Therapeutic community treatment outcomes for substance abusers with antisocial personality disorder

Literature on substance abuse treatment outcomes for clients diagnosed with antisocial personality disorder (APD) remains limited, There is a belief that persons diagnosed with APD will not respond well to treatment, but the limited existing research has not supported this hypothesis. There is also controversy over the proper measurement of APD in substance-abusing populations. This study had two goals, to assess the degree to which specific diagnostic instruments differ in their assessment of APD and to examine the relationship of APD to treatment outcomes.;The Structured Clinical Interview for DSM-III-R (SCID-III), a clinically generated instrument, and the Millon Clinical Multiaxial inventory (MCMI-II), a self-report inventory, were administered to 275 clients randomly assigned to two therapeutic communities (TCs). It was hypothesized that there would be minimal agreement between the two scales diagnosis of APD. This hypothesis was supported. The kappa statistic indicated low agreement between the scales (kappa = .27), with the MCMI-II diagnosing APD more often than the SCID-II. The low agreement on a diagnosis of APD may be due to the different types of information collected by the scales. The SCID-II emphasizes observable behavioral criteria, while the MCMI-II emphasizes pathological personality traits, The MCMI-II's focus on pathological personality traits nay more accurately diagnoses APD in substance-abusing populations with extensive criminal histories. Definite conclusions regarding the proper measurement of APD in substance-abusing samples is difficult without additional empirical evidence.;It was also hypothesized that clients diagnosed with APD via the MCMI-II would have poorer treatment outcomes than those with no APD, while a SCID-II diagnosis of APD would be unrelated to outcomes. This hypothesis was not supported. Logistic regression analyses indicated that a MCM-II diagnosis of APD was unrelated to treatment outcomes. Moreover, SCID-II APD clients were more likely to complete treatment than those with no APD. Treatment completion was the most important factor in reducing recent drug use and post-discharge arrests.;The results indicate that persons diagnosed with APD, with histories of substantial drug abuse and criminality, can benefit from TC treatment with aftercare in the community or at the very least, do as well as those with no APD.