A retrospective evaluation of cases with substance use history and criminal responsibility report issued by the department of Forensic Medicine, Suleyman Demirel University School of Medicine, between 2022 and 2023

Aim: The aim of this study is to evaluate the factors that affect criminal responsibility in patients over the age of 15 with a history of substance use who have been sent to our Forensic Medicine Department to issue a report on criminal responsibility between 2022 and 2023. Method and Material: In this retrospective study, forensic expert reports that have been prepared between 01.09.2022 and 01.09.2023 for 141 cases/80 individuals who are over the age of 15 and have been sent for the evaluation of criminal responsibility to Suleyman Demirel University School of Medicine, Forensic Medicine Department, were analyzed. Categorical variables were reported using frequencies and percentages, while numeric variables were reported using mean, standard deviation, mean, and minimal and maximal values. The association between the categorical variables was evaluated using statistical methods such as Pearson chi-square and Fisher's exact tests, depending on the appropriateness of the variables. The normal distribution of numerical variables was assessed using the Kolmogorov-Smirnov test. For numerical variables that did not show a normal distribution, non-parametric tests such as the Mann-Whitney U test or the Kruskal-Wallis test were used based on the number of groups in the independent categorical variable. All data were considered significant if P ≤0.05. Result: The study population showed that 98.6% of the cases were male, and 58.9% of them had experienced issues related to military service due to psychiatric illness. 99.3% had a history of previous legal encounters, and 53.19% were diagnosed with substance use disorder. Forensic expert reports indicated that 70.9% of the cases were fully criminally responsible; 14.2% had diminished criminal responsibility, and 14.9% lacked of criminally responsibility. The study revealed a statistically significant higher rate of issuing diminished criminal responsibility in forensic expert report among those who was seen by Alcohol and Substance Addiction Treatment Center (AMATEM) compared to those who were not seen. Cases that committed crimes against public health had statistically significantly higher rates of methamphetamine, cannabis, or ecstasy use compared to those who committed crimes against property. There was no statistically significant relationship between statements of being under the influence of substances or experiencing substance withdrawal during the crime and the evaluation of criminal responsibility. However, among those professionally evaluated to be in substance withdrawal during the crime, there was a statistically significant higher rate of issuing diminished criminal responsibility in forensic expert report compared to those not in withdrawal, and a statistically significant lower rate of issuing full criminal responsibility in forensic expert report. It was also found that the rate of issuing lack of criminal responsibility was statistically significantly higher for cases with a shorter duration between the crime and the evaluation of criminal responsibility compared to those with a longer duration. Regarding individuals: those with multiple diagnoses had substance use disorder in 45% of individuals, antisocial personality disorder in 41.3%, depressive episodes in 21.3%, and anxiety disorders in 18.8%. Among those with multiple substance use, 48.75% used heroin, 47.5% used methamphetamine, and 38.75% used cannabis. Of those using heroin, 76.9% had seen by AMATEM, as did 50% of those using methamphetamine, and 43.8% of those using cannabis. There was no statistically significant relationship found between the number of substances used and seeing by AMATEM, but there was a statistically significant relationship between seen by AMATEM and heroin use rates. Discussion: Factors such as the manner in which the crime occurred according to the investigation and prosecution documents, the age of the individual, the manner in which the crime is described in their initial statement after the crime, the assessment of mental state during detention, admission and releasing medical examinations after the crime, past psychiatric history, hospitalizations, visit to AMATEM and the proximity of the application to the date of the crime, emotional state while describing the crime during medical examination, previous diagnosis of substance disorder, laboratory report regarding substance use, and the relationship between the committed crime and the effects of substance use or withdrawal (the impairment of the individual's ability to perceive the legal meaning and consequences of their actions or to control their behavior due to the development of withdrawal or the intense distress caused by withdrawal leading to the individual's use of substances) must be evaluated as a whole when evaluating criminal responsibility. It is recognized that substance disorder is also a mental illness, and when individuals with substance dependence commit crimes as a result of it, it is believed that merely punitive measures to isolate them from society for a certain period without enrolling them in any treatment program only postpones the problem rather than solving it. Therefore, it is necessary to conduct studies aimed at understanding the problems experienced by them and to approach them with a multidisciplinary method, taking into account the professional support needed by individuals. Additionally, there is a need to increase both the quantity and quality of treatment centers in order to address their problems effectively. Keywords: Substance dependence, criminal responsibility, forensic psychiatry