Court Mandates Help Men With Antisocial Personality Disorders Stay in Treatment

Men with co-occurring substance abuse and antisocial personality disorders may particularly benefit from judicially mandated addiction treatment. Such legal pressure has been shown to exert a positive effect on treatment retention in a general population of drug abusers (see What the Numbers Say).

Dr. Stacey B. Daughters and colleagues at the University of Maryland recently studied 236 men who began therapy for substance abuse problems. Ninety-three of the men met standard criteria for antisocial personality disorder (ASPD), a condition characterized by chronic behavior problems, deceitfulness, and lack of conscience and regard for others.

Among men without ASPD, 85 percent remained in therapy whether the treatment was voluntary or mandated. However, the investigators found that among men with ASPD, about 94 percent of those who were legally required to participate in residential substance abuse treatment remained for a month, compared with just 63 percent of those who had volunteered to enter treatment.

Although ASPD is rare in the general population, researchers estimate that 40 to 50 percent of people in drug treatment programs have the disorder. Moreover, prior research suggests that ASPD increases the risk for addiction treatment dropout, relapse, and, among those with jail sentences, a return to criminal behavior.

The Maryland team's findings have two important implications for substance abusers with ASPD: Judicial mandates offer a way to keep them in addiction treatment programs, and voluntary participants may require special interventions to keep them actively engaged in therapy.

Journal of Substance Abuse Treatment 34(2):157-164, 2008. [Abstract]