175 237 342 521 899 1299 2240
Sex:
                   
Male
196 195 223 262 339 409 558 886 1262 2161
Female
258 242 247 270 296 344 369 463 467 621
Origin:
                   
Professional contact
74 68 63 57 56 58 45 54 56 43
Medical treatment
276 246
232
255 299 310 299 297 257 306
Non-therapeutic
98 122
159
212 270 372 580 982 1385 2420
Age (heroin addicts)
                   
Under 20
0 1 2 3 17 40 134 317 381 729
20 to 34
35 52 87 126 162 219 319 479 827
1390
35 to 49
7 14 19 24 38 61 52 83 66 78
50 and over
26 27 24 22 20 22 16 20 24 20
Aged under 20 (percentage)
0 1 2 2 7 11 26 35 29 33

Another group of studies deals with samples of heroin addicts treated at drug dependence clinics or in hospital. Bewley and Ben-Arie [ 6] found that 75% of male in-patients had a history of conviction, and 57% had been convicted more than once. Willis [ 7] studied 42 male and 16 female heroin addicts (mean age 20.4 years) admitted to hospitals, and found a history of arrest or conviction in 79%, whilst 38% had previously been in prison. In a more recent study of 100 out-patients of both sexes attending an addiction clinic, Willis [ 8] found that 51 had committed offences prior to using any drug; 14 patients had been in approved school, 15 in borstal, 32 in a remand home and 48 on probation; 63 patients had been in prison on remand or on a sentence, and 19 were on probation at the time of the survey.

Yet a third approach has been the study of drug offenders appearing in the courts. Bean [ 9] studied 100 consecutive offenders (88 males and 12 females) charged with drug offences in central London courts. His sample included users of cannabis, amphetamines and other drugs, and 51 were daily heroin takers. Their mean age was 20.4 years, and compared to the general population there was an excess of social class I and II and of social class V (Registrar General's classification); 71% of his sample had a history of previous conviction for an indictable offence, and 57% had two or more previous convictions. Of the 95 offenders who admitted that they were taking drugs, 39 had been convicted of an indictable offence before first starting to take drugs. Delinquency prior to drug use was associated with a lower social background. There was no decrease in delinquency after drug use and offences against property predominated both before and after they had started using drugs.

Apart from Bean's survey of drug offenders, the studies reviewed above were not primarily concerned with the problem of delinquency among addicts and so far little attention seems to have been paid to this aspect of heroin addiction in Britain.

II. Heroin addicts in prison

Our present study aims at exploring the relationship between heroin addiction and delinquency in a group of male and female addicts interviewed in remand prisons in the London area. Addicts appearing in court are commonly remanded in custody for psychiatric reports prior to sentence, or pending the analysis of drugs found in their possession. Thus only a small minority of subjects were actually serving a prison sentence at the time of interview. The study of the male addicts was carried out by one of us (I.P.J.) during the summer months of 1967 at a remand prison dealing with men over the age of 21. A similar study was carried out (by P.T. d'O.) at an adult female remand prison and at an associated remand centre for girls aged 17 to 20 years (in a few instances girls under the age of 17 had been admitted to this remand centre if considered too disturbed to be managable in the remand home for younger girls). The two studies were carried out independently and consequently in some instances the data are recorded in a slightly different form in the following tables. However, the social characteristics and delinquency patterns of the male and female addicts were in many respects so similar that it is considered worthwhile to present the results of the two studies together, though only a proportion of the findings are set out in this paper.

Social characteristics and drug use in male addicts

The sample consisted of 50 unselected non-therapeutic heroin addicts. The majority had been remanded for a psychiatric report before their cases could be disposed of in court. Each was submitted to a detailed structured interview which enquired about drug habits, family, social and medical history, and previous delinquency, if any. Each subject's criminal record was checked for previous convictions. Some of the data were compared with those from a group of 50 unselected first-sentence short-term prisoners, matched only for age.

The mean age of the sample was 23.9 years, and 90% were under the age of 30. All but one of the sub- jects were white; 35 were born in England and Wales, 5 in Scotland, 4 in Eire, 2 in Canada and 1 each in Australia, Cyprus, Malta and Jamaica. All had been addicted to heroin at some stage and table 2 indicates the pattern of addiction. All had become addicted from illicit heroin in the first instance, and most of them used heroin in combination with cocaine or methylamphetamine, both in large daily quantities; 60% of the sample had regularly used more than 180 mg. of heroin per day, and 30% more than 360 rog. per day. During 1967 there had been a progressive increase in the use of methadone and methylamphetamine, with a decline in the amount of cocaine used. This reflected a change in medical prescribing habits. Most addicts stated a preference for a combination of heroin and methylamphetamine. Over three quarters of the subjects had also misused cannabis and oral amphetamines, but only 66 7o admitted to regular use of cannabis prior to narcotic addiction; 24% misused LSD occasionally and 14% frequently, whilst 66% admitted to regular or occasional misuse of barbiturates.

TABLE 2

Pattern of drug abuse in 50 male addicts

Drug

Heroin

Cocaine

Methadone

Methyl-amphetar-nine

Number addicted to drug at some stage
50 36 26 44
Original source of drug:
       
Doctor's prescription
0 9 13 22
lllicit drug source
50 27 13 22
Recent drug misuse:
       
Off drug
9 18 9 5
Intermittent use
3 6 10 9
Daily use
38 12 7 30
Recent source of drug:
       
Medical source
21 7 9 20
Illicit supplies only
20
11
8 19

The addicts as a group were of average social class background and intelligence. Comparison with the control group of first-sentence prisoners showed that 28% of the addicts had obtained places in grammar type schools, compared with only 6% of the controls. However, few had remained at school behind the age of 15 or acquired any educational qualifications. Few established any stable pattern of employment after leaving school. Only 17 (34%) of the subjects had ever. obtained jobs requiring special skills, and' after addiction to heroin there had been a progressive deterioration in the work record of all but 9 subjects. Prior to arrest only 16% were working regularly, whilst 14% had occasional or casual jobs and 62% were living on social security payments.

Compared with the control group the addicts showed no greater incidence of childhood deprivation, nor of a family history of mental illness or addiction; 8 subjects were homosexually orientated; compared with 50% of the controls only 20 % of the addicts had married, and only 2 of the addicts were still living with their wives. About half the wives and cohabitees of the addicts were themselves addicted to drugs.

2. Social characteristics and drug use in female addicts

In view of the comparatively small number of female addicts, this study comprised all heroin addicts aged under 21 committed to the remand centre (40 subjects) and all addicts over 21 committed to the women's prison (26 subjects) between January 1967 and June 1968. As in the case of the male addicts, the great majority were on remand and only a few were serving a prison or borstal sentence at the time of the study. Their age ranged from 16 to 30, with a mean age of 20.4 years. All but 2 of the subjects were white; 53 were born in England and Wales, 7 in Scotland, 4 in Ireland, and 1 each in the U.S.A. and New Zealand. All the subjects were "non-therapeutic" addicts who were daily heroin users prior to admission and were physically dependent on heroin (as judged by the presence of an abstinence syndrome). Their mean daily dose of heroin was 180 mg., and all but one of the subjects were multiple drug users. Their pattern of drug use is shown in table 3. The trend towards an increased use of methadone and methylamphetamine and the decline in the use of cocaine noted among the male addicts in 1967 continued during 1968. If the female sample had been restricted to the first half of 1968, the incidence of concurrent use of methylamphetamine would have approached 100%. There was also a decline in the use of LSD, and Mandrax (methaqualone with diphenhydramine) began to replace or supplement the use of barbiturates and Doriden (glutethimide) during the latter part of the period. Half the subjects obtained all their heroin from illicit sources, the same proportion as among the male addicts, whilst the majority of subjects getting heroin on prescription claimed that they were supplementing their supplies of heroin by buying the drug from other addicts.

TABLE 3 Pattern of drug abuse in 66 female heroin addicts

 

Number of subjects

 

Before heroin addiction

Used with heroin

1. Drugs misused:
   
Cannabis
42 (64 %)
6
Oral amphetamines
43 (65 %)
3
Methylamphetamine by injection
11
58 (88 %)
Cocaine
4 16
Methadone ( Physeptone)
2 17
Lysergide
13 2
Barbiturates
3 11
Methaqualone capsule ( Mandrax)
1 3
Glutethimide ( Doriden)
-
1
Excessive alcohol consumption
8
-
2. Other drugs misused in addition to heroin:
           
Number of drugs
None
1 2 3 4 5
Number of subjects
1 29 23 9 3 1
 
12-13
14-15
16-17
18-19
Over 19 years
3. Age at starting drugs:
         
Heroin
-
3 13 33 17
Other drugs
6 15 26 12 7
 
Under 3 months
4 to 11months
1 to 5 years
Over 5 years
4. Duration of heroin addiction:
       
Number
4 27 26 9

The social background of the sample showed a wider range than the general female prison population, but compared with the general population there was an excess of social classes IV and V. The group as a whole were of slightly above average intelligence, but as in the case of the male addicts, poor educational performance and premature school leaving were evident. Their work pattern was usually highly unstable even prior to addiction to heroin. They had a marked preference for jobs which did not involve sustained or close relationships with people (e.g. petrol pump attendant, club hostess, etc.); 10 women had a history of convictions for soliciting, none of the subjects was regularly employed at the time of arrest, and only 6 were engaged in some form of casual work. Over half had no fixed abode, and only 4 girls were still living with their parents There was a high incidence of parental deprivation

(defined as permanent absence of a parent through death, divorce, separation or desertion); 39% had experienced such deprivation under the age of 5 and 63 % under the age of 15, whilst a quarter of the group had been in children's homes. The high incidence of homosexuality was one of the most striking findings: 23 of the subjects showed exclusively homosexual orientation, with ratings of 5 and 6 in terms of Kinsey's classification; 12 of these were transvestites; a further 9 subjects were markedly bisexual (with Kinsey ratings of 3 and 4). Thus the over-all incidence of homosexuality was 48%.

3. Delinquency in male addicts

Table 4 details the 63 offences with which the 50 subjects had been charged at the time of interview (a current offences "). It will be seen that 58 %o of the charges related to drugs, whilst 42 %o were for non-drug offences, mainly against property; 22 %o of the addicts had a history of juvenile court conviction and a further 16 had been convicted by adult courts prior to addiction to heroin; thus the over-all incidence of convictions prior to heroin addiction was 76%; I0 of the subjects had only been convicted since addiction, and only 2 had no convictions prior to the current offence which brought them into the study. At the time of study, 6 of the addicts had previously been sentenced to imprisonment once, 4 twice and 13 more than twice. Table 5 shows the age of the 50 subjects at the time of their first conviction, and the age at the time of their first drug offence (for the 39 subjects who had a history of conviction for drug offences). Table 6 details the offences of the 48 subjects with a history of previous adult court convictions (convictions for simple drunkenness or traffic offences acts are omitted).

TABLE 4

Current offences committed by the 50 male and 66 female heroin addicts

Percentage
 

50 male addicts

66 female addicts

Type of offence
   
Drug (or prescription) offence
50 41
Drug offence and non-drug offence
8 4
Non-drug offence
42 55
Police charges
   
Dangerous Drugs Act (narcotics offence)
21 35
Drugs (Prevention of' Misuse) Act, 1964
7 35
Prescription forgery, etc
6 8
Theft, receiving stolen goods, etc
14 33
Housebreaking, etc
5 1
Taking Motor Vehicle
3 1
Suspected person and suspicion
4
-
Assault, violent robbery, etc
2 1
Wilful damage
1 4
Vagrancy or trespass
-
4
Breach of probation
-
9
Total charges involved
63 96

TABLE 5

Age at first conviction and age at first drug offence of the 50 male heroin addicts

Age (years)

First conviction

First drug offence

Under 13
7
-
13-16
15
-
17-20
15 a
7
21-24
12 b
25
25-28
-
5
Over 28
1 a
2
TOTAL
50 39

a One was for a drug offence.

b Five were for drug offences.

NOTE.-- Mean age at first conviction was 17.2 years. Mean age at first drug offence was 22.8 years.

4. Delinquency in female addicts

During the 18 month period, the 66 female subjects accounted for 96 remands: 43 were remanded once, 18 twice, 4 three times and one subject was remanded five times. Table 4 details the current offences which brought the subjects into the survey. The majority of these (55%) were for non-drug offences; 51 subjects (77%) had a history of previous convictions (including juvenile court appearances) prior to entering the sample. Table 6 details the types of offences committed by them, and compares 107 offences prior to addiction with 62 offences committed since the onset of heroin addiction; 40 subjects (60%) had convictions prior to becoming addicted to heroin; 31 of these were convicted more than once; 32% of the sample had a history of being in approved schools, 30 % had been through borstal, and 65% had been under supervision either under an aftercare licence from approved school or borstal, or under a probation order.

III. Discussion Differences among the sexes

The two studies show that in both sexes there was abundant evidence of sociopathic personality patterns and delinquent conduct prior to addiction to heroin: 44% of the male addicts had appeared before the juvenile courts and 76 % had been convicted by a court before narcotic addiction. Among the women, the incidence of court convictions prior to addiction was somewhat lower (60 %). Not all of these were convictions for criminal offences, as "Fit Person Orders" made by a juvenile court in the case of girls regarded as being "in need of care and protection" were included (19 cases). Such orders are commonly made because of waywardness and sexual promiscuity rather than criminal offences. The women in this study were a highly disturbed, unstable and emotionally deprived group, and this applied especially to those under 21 years of age seen at the remand centre. The women generally showed more-overt psychiatric disturbance than their male counterparts. The high incidence of homosexuality (48 %) was one indication of the severity of their disturbance. The group showed many similarities to the 38 "roofless" girls described by Times [ 10] , among whom 23 regarded themselves as lesbian. Viewed in the context of their long history of disturbed and often delinquent conduct, their aimless drifting, their profound lack of self-regard or sense of personal identity, heroin addiction in our female addicts seemed almost a minor symptom; it could be regarded as the most recent development in their lifelong pattern of maladjustment. With regard to sex differences in delinquency, a number of studies have noted that the small minority of girls who become delinquent are more seriously disturbed and more often come from, very disordered home backgrounds 11. Social and cultural factors similar to those operating in delinquency may account for the greater degree of emotional disturbance among the female addicts in this study.

TABLE 6 Previous convictions of the 50 male and 66 female heroin addicts

 

48 male addicts 288 adult convictions

51 female addicts 169 juvenile and adult convictions

Type of offence

Prior to addiction (N = 122)

Since addiction (N = 166)

Prior to addiction (N = 107)

Since addiction (N = 62)

Drug offences
5 ( 4 %)
61 (37 %)
5 ( 5% )
14 (22 %)
Theft, receiving, housebreaking
76 (62 %)
62 (38 %)
43 (40 %)
23 (37 %)
Taking away motor vehicle
14 (12%)
10 (6%)
1 1
Fraud, cheque forgery, etc
9 4
-
-
Suspicion, vagrancy, trespass
7 10 3
-
Assault, aggressive conduct charge
5 12 10 8
Robbery
1
-
-
-
Minor sex offence
2 2
-
-
Soliciting/importuning, etc
1 2
11 (10 %)
7 (12 %)
Breach of probation order
-
-
15 9
Needing care and protection
-
-
19
-
Other charge
2 3
-
-

Delinquency patterns

Table 5 shows that among the male addicts, the first conviction for a criminal offence tended to precede the first drug offence by several years. Among the female addicts, 78% of first convictions were for a non-drug offence, and among the 57 recidivists 61% of the most recent convictions were also for non-drug offences. One concludes that in both male and female addicts the first contact with the courts was usually due to delinquency not involving drugs, and that even after addiction the majority continued to commit non-drug offences. As will be seen from table 4, most of the previous offences committed by the group were minor offences against property. It is also notable that among the women, many were wayward girls who were considered to be in need of care and protection, or who were charged with breaching the conditions of a probation order (e.g. by failing to maintain contact with their probation officer). Apart from an increase in the proportion of drug offences, there was little change in the pattern of delinquency after the development of heroin addiction.

Offences involving aggression were uncommon. Among the men there were only 5 subjects convicted of assault or musing actual bodily harm, and none of these offences appears to have been very serious. Among the women, aggressive offences were usually minor assaults on the police occurring during the course of arrest, or damage to property such as the breaking of windows in police stations. It is our impression that much of the aggression was attributable to intoxication with methylamphetamine, and after this drug was withdrawn from general use (in October 1968) the small number of -aggressive offences has further declined.

The drug offences were mostly for illegal possession or for forgery of prescriptions, and in the present sample there were few instances of addicts being charged with supplying drugs to others. It is true that many British addicts sell heroin and other drugs obtained by them on prescription which is surplus to their own require- ments, but the addicted pusher who indulges in peddling in order to pay for his own supply of drugs is not a feature of the British scene.

The addicts in our study were, on the whole, markedly inefficient criminals. The high dosage of intravenous heroin they used in combination with large amounts of cocaine or methylamphetamine resulted in a degree of drug intoxication that rendered them clumsy and inept in carrying out their offences. They were often arrested on the spot. For example, one man after taking a grain of heroin and two ampoules of methylamphetamine walked into a supermarket and was stopped in an obviously intoxicated state trying to walk out with a tin of rhubarb, a small bottle of disinfectant and a clothes line; 27 of the male subjects admitted that at the time of the offence with which they were charged they had been in a state of drug intoxication, whilst only 3 claimed that they were in a state of drug withdrawal and that they had committed their offence because they needed money to obtain further supplies of heroin.

IV. Summary and conclusions

The results of our study of male and female heroin addicts in London remand prisons clearly shows them to be young, highly unstable, sociopathic, multiple drug users. Most were full-time addicts whose daily routine was taken up in "scoring" and "fixing", which left little time for anything but occasional casual employment. There was certainly little evidence that these addicts were enabled to live useful lives on a medical régime of heroin maintenance. They were characterized by a high degree of delinquency, which was not an outcome of their addiction but usually preceded it.

Although addicts interviewed in prison are likely to constitute a sample selectively biased towards delinquency, there are strong reasons for believing that they are not unrepresentative of the London heroin addict population as a whole. A substantial proportion of heroin addicts known to the Home Office are committed to the London remand prisons and remand centres each year. During 1968 more than 200 male heroin addicts over the age of 20 years were remanded to one London prison -and this represents nearly a quarter of all the adult male heroin addicts known to the Home Office Drugs Branch in 1968. An even higher proportion of the female heroin addicts passed through the female prison and remand centre; whilst over 50% of the younger female addicts (under 21 years) known to the Home Office were remanded (or committed) in custody during the course of the year.

The results of other recent studies of British heroin addicts, drawn from samples outside prison, accord with our own findings and show an almost uniformly high rate of delinquency.

Heroin addiction in Britain occurs predominantly in young people of marked sociopathic personality, most of whom were delinquent prior to their addiction. We found no evidence to suggest that heroin addiction was an alternative to other types of delinquent behaviour and on the contrary, it was usual to find that the delinquent behaviour continued unchanged after addiction.

The close relationship between addiction and delinquency in a substantial proportion of British heroin addicts must have a bearing on future methods of treatment, control and prevention in this country. The further development of specialized treatment facilities within the penal framework or in semi-secure units in association with the National Health Service, and the development of a probation and parole system specially designed for the supervision and aftercare of the delinquent addict are some of the questions that require consideration. Long term follow up studies are also needed to elucidate the natural history of delinquency and addiction and to test the hypothesis that delinquent addicts mature out of addiction simultaneously with their maturation from delinquency.

Acknowledgements

The authors gratefully acknowledge the help of colleagues in the Prison Medical Service in carrying out this study. We are grateful to the Drugs Branch of the Home Office for allowing us to use the statistical information incorporated in table 1, and to the Director of Prison Medical Services for permission to publish. Any opinions expressed are solely those of the authors and should not in any sense be taken as representing the views or policies of the Home Office.

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001

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002

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003

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004

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005

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006

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007

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008

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009

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010

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011

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