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Antisocial Personality Disorder and Addiction

A co-occurring disorder is a term used when a person has a substance use disorder (SUD) and a mental health disorder at the same time.1 The disorders can influence one another in a way that makes symptoms more severe.1

An antisocial personality disorder is a type of severe mental health disorder that has a strong correlation with substance misuse. Antisocial personality disorder and addiction can co-occur.3 Continue reading to learn about what antisocial personality disorder is, potential causes, the signs of antisocial personality disorder, and the relationship between antisocial personality disorder and addiction.

What is Antisocial Personality Disorder?

An antisocial personality disorder is classified as a cluster B type personality disorder in the Diagnostic and statistical manual of mental disorders, 5th Edition (DSM 5), in which people have emotional and unpredictable behavior when interacting with other people.3 It is characterized by highly dysfunctional thought processes and deceitful, manipulative behaviors that show disregard and lack of empathy for others.2, 3, 5

Diagnosis of antisocial personality disorder can sometimes be confused with:5

  • Other personality disorders due to common features.
  • Substance use disorders.
  • Schizophrenia and bipolar disorders.
  • Criminal behavior that is unrelated to mental health disorders.

An antisocial personality disorder is correlated with a high rate of substance misuse.3, 5 People who have co-occurring antisocial personality disorder and substance use disorders are also more likely to begin using substances at earlier ages, which can make rehabilitation a more challenging process.7

Causes of Antisocial Personality Disorder

The exact cause of antisocial personality disorder isn’t known, but research suggests a combination of genetic and environmental factors.3 Adverse childhood experiences, which consist of exposure to varying forms of trauma, are thought to be a significant environmental cause.3 Childhood disorders, like conduct disorder and attention deficit hyperactivity disorder (ADHD), also showed an increased risk for developing an antisocial personality disorder.3

Childhood trauma survivors show a significant risk of developing co-occurring disorders.1 The development is thought to correlate to attempts to self-medicate from the trauma or to manage post-traumatic stress symptoms.1 People with mental illness may experience changes in the brain that can make the rewarding effects of substances more intense, which may lead them to continued substance use.1

Signs of Antisocial Personality Disorder

Only a trained mental health professional can diagnose antisocial personality disorder, other mental health disorders, and substance use disorders. A mental healthcare practitioner can identify symptoms and prescribe appropriate treatment, which may include medication, and refer to a medical doctor for additional physical concerns.3 Medical care is important because many people with antisocial personality disorder are at higher risk for traumatic injuries, sexually transmitted illnesses (STIs), and suicide.3

Criteria for being diagnosed with an antisocial personality disorder include the following:5

  • A pattern that demonstrates disregard or violation of rights of others since the age of 15. Must include 3 of the following:
    • Consistent problems with authority or abiding by the law
    • Repeated actions of conning others and lying—usually for self-pleasure or profit
    • Impulsive behavior
    • Irritability or aggressive behavior that can lead to fights or physical assault
    • No sense of safety for self or others
    • Irresponsible tendencies, such as failing to show up to work or school consistently
    • Lack of remorse, empathy, or compassion, or an indifferent attitude toward mistreating another person
  • The person must be 18 or older.
  • A history of conduct disorder, typically before the age of 15.
  • Displays antisocial behavior that cannot be explained by another diagnosis.

All other disorders should be ruled out through a careful physical examination and history intake before diagnosing antisocial personality disorder to ensure a person receives proper care and treatment.3

What’s the Relationship Between Antisocial Personality Disorder and Addiction?

Antisocial personality disorder and substance abuse are often influenced by trauma, leaving the person at a higher risk of developing these disorders.3 Personality disorder diagnoses, like antisocial personality disorder, range from 34.8% to 78% among people who are diagnosed with an addiction.7

Overlapping causes for co-occurring substance use and mental health disorders include stress, epigenetics, brain changes, and adverse childhood experiences.1

Antisocial personality disorder and borderline personality disorder are among the top 2 personality disorders ranked for prevalence among people diagnosed with a substance use disorder.7

Researchers believe that antisocial personality and substance use disorders are commonly diagnosed together because of impulsive and aggressive tendencies.8 Both disorders affect the same part of the brain, leading to an increased risk of aggression and impulsivity.8

Co-Occurring SUDs with Antisocial Personality Disorder

Alcohol, cannabis, and nicotine use disorders are most commonly diagnosed in people with an antisocial personality disorder.7 There’s an increase in the chances of a person receiving an antisocial personality disorder diagnosis if they have long-term drug use that exceeds 12 months.6

A pattern of polysubstance misuse can also be observed in those who have an antisocial personality disorder and misuse substances.6 This may be attributed to what’s available to the person at the time of use. As teenagers and children are developing, substances can have a greater impact on their brain functioning, resulting in more severe mental illness and substance use disorder symptoms.1

Alternatively, having a mental illness in childhood increases the odds that a person will be diagnosed with a substance use disorder.1 Better diagnosis methods and identification can help bridge this gap in care that can later lead to co-occurring disorders.1

Treatment for Co-occurring Disorders

Individualized treatment is important when treating mental health and substance use disorders to ensure each person gets the appropriate level of care and support necessary to help them recover.4

The following are different types of treatment used for co-occurring antisocial personality disorder and substance use disorder:7

  • Behavioral therapies like dialectical behavioral therapy have been found to be effective for personality disorders in some studies. However, more research and analysis need to be done.
  • Pharmacotherapy, or the use of medication, is highly encouraged to help treat aspects of antisocial personality disorder and SUDs. Medications can help address aggression, impulsivity, ADHD, and moods associated with an antisocial personality disorder. Medication for the treatment of certain SUDs can help reduce withdrawal symptoms and reduce cravings when a person enters treatment.

Unfortunately, there aren’t many studies available that report on effective treatment for co-occurring antisocial personality disorder and substance use disorder.3 This is due to a multitude of challenges that people face when getting treatment.

The following are common challenges a practitioner may encounter when treating a person with antisocial personality disorder and substance use disorder together:

  • Higher risk for incarceration, which can delay or block treatment altogether.3
  • Research has shown that hospitalization is an ineffective method of treatment and can often escalate the behavior.3
  • Many people are noncompliant with treatment, making regular treatment attendance difficult.3
  • The treatment team may not be properly trained in treating psychiatric conditions like antisocial personality disorder.3

Find Treatment for Co-occurring Disorders

Living with or supporting a person with co-occurring disorders can be challenging; however, with support, you or a loved one may find the help they need to stop using substances and start on a new path.

American Addiction Centers (AAC) specializes in treating co-occurring disorders and has facilities across the U.S. ready to support you. Contact our caring admissions staff at to get your questions answered and learn about treatment options. If you have health insurance, they can check your insurance to see how it can help pay for treatment, so you can get started today.