The Treatment of Substance Misuse in Psychopathic Individuals: Why Heterogeneity Matters

Abstract

Psychopathy is a personality syndrome characterized by egocentricity, grandiosity, remorselessness, callousness, impulsivity, and manipulativeness. It is also a disorder highly comorbid with substance use disorders (; ; ). However, unlike their other criminal counterparts, psychopaths' substance use related problems appear remarkably resilient despite treatment () leading many to conclude the dually diagnosed psychopathic substance misuser is “untreatable.” However, this pessimistic stance is predicated upon the notion that psychopathy is a homogeneous, categorical construct. Such a conclusion leaves little hope for treating substance use problems in this population, and has certainly attenuated efforts at developing effective clinical interventions (). In this review, we argue that conceptualizing psychopathy as a heterogeneous and dimensional construct reveals a common thread of negative emotionality (NEM) that may clarify the relations between psychopathy and substance use disorders as well as pave the way for more practical and viable treatment options.

Keywords:

• psychopathy
• substance use disorders
• treatment
• subtypes
• criminals

Notes

¹Treatment can be briefly and usefully defined as a planned, goal directed, and temporally structured change process; of necessary quality, appropriateness and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help based (AA, NA, etc.), and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities – which aren't also used with nonsubstance users. In the West, with the relatively new ideology of “harm reduction” and the even newer Quality of Life (QOL) treatment-driven model, there is now a new set of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Editor's note.