Antisocial personality and drug abuse treatment process

Abstract

Evaluators of drug abuse treatment frequently report that antisocial personality (ASP) is prevalent among treatment clients and is associated with poorer outcomes; however, these findings are not universal. In these studies, attention has been given to various definitional aspects of the ASP diagnosis, but few have addressed the role of treatment process. The current study defined three groups of clients, based on age of onset for antisocial behaviors as well as number of behaviors. Clients who met only adult antisocial criteria were generally similar to those who met both childhood and adult criteria, in terms of pretreatment background. Using a structural equation modeling framework, a moderating effect of ASP was found. Specifically, the three groups exhibited different structural models of treatment process and outcome. Alliance with counselor and during-treatment cocaine use were important determinants of retention in treatment and long-term outcomes for clients who met both childhood and adult criteria. For clients who met only adult criteria, a desire for help in addressing drug problems was associated with dropout from treatment if no satisfactory alliance with counselor developed.