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. Author manuscript; available in PMC: 2025 Oct 1.
Published in final edited form as: Crim Behav Ment Health. 2024 Sep 12;34(5):431–445. doi: 10.1002/cbm.2353

Psychopathy Traits Explain Variance Shared Between Features of Substance Use Disorders and Violence

Samuel R Vincent 1, Emily E Graupman 1, William J McGarrigle 2, David S Kosson 1
PMCID: PMC11625409  NIHMSID: NIHMS2028190  PMID: 39267284

Abstract

Background:

There is a substantial research literature on identifying risk and protective factors for violence perpetration. Substance use disorders have long been identified as constituting a significant predictor of violent behaviour. Psychopathy traits have also been similarly recognised, but inter-relationships between psychopathy traits, features of substance use disorders and violence have been little explored.

Aims:

To determine the degree to which shared variance between substance dependence symptoms and violence, as indicated by criminal charges for violent offences, among jailed men can be explained by psychopathy traits.

Methods:

Features of dependence on substances in three drug classes (alcohol, cannabis, cocaine) were assessed in a sample of 682 men in a county jail awaiting trial on criminal charges, many for violent offences. Statistical comparisons of zero-order and partial correlations tested whether accounting for psychopathy total and facet scores, assessed by the Psychopathy Checklist-Revised (PCL-R), affected associations between substance dependence symptoms and violent charges.

Results:

Total PCL-R scores accounted for a significant proportion of the shared variance between history of criminal charges for violence offences and lifetime substance dependence symptoms in all three drug classes. At the facet level, controlling for ratings on the interpersonal and modified antisocial facets reduced the association between criminal charges for violent offences and symptoms of cocaine dependence; controlling for ratings on a modified antisocial facet also attenuated links between alcohol and cannabis dependence symptoms and history of charges for violent offences

Conclusions:

These findings build on the sparse literature to date on the role of psychopathy traits on relationships between features of substance use disorders and violence. Given that the observed connection between substance dependence symptoms and charges for violent offences is partly accounted for by individual differences in psychopathy traits, it follows that effective treatment for those traits may be useful, perhaps essential to reducing links between features of some substance use disorders and violent offending.

Keywords: Psychopathy, Substance Dependence, Violence, Shared Variance, Incarcerated Sample

INTRODUCTION

Approximately 1.2 million violent crimes are reported to authorities in the USA annually (Federal Bureau of Investigation, 2023). Improving our understanding of risk factors that contribute to violence may allow for more targeted prevention efforts. Past research has consistently demonstrated that features of substance use disorder are associated with an increased risk of violent behaviour (for a meta-meta-analysis see Duke et al., 2018). Other research suggests, however, that psychological factors may account for some of the risk previously attributed to substance use (Lammers et al., 2014). Psychopathy is a construct of personality pathology associated with a combination of impairments in emotion with arrogant and deceptive interpersonal behaviour, and persistent and impulsive antisocial behaviours. Psychopathy, as indicated by high scores on psychopathy rating scales, has also been identified as a robust risk factor for violence (Porter et al., 2018). Our aims were to explore inter-relationships between features of substance use disorder, levels of psychopathy traits and charges for violent offences.

Substance Use and Violence

The link between features of substance use disorder and violent behaviour is well-established and may be bi-directional (for reviews, see Boles & Miotto, 2003; Duke et al., 2018; Testa, 2004). Findings from longitudinal and controlled laboratory studies have led researchers to argue that alcohol use, in particular, is a contributing cause of violence or aggression (Boden et al., 2012; Parrott & Eckhardt, 2018), however, the converse is also true - aggression predicts alcohol use (e.g., Lawler et al., 2021; cf. Reyes et al., 2012). Alcohol is also the substance considered to be most relevant to specific types of aggressive behaviours including sexual assault, verbal and physical aggression, and physical violence, whether directed toward intimate partners, acquaintances or strangers (Tomlinson et al., 2016). Other commonly used substances such as cannabis (Beaudoin et al., 2019), psychostimulants (Kuypers et al., 2017; cf. O’Malley et al., 2022), and opioids (Maremmani et al., 2010) have each been associated with various aggressive behaviours. The impact of substance use on violence may vary according to presence or absence of comorbid psychological disorders and personality traits. Post traumatic stress disorder (PTSD), for example, has been found to account in part for the relationship between drug use and violent offending among correctional and clinical samples (Barrett et al., 2011; Howard et al., 2017). In addition, impulsivity has been implicated as a predictor of violent behaviour among individuals with substance use disorders (Fantin et al., 2024; Heinz et al., 2015; Moulin et al., 2018). Such findings underscore the importance of considering how individual factors, including personality traits, influence the relationship between features of substance use disorder and violent offending.

Psychopathy and Violence

Psychopathy is a form of personality pathology that has been reliably linked to violent offending (Porter et al., 2018; Thomson, 2018). Psychopathy traits have been associated with violent offending across a diverse range of samples (Flight & Forth, 2007; Hodges & Heilbrun, 2009) and is widely considered an important risk factor for violent recidivism (Asscher et al., 2011; Hare & Neumann, 2008). Further, psychopathy traits have been found to predict a variety of forms of violence, including reactive and instrumental aggression (Blais et al., 2014) and intimate partner violence (Cunha et al., 2018; Robertson et al., 2020). Despite these longstanding links observed between psychopathy traits and a variety of forms of violence, public health approaches to violence have rarely considered their implications for treatment and prevention efforts (Reidy et al., 2015).

The Psychopathy Checklist-Revised (PCL-R; Hare, 2003) is one of the most commonly used clinician-rated measures of psychopathy and its traits (or facets). Factor analyses point to four facets that underlie ratings on this instrument: affective unresponsiveness and grandiose and manipulative interpersonal behaviour facets (referred to as Factor 1 when combined) as well as impulsive and irresponsible lifestyle and early, persistent, and versatile antisocial behaviour facets (referred to as Factor 2 when combined; Hare, 2003). Further research has examined which of these PCL-R facets appear to be driving the relationship between psychopathy traits and violent offending. Some studies suggest that the antisocial facet is central to this relation (Walters & Heilbrun, 2010), although its importance has been questioned because ratings on this facet are impacted by a history of prior antisocial behaviours, so there is some circularity here. Moreover, some studies suggest that the interpersonal and affective traits are linked to some more specific forms of violence – for example instrumental aggression (Walsh et al., 2009), intimate partner violence (Swogger et al., 2007), and violent recidivism (Sohn et al., 2020), an understanding which may open more avenues for prevention, especially if deconstructed further into such problems as impaired capacity to read emotions or intent in others.

Psychopathy and Substance Use

The case studies that led to the concept of psychopathy identified a tendency among individuals with such personality types to misuse substances (Cleckley, 1964), which has since been corroborated by substantial empirical evidence (Brennan et al., 2022). Cleckley also suggested that individuals with psychopathy traits were especially prone to ‘disagreeable behaviour’ (including violence) when under the influence of substances, although he was only explicit about alcohol. There is little direct evidence bearing on this proposal, but one review suggested that available data are consistent with Cleckley’s proposal although the relationships may depend on the nature of the sample or the way psychopathy traits are assessed (Swogger et al., 2018).

Facet-level analyses have revealed differential associations with distinct substance-related outcomes. For example, the lifestyle traits of psychopathy have been most consistently associated with clinical indicators of substance use, such as substance use disorder symptoms (Brieman et al., 2024; Walsh et al., 2007) and diagnoses (Coid et al., 2009b). By contrast, the antisocial traits of psychopathy are most strongly associated with outcomes other than formal diagnostic criteria, such as initiating drug use at young ages (Schulz et al., 2016), versatility of substance use (Coid et al., 2009a), and weekly alcohol consumption (Neumann & Hare, 2008).

Beyond the lifestyle and antisocial traits, the interpersonal and affective traits also show robust and selective associations with particular substance use indices. Regarding the interpersonal facet scores, findings from several large independent correctional samples (Ns ≥ 354; Brieman et al., 2024; Coid et al., 2009a; Walsh et al., 2007) and one community sample (N = 496; Coid et al., 2009b) indicate positive relations with cocaine-related outcomes including: lifetime use of cocaine and other psychostimulants (e.g., amphetamine; Brieman et al., 2024; Coid et al., 2009b), presence of cocaine use disorders (Coid et al., 2009a), and severity of cocaine symptoms (Brieman et al., 2024; Walsh et al., 2007). Conversely, the affective traits largely appear to be protective against features of substance use disorder. Brieman et al. (2024) found that male prisoners who were rated high on the affective facet were less likely to have engaged in illicit substance use. Further, replicating prior facet-level reports (Maurer et al., 2023; Walsh et al., 2007; cf. Coid et al. 2009a, 2009b), among prisoners who did endorse histories of drug use, higher levels of affective traits were associated with less severe substance-related impairment (Brieman et al., 2024). Taken together, these findings suggest that high interpersonal facet scores may indicate heightened risk for engaging in problematic patterns of cocaine and other psychostimulant use and also reduce the frequency of experiences of remorse, guilt, and empathy, which, if present, may reduce motivation to regulate affect via substance use.

To what extent are links between substance misuse and violence explained by psychopathy?

Given the interrelationships between features of substance use disorder, psychopathy traits, and violence, it is plausible that psychopathy traits may account for some of the shared variance between substance dependence symptoms and violent offending. To our knowledge, the only authors to examine this empirically are Okano et al. (2016), who examined whether psychopathy traits mediated the relationship between alcohol dependence symptoms and intimate partner violence in a longitudinal sample of civil psychiatric patients and a cross-sectional sample of undergraduate students. Within the undergraduate sample, the relationship between indicators of alcohol dependence and violence was reduced by adding self-reported psychopathy traits to the model, a finding interpreted as evidence for mediation. This effect was not examined in the clinical sample because the Baron and Kenny (1986) preconditions for mediation were not met.

The study of mediation in cross-sectional research is not without controversy (Cain et al., 2018). Methodologists have argued that mediation implies a theoretically causal and temporal relationship between variables, such that the ‘predictor variable’ must be causally and temporally linked to the mediator, which in turn must be causally and temporally linked to the outcome (Fairchild & McDaniel, 2017). Given the findings from their cross-sectional sample, Okano et al. (2016) argued that, in some contexts, psychopathy traits mediated the relationship between alcohol dependence symptoms and intimate partner violence. Yet, the implication that alcohol dependence symptoms cause psychopathy traits appears inconsistent with contemporary theoretical perspectives on the development of psychopathy.

A better way to investigate this question is to compare zero-order and partial correlations. Such comparisons are often used to assess the confounding effect of a third variable on the relationship between an independent and dependent variable. Although confounding and mediational analyses are statistically identical (MacKinnon et al., 2000), the identification of shared variance associated with confounding does not require assumptions about the temporal order among the variables examined. Therefore, although Okano et al.’s (2016) suggestion that psychopathy scores contribute to both alcohol dependence symptoms and violence does not meet contemporary criteria for mediation, their findings nevertheless suggest psychopathy traits may account for some of the shared variance between alcohol dependence symptoms and intimate partner violence. Given the paucity of studies examining these relationships, further investigations of their robustness are warranted.

Aims

This study was designed to investigate whether psychopathy traits account for a significant proportion of the shared variance between substance dependence symptoms and violence. This study expanded upon Okano et al. (2016) in a number of ways. First, we statistically compared zero-order and partial correlations to investigate the extent to which psychopathy traits account for the relationship between substance dependence symptoms and violence, better reflecting the possible bidirectional and atemporal nature of the variables being considered. Secondly, in addition to examining psychopathy as a total score, we examined which facets of psychopathy are most implicated in any such relationships. Thirdly, instead of using self-reported intimate partner violence as the criterion variable, we investigated whether these findings could be extended to charges for violent offences more broadly. Finally, in addition to examining these issues regarding alcohol dependence symptoms, we also examined whether the links between criminal charges for violent offences and cocaine and cannabis dependence symptoms are reduced by controlling for psychopathy scores.

METHOD

Ethics

All studies procedures were approved by the Rosalind Franklin University of Medicine and Science Institutional Review Board prior to the onset of data collection.

Participants

Participants were recruited from a jail housing inmates from a moderately sized (c.700,00 residents) county in a Midwestern state that includes urban, suburban, and rural areas. This county is predominately European American with smaller populations made up of racial and ethnic minority residents (e.g., European American c. 60%, Latine c. 8%, Black c.8%) and includes residents from a wide range of socioeconomic backgrounds. At any one time, there are roughly 650 men and women in this county jail, at different stages in their criminal cases - including those awaiting trial, those who have been found guilty and serving sentences of up to a year for minor offences (i.e., misdemeanour convictions), and those awaiting transfer to state prisons for longer sentences. Participants included in the current study represented participants who were recruited from a larger data collection protocol who had completed all the measures required for the current study. Inclusion criteria included being biologically male, between the ages of 18 and 45 years old, in the jail’s general population for at least two weeks and being without active psychosis. Inmates were selected randomly from the jail’s roster and were provided with information regarding the nature of the studies and their risks and benefits. Those who agreed to participate were then screened to ensure they met/did not meet inclusion/exclusion criteria. They were given an opportunity to have any questions answered by a research assistant before reviewing and, if content, signing a consent form. After completion of the study, a small monetary payment was placed in their jail commissary accounts.

Measures

Psychopathy Checklist-Revised (PCL-R; Hare, 2003)

The PCL-R is the most widely used and extensively validated instrument for assessing psychopathy in adults. This clinician-rated checklist, administered and completed by trained research assistants, consists of 20 items, each rated on a three-point scale based on information provided by participants and behavioural observations during a semi-structured interview as well as examination of collateral information such as institutional records. Item ratings are summed to yield a total dimensional score. In addition, ratings on the items comprising the four validated facets are summed to provide interpersonal, affective, lifestyle, and antisocial facet ratings. Ratings on the PCL-R demonstrated acceptable internal consistency (McDonald’s Ω = 0.81; McNeish, 2018). Of 682 participants, two trained raters were available for 95 PCL-R assessments (14%), yielding a single-rater, two-way random effects consistency agreement model indicating good interrater agreement, (intraclass correlation coefficient = 0.86; Koo & Li, 2016).

Due to concerns that ratings on two items on the antisocial facet (Juvenile Delinquency and Criminal Versatility) could be especially influenced by reports of violent offending, ratings on these two items were omitted before computing prorated PCL-R total and antisocial facet ratings. Similarly, because impulsivity has been linked to both substance use (Kozak et al., 2019) and violent offending (Meijers et al., 2017), ratings on the Impulsivity item of the lifestyle facet were also omitted before computing prorated PCL-R total and lifestyle facet ratings. Because these systematic exclusions of specific item ratings could alter the level and distribution of psychopathy traits, we refer to these ratings here as modified PCL-R total ratings, modified lifestyle facet ratings, and modified antisocial facet ratings. In light of the large sample size, only participants with data for all study variables were included in analyses.

Structured Clinical Interview for DSM-IV (SCID-I; First et al., 2002)

The SCID-I is a semi-structured interview designed to measure presenting features of mental disorders using the diagnostic criteria outlined in the American Psychiatric Association’s (APA) Diagnostic and Statistical Manual of Mental Disorders – 4th Edition (DSM-IV; APA, 1994). The DSM-IV provided diagnostic criteria for two distinct disorders for each substance category: substance dependence and substance abuse. In the current study, we examined the number of substance dependence features endorsed by the participant.

Although the authors of the DSM – 5th Edition (DSM-5; APA, 2013) elected to combine substance dependence and abuse into a single disorder - substance use disorder - the DSM-5 criteria for this include all seven of the symptoms that comprise substance dependence in the DSM-IV (Compton et al., 2013). It is important to acknowledge that the DSM-IV substance dependence symptoms do not capture the full range of DSM-5 substance use disorders: they do not include some important features such as recurrent substance use in situations that are physically hazardous (that were classified under substance abuse in the DSM-IV).

The SCID-I provides scores for dependence on seven different types of substances (alcohol, sedatives, cannabis, stimulants, opioids, cocaine, hallucinogens). Each item of the SCID-1 measures whether an individual reports the experience captured by each specific dependence symptom (N = 7) for each substance category. Each item was scored by indicating “0” if a participant’s experience did not meet the dependence symptom criterion and “1” if the participant had endorsed the dependence symptom. The presence of each of the dependence symptoms was then summed for each type of substance. In the light of the low base rates and lack of variance of substance dependence symptoms for sedatives, non-cocaine stimulants, opioids, and hallucinogens, we confined analyses to variance in ratings for alcohol, cannabis, and cocaine dependence symptoms.

Violent Charges

The number of charges for violent offences each individual had ever received was coded, based on a review of available criminal records, and summed. Violent charges included charges related to robbery, assault, murder, weapons charges, kidnapping, and sex crimes.

Analytic plan

Prior to conducting any analyses, scores on all variables were Winsorized to reduce the impact of any univariate outliers (Erceg-Hurn & Mirosevich, 2008). After this process, all variables were considered normally distributed as evidenced by skewness statistics with absolute values less than 2.0 (Kim, 2013). All analyses were conducted in R, version 4.2.2 (R Core Team, 2022). The pzcor function from the zeroEQpart package (Richard, 2018) was applied to implement the bias-corrected and accelerated bootstrap method for assessing the statistical significance of relationships (Efron & Tibshirani, 1983). A series of analyses, each with a total of 1,000 bootstrap samples, were employed to determine whether zero-order correlations between each type of substance dependence symptom and the number of violent charges differed from the partial correlations controlling for PCL-R total ratings and for each of the four validated PCL-R facet ratings (one at a time). For each analysis, we applied the pzconf function to generate bootstrapped confidence intervals for the degree of change between the zero-order and partial correlations.

RESULTS

General description of the sample

Participants were 682 male inmates at a midwestern county jail. Their ages ranged from 18 – 45 (M = 25.86, SD = 6.39). Education levels ranged from 6 – 17 years (M = 11.29, SD = 1.71). The ethnic make-up of the sample was as follows: African American (n = 336, 49%), European American (n = 294, 43%), Latino (n = 38, 6%), and other (n = 14, 2%). Descriptive statistics for all study variables can be found in Table 1. Diagnostic criteria for substance dependence, as defined by meeting three of more substance dependence symptoms, was met by 285 participants (42%) for alcohol, 237 participants (35%) for cannabis, and 142 participants (21%) for cocaine. Roughly a fourth of participants (N = 172) could be classified as having psychopathy if using the cut-off score of 30 on the PCL-R (Hare, 2003). Most of the study’s sample had a history of receiving at least one charge for a violent offence (N = 505, 74%) with 198 of these participants (29%) having had five or more charges for a violent offence, historically.

Table 1.

Substance use, violence and psychopathy checklist scores: Descriptive Statistics for all Study Variables

M (SD) Range Skew Kurtosis
Violent Charges 3.86 (5.25) 0–45 2.82 12.62
Substance Dependence Symptoms
 Alcohol 2.28 (2.33) 0–7 0.59 −0.98
 Cannabis 1.92 (1.93) 0–7 0.70 −0.59
 Cocaine 1.13 (2.11) 0–7 1.62 1.10
PCL-R Ratings
 Total 24.11 (6.87) 5.56–38.95 −0.37 −0.54
 Interpersonal Facet 4.44 (2.12) 0–8 −0.16 −0.80
 Affective Facet 4.74 (1.97) 0–8 −0.24 −0.63
 Lifestyle Facet 6.46 (2.0) 0–10 −0.53 −0.01
 Antisocial Facet 6.63 (2.37) 0–10 −0.48 −0.46
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Note. PCL-R = Psychopathy Checklist-Revised. Violent Charges reflect the untransformed version of the variable. PCL-R Ratings reflect prorated ratings. Skew and Kurtosis values reflect skewness and kurtosis statistics. The skewness and kurtosis statistic for the Winsorized version of the violent charges variable was 1.67 and 2.36, respectively.

Zero-order and Partial Correlations

Zero-order correlations between substance dependence symptoms and charges for violent offences, and partial correlations controlling for modified PCL-R total and individual facet ratings one at a time, are presented in Table 2. The number of charges for violent offences were positively associated only with the number of alcohol dependence symptoms; no significant relationships were observed between the number of charges for violent crimes and the number of cannabis or cocaine dependence symptoms. After controlling for PCL-R total scores, however, the number of criminal charges for violent offences were no longer linked to alcohol dependence symptoms. Even so, the correlation between number of criminal charges for violent offences and alcohol dependence symptoms remained significant in analyses that controlled for only the affective, interpersonal, or lifestyle facet scores individually. The lack of significant relationship between number of cannabis symptoms or cocaine dependence symptoms and violence charges remained after controlling for any of the PCL-R facet scores.

Table 2.

Zero-order and Partial Correlations Between Features of Substance Dependence and Criminal Charges for Violent Offences, After Controlling for PCL-R Total and Facet Ratings

Substance
Dependence
Symptoms		 Criminal Charges for Violent Offences
Zero-Order Partial (Controlling for)
Total Interpersonal Affective Lifestyle Antisocial
Alcohol 0.09* 0.06 0.08* 0.09* 0.08* 0.05
Cannabis 0.07 0.04 0.06 0.07 0.07 0.03
Cocaine 0.04 0.01 0.02 0.04 0.03 0.02
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Note. PCL-R = Psychopathy Checklist-Revised

*

= p < 0.05.

Bootstrapped Difference Tests

PCL-R Total Rating Scores

For all three substance categories examined, bootstrapped difference tests indicated that the magnitude of the correlations between substance dependence symptoms and violent charges changed significantly after controlling for modified PCL-R total ratings. In this context, we use the term Δr to denote the change in magnitude of the association from the zero-order correlation to a partial correlation controlling for a psychopathy rating. The relationship between alcohol dependence symptoms and violent charges weakened after controlling for modified PCL-R total ratings (Δr = −0.03, 95% CI [−0.01, −0.06]).

Similar findings were demonstrated for cannabis (Δr = −0.04, 95% CI [−0.02, −0.06]) and cocaine dependence symptoms (Δr = −.03, 95% CI [−.01, −.05]), despite nonsignificant zero-order relationships between substance dependence symptoms and violent charges.

Although we did not examine indirect effects, the use of a bootstrapped difference test to determine if there is a statistically significant reduction in the magnitude of the bivariate correlation between the predictor variable and the outcome variable and the partial correlation after controlling for a third variable is conceptually akin to mediation (MacKinnon et al., 2000), as discussed above. Current perspectives on mediation no longer consider a statistically significant total effect to be a prerequisite for investigating indirect effects (Kenny & Judd, 2014; Rucker et al., 2011). In this context, it appears straightforward to interpret statistically significant bootstrapped difference tests as meaningful, even in the absence of significant bivariate correlations.

PCL-R Facet Scores

Controlling for only affective facet scores had no impact on any of the relationships between number of criminal charges for violent offences and substance dependence symptoms for alcohol, Δr = −0.0004, 95% CI [−0.02, 0.02]), cannabis, Δr = −0.01, 95% CI [−0.03, 0.01] or cocaine, Δr = 0.004, 95% CI [ −0.01, 0.02]. In contrast, controlling only for interpersonal facet ratings significantly reduced the (nonsignificant) association between cocaine dependence symptoms and violent charges (Δr = −0.02, 95% CI [−0.01, −0.04]). Controlling only for interpersonal facet ratings did not account for a significant proportion of the variance shared between violent charges and alcohol (Δr = −0.01, 95% CI [−0.02, 0.01]) or cannabis dependence symptoms (Δr = −0.01, 95% CI [−0.03, 0.001]).

Partial correlations controlling for only modified lifestyle facet ratings did not significantly change the relationship between violent charges and any type of substance dependence indicator (for alcohol, Δr = −0.01, 95% CI [−0.02, 0.001], cannabis (Δr = −0.01, 95% CI [−0.02, 0.001], and cocaine (Δr = −0.01, 95% CI [−0.02, 0.0006]). After controlling for ratings on modified antisocial facet ratings, relationships between substance dependence indicators and the number of charges for violent offences were attenuated for alcohol (Δr = −0.03, 95% CI [−0.02, −0.06]), cannabis (Δr = −0.04, 95% CI [−0.02, −0.07]), and cocaine (Δr = −0.02, 95% CI [−0.003, −0.04]).

DISCUSSION

This study provides evidence that elevated psychopathy scores account for a significant proportion of the variance observed in the relationships between the number of dependence symptoms for alcohol, cannabis, or cocaine and lifetime number of charges for a violent offence. Specifically, controlling for psychopathy traits reduced the strength of the observed relationships between three indices of the severity of substance dependence and violent criminal behaviour. Consistent with our hypotheses, these findings demonstrate that, in this sample of male jail inmates, psychopathy traits contribute significantly to the relationship between substance dependence symptoms and violent offending. Moreover, analyses revealed significant and unique contributions of the interpersonal facet and of a modified version of the antisocial facet.

These results are partly consistent with those of the prior study exploring psychopathy scores as a mediator of the relationship between alcohol dependence symptoms and intimate partner violence perpetration among adults living in the wider community. Like Okano et al. (2016), we found overall levels of psychopathy traits accounted for a significant proportion of the shared variance between alcohol dependence symptoms and violence. Our findings also suggest this relationship extends to cocaine and cannabis dependence symptoms, and to the examination of the number of charges for any violent crimes, rather than self-reports of one specific violent crime, intimate partner violence.

Our findings also provide evidence for the utility of statistically comparing zero-order versus partial correlations rather than employing mediation methods to examine these relationships in cross-sectional research studies. Contemporary discussions of mediation require that a putative mediating variable is expected to occur after the independent variable occurs but before the dependent variable, even if all the variables are measured at the same time. Given the expectation that personality traits develop early in life and are often present before the development of concerns about violence or features of substance use disorder (e.g., Malmberg et al., 2012), it appears that a focus on shared variance, rather than temporal mediation, represents these conceptual relationships more precisely.

We recognize, however, that longitudinal studies have important advantages in examining these kinds of relationships. Two longitudinal studies have found that self-reported alcohol use during adolescence appeared to predict self-reported levels of psychopathy traits, but the findings are somewhat nuanced. Charalampous and colleagues (2019) reported that higher levels of alcohol dependence symptoms indicators predicted lower subsequent levels of the interpersonal traits of psychopathy. The other reported that excessive alcohol consumption predicted higher overall levels of psychopathy traits at follow-up (Hawes et al., 2015). Future longitudinal studies can help to examine whether shared variance between substance misuse and violent criminal activity can be explained by variance in psychopathy traits earlier in life.

In addition, our findings build on previous research by examining the role of specific psychopathy facets in the relationship between features of substance use disorders and violent behaviour. Findings indicated most of the observed effects of psychopathy traits were attributable to ratings on our modified version of antisocial facet. Because we omitted ratings on juvenile delinquency and criminal versatility, this finding suggests that it is high levels of early behaviour problems, poor anger control, and lack of compliance with conditional releases that are related to both participation in violent crimes and the development of dependence on several different kinds of substances. This finding is consistent with prior evidence suggesting that, compared to the other facets, persistent antisocial behaviours are inevitably associated with indices of aggression and violence (Thomson et al., 2019; Walters & Heilbrun, 2010), but this and the fact that substance misuse is commonly regarded as antisocial always leaves open the argument that these relationship are simply circular. At the same time, there is growing evidence that the antisocial traits of psychopathy are associated not only with criminal conduct but with several other kinds of indices. These findings suggest that persistent antisociality itself does not simply reflect a propensity for violating rules or the rights of others. Notably, Klipfel and Kosson (2018) reported that, in a large sample of inmates, levels of the antisocial facet traits were specifically and uniquely associated with symptoms of Paranoid Personality Disorder. In other samples, high antisocial facet scores have been linked to poorer facial affect recognition (Igoumenou et al., 2017) and more PTSD symptoms (Blonigen et al., 2012) above and beyond the effects of the other facets of psychopathy.

It is interesting that interpersonal traits accounted for a significant proportion of the specific relationship between violence and cocaine dependence symptoms. This finding appears consistent with evidence for significant and unique relationships between the interpersonal facet of psychopathy and cocaine misuse (Brieman et al., 2024; Coid et al., 2009a; Coid et al., 2009b). Given that the interpersonal traits of psychopathy have also been linked to instrumental aggression (Walsh et al., 2009), one question for future research is whether the shared variance between cocaine dependence symptoms and violence is largely specific to cases of planned or predatory violence.

The importance of the interpersonal and antisocial facet on the relationship between features of substance use disorder and violent offending may have treatment implications. Notably, interventions targeting antisocial traits may help reduce the risk for violent offending among individuals with substance use disorder. Although there is pessimism about the effectiveness of treating psychopathy (Salekin et al., 2010), some studies have demonstrated mitigation of the risk for violent offending among those with high levels of psychopathy traits. Of particular promise is the two-component model described in Wong et al. (2012) which targets Factor 2 traits (including the antisocial facet traits) as a means of reducing the risk for violence. This intervention has demonstrated effectiveness in reducing violent recidivism (Wong et al., 2012; Olver et al., 2013; Olver & Wong, 2009) and may be particularly helpful for individuals with comorbid substance use disorders and antisocial traits. In particular, our findings suggest that such individuals may be at especially heightened risk for committing violent offences. We are not aware of any therapeutic interventions specifically designed to treat the interpersonal facet traits of psychopathy.

Limitations

Our findings must be interpreted in light of this study’s limitations. First, the generalizability of the findings is limited given the use of an exclusively male, incarcerated sample. Although the Okano et al. (2016) community sample consisted primarily of women, it remains important to investigate whether psychopathy traits similarly account for a proportion of the relationship between substance use and violence in additional diverse samples. Secondly, the cross-sectional design of the study limits the inferences that can be made regarding causal relationships among substance dependence, psychopathy traits, and violence (Maxwell et al., 2011). Thirdly, it is important to acknowledge that, even though the relationship between substance dependence symptoms and charges for violent offences was significantly reduced by accounting for psychopathy traits, the effect sizes were small. Therefore, it is important for future research to explore other factors that may also contribute to these relationships. Fourthly, the use of charges as an index of violent offending is unlikely to capture the frequency and severity of an individual’s violent behaviour. Fifthly, although substance dependence diagnostic criteria of the DSM-IV comprise much of the diagnostic criteria of substance use disorders in the DSM-5, they are not equivalent constructs. Additional research is needed to evaluate the robustness of the current study’s findings using measures of substance use disorder symptoms as described in the DSM-5. Sixth, the decision to employ charges for violent offences as opposed to convictions of violent offenses as the measure of violence may have impacted on the validity of the results as an individual may be charged with an offense that they are never determined to have committed (i.e., found innocent, charges dropped). Replication in independent samples using multiple measures of violence may provide evidence for the robustness of these findings.

Conclusions

Our study provides evidence that higher scores on the PCL-R account for a significant proportion of the variance in relationships between various types of substance dependence symptoms and charges for violent crimes, thus building on prior findings that had focused on alcohol as the substance of interest. More specifically, we found that a modified index of antisocial traits was particularly influential in these relationships, although the interpersonal traits may also be important for links between cocaine dependence symptoms and violent crime. Improving our knowledge about underlying mechanisms that may account for links between different damaging and dangerous behaviours may improve our ability to develop effective violence prevention strategies and interventions.

Funding Statement:

The research and preparation of this article were supported in part by Grant MH57714 from the National Institute of Mental Health to David S. Kosson.

Footnotes

Conflict of interest disclosure: We have no known conflicts of interest to disclose.

Ethics approval statement: All studies procedures were approved by the Rosalind Franklin University of Medicine and Science Institutional Review Board prior to the onset of data collection.

Data availability statement:

All data are available upon request to the corresponding author.

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