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

Figures & data

Table 1 Differences Between Patients with and without Antisocial Personality in a Cohort of Patients in Treatment for Alcohol Use Disorder (n = 113)

	AUD Patients without ASPD	AUD Patients with ASPD	p–values	OR or r
	n = 96 (85%)	n = 17 (15%)
Background
Gender (male)	66 (68.8)	17 (100)	0.006^a
Age (years)	54.1 (48.3–58.5)	39.8 (32.7–50.9)	<0.001^b	0.35
Having paid job as source of income	15 (20.0)	2 (16.7)	1.000^a	0.80
Marital status (living with a partner)	21 (27.6)	1 (8.3)	0.281^a	0.24
Psychosocial measures
HSCL (mean score)	2.0 (1.5–2.6)	2.2 (1.9–2.5)	0.288^b	0.12
Childhood trauma severity	2.0 (0.0–3.0)	4.0 (2.3–4.8)	0.003^b	0.32
Adult trauma severity	1.0 (0.0–2.0)	2.0 (0.5–2.0)	0.104^b	0.18
ASRS 6 (sum score)	11.0 (9.0–16.0)	16.0 (13.5–18.0)	0.009^b	0.29
Self–report measures on addiction
Age at first alcohol use (years)	15.0 (14.0–16.0)	14.0 (12.0–15.0)	0.051^b	0.18
AUDIT	29.0 (21.5–33.5)	34.0 (28.3–38.7)	0.022^b	0.25
History of previous AUD treatment	62 (65.3)	12 (70.6)	0.785^a	1.28
Dependence other substances	14 (14.6)	10 (62.5)	<0.001^a	9.76
Biological measures for alcohol use at inclusion
γ–GT (U/L)	42.5 (26.0–77.5)	29.0 (20.5–63.0)	0.057^b	0.18
PEth (μmol/L)	0.3 (0.1–0.6)	0.2 (0.0–0.6)	0.147^b	0.14
Prolactin (mU/L)	133.5 (99.0–186.5)	132.0 (110.0–186.5)	0.753^b	0.03
Relapse or drop-out 6 weeks
Relapsed or dropped out at 6 weeks	17(19.5)	3 (21.4)	1.000^a	1.04

Notes: Descriptive statistics are presented in the form of number (percentage) for the categorical variables and median (25%–75%) for the continuous variables; ^aFisher’s exact test; ^bMann Whitney’s U-test; effect sizes are reported as Odds ratio (OR) for categorical variable and as “r” for continuous variables.

Abbreviations: ASPD, antisocial personality disorder; AUD, alcohol use disorder; HSCL, Hopkins’ Symptom Checklist; ASRS, Adult ADHD Self-Report Scale; AUDIT, Alcohol Use Disorder Identification Test; PEth: Phosphatidylethanol and γ-GT: Gamma-glutamyltransferase.

Table 2 Logistic Regression Model of Having Comorbid Antisocial Personality Disorder Among Patients in Treatment for Alcohol Use Disorder (n = 113)

	Reference		Unadjusted	p-values	Adjusted ^a)	p–values
Age	Continuous	OR (95% CI)	0.89 (0.84–0.95)	<0.001	0.89 (0.81–0.99)	0.035
Childhood trauma severity	Continuous	OR (95% CI)	1.63 (1.15–2.30))	0.006	2.02 (1.10–3.72)	0.024
ASRS 6 (sum score)	Continuous	OR (95% CI)	1.23 (1.04–1.46)	0.014	1.31 (0.95–1.79)	0.096
AUDIT (sum score)	Continuous	OR (95% CI)	1.15 (1.01–1.30)	0.033	1.07 (0.91–1.25)	0.413
Dependence other substances	Absence of other substance dependence	OR (95% CI)	9.76 (3.06–31.14)	<0.001	4.38 (0.62–30.78)	0.137

Notes: ^a)Adjusted for all significant covariates in the unadjusted analysis; Nagelkerke’s R² for the multiple regression analysis was 0.577 and the Hosmer-Lemeshow goodness of fit test was χ² = 9.623, df = 8, p = 0.292.

Abbreviations: OR, odds ratio; CI, confidence Interval; ASRS, Adult ADHD Self-Report Scale; AUDIT, Alcohol Use Disorder Identification Test.

Table 3 Difference in Early Relapse or Drop-Out Pattern Between Patients with and without Antisocial Personality in a Cohort of Patients in Treatment for Alcohol Use Disorder (n = 96)

	AUD Patients without ASPD				AUD Patients with ASPD				AUD Patients with and without ASPD
	Relapse or Drop-Out		p-values	OR or r	Relapse or Drop-Out		p-values	OR or r	Relapse or Drop-Out
									No		Yes
	No	Yes			No	Yes			p-values	OR or r	p–values	OR or r
	n = 65	n = 17			n = 11	n = 3
Background
Gender (male)	48 (73.8)	11 (64.7)	0.546^a	1.54	11 (100)	3 (100)			0.110^a		0.521^a
Age (years)	54.2 (47.9–58.1)	54.6 (52.6–61.6)	0.232^b	0.13	35.8 (31.1–47.6)	44.2 (33.3–.)	0.243^b	0.31	<0.001^b	0.41	0.491^b	0.15
Having paid job as source of income	10 (18.2)	3 (23.1)	0.702^a	1.35	2 (28.6)	0 (0.0)	1.000^a		0.612^a	1.80	1.000^a
Marital status (having a partner)	14 (25.0)	4 (30.8)	0.730^a	1.33	0 (0.0)	0 (0.0)			0.333^a		1.000^a
Psychosocial measures
HSCL (mean score)	1.9 (1.5–2.5)	2.2 (1.6–3.0)	0.202^b	0.16	2.2 (1.9–2.5)	3.1 (3.0–.)	0.040^b	0.69	0.518^b	0.08	0.146^b	0.38
Childhood trauma severity	2.0 (0.0–3.0)	1.0 (0.0–2.8)	0.394^b	0.10	4.0 (2.0–4.0)	6.0 (6.0–6.0)	0.036^b	0.70	0.084^b	0.22	0.035^b	0.56
Adult trauma severity	1.0 (0.0–2.0)	1.5 (0.0–2.0)	0.692^b	0.05	2.0 (0.0–2.0)	4.0 (4.0–4.0)	0.023^b	0.76	0.394^b	0.11	0.037^b	0.56
ASRS 6 (sum score)	11.0 (8.3–15.0)	11.0 (9.5–16.0)	0.604^b	0.06	16.0 (13.0–18.0)	15.5 (15.0-.)	0.881^b	0.05	0.026^b	0.29	0.439^b	0.20
Self–report measures on addiction
Age at first alcohol use (years)	15.0 (13.0–16.0)	16.0 (15.0–17.5)	0.002^b	0.35	15.0 (13.0–16.0)	12.0 (11.0–.)	0.133^b	0.40	0.832^b	0.02	0.019^b	0.53
AUDIT (sum score)	29.0 (21.5–34.0)	31.0 (27.0–34.0)	0.457^b	0.09	35.0 (29.0–37.0)	28.5 (23.0-.)	0.184^b	0.44	0.022^b	0.29	0.732^b	0.09
History of AUD treatment	41 (64.1)	12 (70.6)	0.776^a	1.35	7 (63.6)	3 (100.0)	0.505^a		1.000^a	0.98	0.539^a
Dependence other substances	10 (15.4)	2 (11.8)	1.000^a	0.73	7 (63.6)	1 (33.3)	0.538^a	0.29	0.002^a	9.63	0.404^a	0.38
Biological measures for alcohol use at inclusion
γ–GT (U/L)	38.0 (26.0–73.0)	55.0 (26.3–84.5)	0.455^b	0.08	23.0 (21.0–31.0)	13.0 (12.0–.)	0.241^b	0.31	0.033^b	0.24	0.044^b	0.46
PEth (μmol/L)	0.3 (0.1–0.6)	0.4 (0.2–0.6)	0.559^b	0.06	0.3 (0.1–0.6)	0.2 (0.0–.)	0.389^b	0.23	0.505^b	0.08	0.071^b	0.40
Prolactin (mU/L)	124.5 (100.0–255.0)	112.0 (79.8–149.8)	0.163^b	0.16	122.0 (72.0–174.0)	169.0 (159.0-.)	0.243^b	0.31	0.675^b	0.05	0.025^b	0.51

Notes: Descriptive statistics are presented in the form of number (percentage) for the categorical variables and median (25%–75%) for the continuous variables; ^aFisher’s exact test, ^bMann Whitney’s U-test; effect sizes are reported as Odds ratio (OR) for categorical variable and as “r” for continuous variables; Due to small sample size in the relapse or drop-out group on patients with ASPD, we were not able to report the 75 percentiles for most of the variables.

Abbreviations: ASPD, antisocial personality disorder; AUD, alcohol use disorder; HSCL, Hopkins’ Symptom Checklist; ASRS, Adult ADHD Self-Report Scale; AUDIT, Alcohol Use Disorder Identification Test; PEth: Phosphatidylethanol and γ-GT: Gamma-glutamyltransferase .

Figure 1 Comparison of alcohol use disorder patients (N=96) with and without comorbid antisocial personality in terms of early relapse or drop-out versus treatment adherence (No relapse and no drop-out) using Mann Whitney’s U-test. Panel (A) shows age at first drink, panel (B) shows childhood trauma severity, panel (C) shows adult trauma severity and panel (D) shows baseline levels of prolactin using mean, standard deviation, and level of significance.