The Impulsive Lifestyle Counseling Program for Antisocial Behavior in Outpatient Substance Abuse Treatment

Antisocial personality disorder as a predictor of polydrug use: a longitudinal study of the dual mediating roles of deviant peer association and self-control among juvenile offenders

BACKGROUND

Antisocial personality disorder (APD) has been linked to increased risk for polydrug use (PU). However, there is a dearth of research focusing on the mechanisms underlying this risk.

AIMS

To examine the relationship between APD and PU; to test for the mediating effects of deviant peer association (DVA) and self-control in this relationship; to determine if the magnitudes of observed mediation effects are equivalent.

METHODS

The Pathways to Desistance data were analyzed. Generalized structural equation modeling tested for direct and mediating relationships. Mediation effect equivalence was tested using a Clogg Z test.

RESULTS

Antisocial personality disorder was associated with increased drug use heterogeneity (coefficient = 0.479; CI = 0.107-0.851). This was significantly mediated by self-control and DVA. The magnitude of the mediation was significantly stronger for the self-control path (self-control coefficient = 0.233; CI = 0.044-0.422; DVA coefficient = 0.134; CI = 0.028-0.241).

CONCLUSION

While both self-control and DVA were found to be important for explaining PU in APD, it may be beneficial to focus on self-control to address this problem.

Impulsive Lifestyle Counselling versus treatment as usual to reduce offending in people with co-occurring antisocial personality disorder and substance use disorder: a post hoc analysis

OBJECTIVES

To assess the impact of a short psychoeducation intervention for antisocial personality disorder on offending after randomization to treatment.

DESIGN

Multicentre, superiority, non-blinded randomized controlled trial. Random assignment was conducted in blocks of varying sizes at a central randomization centre. Participants were followed using national register data until 365 days after randomization, migration, or death, whichever occurred first.

SETTING

Thirteen outpatient uptake areas in Denmark.

PARTICIPANTS

Patients with antisocial personality disorder in treatment for substance use disorders were randomized to treatment as usual (TAU, n = 80) or Impulsive Lifestyle Counselling (ILC, n = 96). A total of 165 patients could be linked to criminal records (TAU, n = 74; ILC, n = 91).

INTERVENTION

ILC is a brief psychoeducational program targeting antisocial behavior. The trial was conducted between January 2012 and June 2014.

OUTCOMES

Number of criminal offences leading to convictions based on national registers.

RESULTS

The mean number of offences was 2.76 in the TAU group (95% Poisson confidence interval [CI] = 2.39, 3.16) and 1.87 in the ILC group (95% CI = 0.97, 1.43). Negative binomial regression was used to assess total number of convictions, as well as convictions for violent, property, driving under the influence, and drug-related crimes. In both adjusted and unadjusted analyses, random assignment to ILC was associated with a lower number of total offences (incidence rate risk ratio [IRR] = 0.43, p = .013; adjusted IRR = 0.45, p < .001) and convictions related to violence (IRR = 0.19, p = .001 adjusted IRR = 0.19, p = .007) and property offences (unadjusted IRR = 0.30, p = 0.003, adjusted IRR = 0.42, p = 0.010). Differences between conditions were not significant for driving under the influence (unadjusted IRR = 0.49, p = .370; adjusted IRR = 0.53, p = .417) or drug offences (unadjusted IRR = 1.06, p = .907; adjusted IRR = 0.55, p = .223).

CONCLUSIONS

The ILC program shows promise in reducing offending behavior in people with comorbid substance use and antisocial personality disorder.

TRIAL REGISTRATION

ISRCTN registry, ISRCTN67266318 , 15/10/2012.

Understanding mechanisms underlying the relationship between antisocial personality disorder and substance-impaired driving among young adults involved with the justice system as minors

INTRODUCTION

Antisocial personality disorder is a risk factor associated with increased risk for substance-impaired driving. While past research has focused on identifying prevalence rates for the disorder among substance-impaired drivers, there is a dearth of research focused on identifying the mechanisms by which the disorder actually functions to increase risk for the behavior among young adults who were formerly adjudicated for a serious offense. There are cognitive, affective, and social mechanisms that may help to explain this relationship.

METHOD

Impulse control, hostility, and deviant peer association are examined as mechanisms that explain the relationship in each of these domains, respectively. The Pathways to Desistance data were utilized in analyses, comprising the responses of 1,354 youth who were adjudicated for a serious offense just prior to baseline measurements. Generalized structural equation modeling was used to examine the direct effects of antisocial personality disorder on substance-impaired driving risk and the hypothesized mechanism variables were then included in the model to determine which of them provided significant pathways through which the main relationship operated.

RESULTS

Results indicated that meeting criteria for a diagnosis of antisocial personality disorder was associated with increased risk of substance-impaired driving at follow-up. This relationship was attenuated to non-significance upon inclusion of the mechanism variables and reduced in magnitude by 20%. This attenuation was due almost entirely to impulse control. Practical Applications: This provides indication that intervention for substance-impaired driving offenders with antisocial personality disorder may be most effective when structured around improving impulse control for young adults who were previously involved with the juvenile/criminal justice system.

Antisocial Personality Disorder as a Risk Factor for Opioid Use: The Dual Mediating Roles of Antisocial Attitudes and Self-Control

Antisocial personality disorder is a risk factor for opioid use. There is a dearth of research which examines self-control and moral disengagement as potential mediators of this relationship. This study utilized data from the Pathways to Desistance study in analyses. Generalized structural equation modeling was utilized to test for mediation of the relationship between antisocial personality disorder and opioid use. Bootstrapped standard errors were computed so that a Clogg Z test could be estimated to determine if identified mediation effects significantly differed. Results indicated that a likely diagnosis of antisocial personality disorder increased risk for opioid use. Inclusion of moral disengagement and self-control into the model resulted in attenuation of this effect to non-significance and reduced the magnitude of the effect by around 45%. The contribution of both constructs to the total indirect effect did not significantly differ and only the total indirect effect was significant.

Did you get any help? A post-hoc secondary analysis of a randomized controlled trial of psychoeducation for patients with antisocial personality disorder in outpatient substance abuse treatment programs

BACKGROUND

People in treatment for substance use disorder commonly have comorbid personality disorders, including antisocial personality disorder. Little is known about treatments that specifically address comorbid antisocial personality disorder.

METHODS

Self-rated help received for antisocial personality disorder was assessed during follow-ups at 3, 9 and 15 months post-randomization of a randomized trial of psychoeducation for people with comorbid substance use and antisocial personality disorder (n = 175).

RESULTS

Randomization to psychoeducation was associated with increased perceived help for antisocial personality disorder. Perceived help for antisocial personality disorder was in turn associated with more days abstinent and higher treatment satisfaction at the 3-month follow-up, and reduced risk of dropping out of treatment after the 3-month follow-up, and perceived help mediated the effects of random assignment on days abstinent at 3-month.

FOLLOW-UP

CONCLUSIONS

Brief psychoeducation for antisocial personality disorder increased patients' self-rated help for antisocial personality disorder in substance abuse treatment, and reporting having received help for antisocial personality disorder was in turn associated with better short-term outcomes, e.g., days abstinent, dropout from treatment and treatment satisfaction.

TRIAL REGISTRATION

ISRCTN registry, ISRCTN67266318 , retrospectively registered 17/7/2012.

Reaching out to patients with antisocial personality disorder in substance use disorder treatment: interactions between counsellors and clients in a psycho-educational intervention

Purpose

This article presents the Impulsive Lifestyle Counselling program, a time-limited psychoeducational approach to increasing patient awareness of antisocial personality disorder and its consequences.

Design/methodology/approach

This article describes the ILC program, a program developed as an add-on to treatment for substance use disorders, gives examples of issues and patient-counsellor interactions in the ILC sessions.

Findings

During the ILC sessions the patients engaged with the counsellors in diverse ways, reflecting the varying levels of psychopathology and overall functioning and barriers and incentive for lifestyle changes.

Originality/value

Patients with substance use disorder and comorbid antisocial personality disorder can receive better care with brief counselling that focuses on antisocial behavior and thinking. More diverse evidence-based treatments are needed for this disorder.

Psycho-education for substance use and antisocial personality disorder: a randomized trial

BACKGROUND

Antisocial personality disorder often co-exists with drug and alcohol use disorders.

METHODS

This trial examined the effectiveness of offering psycho-education for antisocial personality disorder in community substance use disorder treatment centers in Denmark. A total of 176 patients were randomly allocated to treatment as usual (TAU, n = 80) or TAU plus a psycho-educative program, Impulsive Lifestyle Counselling (ILC, n = 96) delivered by site clinicians (n = 39). Using follow-up interviews 3 and 9 months after randomization, we examined changes in drug and alcohol use (Addiction Severity Index Composite Scores), percent days abstinent (PDA) within last month, and aggression as measured with the Buss-Perry Aggression Questionnaire-Short Form and the Self-Report of Aggression and Social Behavior Measure.

RESULTS

Overall engagement in psychological interventions was modest: 71 (76 %) of participants randomized to psycho-education attended at least one counselling session, and 21 (23 %) attended all six sessions. The Median number of sessions was 2. All patients reduced drug and alcohol problems at 9 months with small within-group effect sizes. Intention-to-treat analyses indicated significant differences between ILC and TAU in mean drugs composite score (p = .018) and in PDA (p = .041) at 3 months. Aggression declined in both groups, but no differences between ILC and TAU were observed in terms of alcohol problems or aggression at any follow-up.

CONCLUSIONS

Moderate short-term improvements in substance use were associated with randomization to Impulsive Lifestyle Counselling. The findings support the usefulness of providing psycho-education to outpatients with antisocial personality disorder.

TRIAL REGISTRATION

ISRCTN registry, ISRCTN67266318 , 17/7/2012.