Antisocial Personality Disorder Among Patients in Treatment for Alcohol Use Disorder (AUD): Characteristics and Predictors of Early Relapse or Drop-Out

Abstract

Background

Patients with alcohol use disorders (AUD) vary significantly in many clinically important characteristics making them a heterogenous group. AUD patients with comorbid antisocial personality disorder (ASPD) form an important sub-group, and studies indicate that these patients may have poorer treatment outcomes. Therefore, we aimed to investigate the characteristics of AUD inpatients with comorbid ASPD and identify predictors of early relapse or treatment drop-out in these patients.

Methods

In a longitudinal study of AUD patients (n = 113; 30 females; aged 27 to 72 years) in treatment at three residential rehabilitation clinics in Norway, we used interviews and self-report questionnaires to collect data on alcohol use, mental health, and trauma experience. In addition, we assessed biochemical parameters. The patients were followed up at 6 weeks to identify early relapse or drop-out.

Results

Prevalence of ASPD among AUD patients was 15%. AUD patients with comorbid ASPD were exclusively male, of younger age, and reported more childhood trauma, and adult attention-deficit-hyperactivity-disorder symptoms. They reported more hazardous drinking behavior and more often had dependence on substances in addition to alcohol. The presence of ASPD did not predict early relapse or drop-out. However, early relapse or drop-out in ASPD patients was associated with childhood and adult trauma, younger age of drinking debut, and higher baseline prolactin levels.

Conclusion

AUD patients with ASPD had different clinical characteristics to other AUD patients and they had specific predictors of early relapse or drop-out. Our findings indicate that the early relapse or drop-out among AUD patients with ASPD may be attributed to environmental and possibly biological vulnerability. However, further studies with larger sample size are warranted to confirm these preliminary associations.

Keywords:

• alcohol use disorder
• antisocial personality disorder
• relapse
• drop-out

Abbreviations

AUD, Alcohol Use Disorder; ASPD, Antisocial Personality Disorder; ADHD, Attention Deficit Hyperactivity Disorder; ASRS, Adult ADHD Self-Report Questionnaire; M.I.N.I, Mini International Neuropsychiatric Interview; AUDIT, Alcohol Use Disorders Identification test; HSCL-10, Hopkins Symptom checklist-10; γ-GT, Gamma-glutamyltransferase; PEth, Phosphatidylethanol; DSM-IV-TR, Diagnostic and Statistical Manual of Mental Disorders fourth edition text revision; DALYs, Disability-Adjusted Life Years; SFC-MS, Supercritical Fluid Chromatography-Mass Spectrometry; UPC², Ultraperformance Convergence Chromatography.

Acknowledgments

We would like to acknowledge the Research Council of Norway for funding the study; patients for participating in the study; and the treatment centres Riisby, Blå Kors and Trasoppklinikken for serving as data collection sites.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

The study was funded by the Research Council of Norway. The funding body was not involved in the design of the study, the collection, analysis, or interpretation of data, or in the preparation of manuscript.