Cue-induced inhibitory control in forensic patients with alcohol use disorder: A link to criminal recidivism risk assessed by factor 2 psychopathy.

Cue-reactivity and impaired inhibitory control represent well-established mechanisms contributing to substance use relapse, which, in turn, increases the risk of criminal reoffending in forensic populations whose offending behavior is closely linked to substance use. In Germany, such individuals may be mandated to custodial addiction treatment under Section 64 of the Criminal Code (§ 64 StGB). To date, it remains largely unexplored whether inhibitory control deficits under substance-cue exposure relate more directly to indicators of criminal recidivism risk in forensic addiction populations. The present work addresses this gap by examining the relationship between cue-induced inhibitory control and a validated proxy of reoffending risk. Fifty-one abstinent male forensic patients (24 with alcohol use disorder (AUD), 27 with other substance use disorders (SUD)) undergoing treatment under Section 64 completed two Go/NoGo tasks assessing inhibitory control under alcohol-related and neutral stimulus conditions. Controlling for relevant covariates, inhibitory performance (adjusted d ' ) was used to predict scores on Factor 2 of the Psychopathy Checklist: Screening Version (PCL:SV). Among patients with AUD, weaker inhibitory control in the alcohol-cued condition was strongly associated with higher PCL:SV Factor 2 scores (β = -0.79, p = .004), whereas no such association emerged for the neutral condition or for patients with other SUDs. These findings suggest a context-specific link between cue-elicited inhibitory deficits and criminogenic risk in forensic patients with AUD. Cue-related inhibitory impairments may represent a key cognitive mechanism connecting substance use to criminal (re-)engagement. If replicated longitudinally, such measures may inform future approaches to risk assessment and intervention in forensic addiction treatment.