Antisocial personality disorder (ASPD) is an officially recognized condition that belongs to a larger group of mental health disorders known as personality disorders. People with the condition have a persistent pattern of exploitative, manipulative behaviors that violate social norms, damage or impair relationships, and infringe upon aspects of other people’s personal rights. Some mental health professionals equate ASPD with the presence of a psychopathic personality, while others believe the two disorders are distinct. The vast majority of people with antisocial personality disorder abuse drugs and/or alcohol. Conversely, many people with substance abuse issues show signs of ASPD.
No one knows exactly what triggers the onset of antisocial personality disorder. However, current evidence indicates that genetic inheritance and exposure to abuse during childhood play significant roles in its development. Statistically speaking, known risks for ASPD include having a parent with the disorder, having a parent with alcoholism, and being male; fully three times more men develop the disorder than women. Because personality is still developing during childhood and adolescence, doctors rarely diagnose the condition in someone under the age of 18, even if he or she shows signs of antisocial behavior. Still, researchers in the field know that childhood involvement in animal cruelty or arson can sometimes point toward a future ASPD diagnosis.
The US National Library of Medicine’s PubMed Health lists symptoms of antisocial personality disorder that include repeated breaking of laws; lack of remorse for one’s actions; frequent involvement in fighting or stealing; frequent lying; indifference to actions that harm others; indifference to self-harm; easy use of flattery or other forms of emotional or social manipulation; outbursts of anger or arrogant behavior; and easy use of charm or wit when required. When mental health professionals differentiate between antisocial personality disorder and psychopathic personality disorder, they do so because people with ASPD have moderate forms of these symptoms, while people with psychopathic personality disorder have more severe forms of these symptoms.
No one has developed an effective treatment for antisocial personality disorder, PubMed Health explains. Overwhelmingly, people with the disorder don’t voluntarily enter treatment programs specifically designed to address their symptoms. Partly as a result of this fact, most ASPD treatment takes place in response to a court order, or in a prison environment after court proceedings have ended.
ASPD and Substance Abuse
According to researchers at Marquette University, fully 90 percent of all people with ASPD abuse drugs or alcohol. Whether officially diagnosed or not, as many as 40 to 50 percent of all people in substance abuse treatment programs have enough ASPD symptoms to verify an antisocial personality diagnosis. The simultaneous presence of substance abuse and ASPD is known as comorbidity. This term refers to the presence of two or more health conditions, as well as interactions between those conditions that change or intensify their effects on the body. In the case of drug and alcohol abuse, people who also have antisocial personality disorder tend to start abusing their substance of choice at an earlier age than people who don’t have the disorder. In addition, substance abusers with ASPD develop serious abuse-related problems faster than abusers without ASPD; they also develop more damaging forms of these problems.
Problems With Treatment
As stated previously, there is no known treatment that consistently addresses the symptoms of antisocial personality disorder. In fact, many mental health professionals consider the disorder both untreatable and more or less incurable. When they try to enter treatment designed to deal with substance abuse issues, many people with ASPD get excluded from participation simply because they have an antisocial personality diagnosis or exhibit symptoms of antisocial behavior. Similarly, when substance abusers with ASPD try to get treatment for their antisocial behaviors, they often get excluded from participation because their substance-related issues are deemed disruptive to the treatment process.
Despite ASPD’s reputation as an untreatable condition, some patients gain benefits from forms of therapy called cognitive behavioral therapy (CBT) and contingency management (CM). People undergoing cognitive behavioral therapy learn how to think about stressful or challenging situations in new, more manageable ways, then learn how to apply this new thinking in real-world conditions. People undergoing contingency management receive positive reinforcement for behaviors that support the goals of treatment, and either a lack of positive reinforcement or active punishment for behaviors that don’t support the stated treatment goals. According to a 2009 study reported by the National Institute on Drug Abuse, men with comorbid ASPD and substance abuse problems do best when their treatment is mandated by a court of law.