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Antisocial Personality Disorder and Substance Abuse: Signs, Symptoms and Treatment

Treating Sociopathy and Addiction

People with antisocial personality disorder, also known as psychopathy or sociopathy, are at risk for addiction and are more likely to be involved in the criminal justice system.1,2 These people require an integrated treatment plan designed for those with a dual diagnosis.

Antisocial Personality Disorder Definition

Antisocial personality disorder is defined as a “pervasive pattern of disregard for and violation of the rights of others that begins in childhood or early adolescence and continues into adulthood.”1

To receive this diagnosis, the person must be at least 18 years old and have a history of conduct disorder. Conduct disorder is the precursor for sociopathy and is manifested by the following:1

  • Lying or stealing.
  • Aggression toward animals and people.
  • Harming property.
  • Severe rule-breaking.

Signs and Symptoms of Antisocial Personality Disorder

For someone to be diagnosed with antisocial personality disorder, at least 3 of the following signs and symptoms must have been present since the person was 15 years old. That person must also have displayed some signs of conduct disorder during childhood. 1
  • Engages in illegal activities and avoids conforming to social norms.
  • Persistently lies and cons others for enjoyment or personal gain.
  • Displays impulsive behaviors or lack of planning for the future.
  • Exhibits aggressiveness and irritability, which result in violence.
  • Shows complete neglect for the safety of others and self.
  • Demonstrates a lack of responsibility in all facets of life (fails to meet work or financial obligations).
  • Shows an inability to feel remorse after having mistreated or hurt someone.

Personality Features

These individuals tend to lack empathy and are consistently indifferent to the pain of others. Personality features typically include: 1

  • Arrogance.
  • Superficial charm.
  • Self-assured.
  • Extremely opinionated.
  • Exploitive.
  • Irresponsible in many facets of life (parenting, school, work, finances).
  • Manipulative.
  • Features of other personality disorders (narcissistic, borderline).

People with antisocial personality disorder may report feelings of depression, tension, and an inability to tolerate boredom. 1 They are more likely to die due to violence (murder, accidents, suicide) than the general population. 1

Antisocial Personality Disorder and Addiction

Many people with antisocial personality disorder abuse drugs or alcohol. One study found that 90% of people with antisocial personality disorder also suffered from a comorbid substance addiction, while between 40% and 50% of those addicted to drugs or alcohol met the criteria for sociopathy.4

People with antisocial personality disorder and a co-occurring substance abuse disorder are said to have a dual diagnosis and require a comprehensive form of treatment. These people also tend to have more profound physical, legal and social problems from substance abuse. They may have an earlier onset of drug use and quicker development of addiction than non-sociopathic addicts.

The highest rates of psychopathy are seen among men with severe alcoholism or substance addiction in prisons, clinics or other forensic settings. 1 The prevalence rate for this disorder is estimated to be anywhere between 0.2% and 3.3%. 1

Dual Diagnosis Treatment for Sociopathy and Addiction

You should look for certain qualities in a dual diagnosis rehab that will treat co-occurring antisocial personality disorder and substance addiction. The best inpatient dual diagnosis facilities will provide the following services:

  • Intake evaluation. You will be evaluated for any undiagnosed mental health conditions, and the severity of your addiction and personality disorder will be assessed in order to create an individualized treatment plan.
  • Detox.You will receive around-the-clock care while detoxing from alcohol or drugs and medication, if necessary.
  • Medical maintenance. Although not typically recommended for sociopaths or psychopaths, medication can be used to treat co-morbid anxiety or depression, or severe aggression, in some cases. 6
  • Therapy. Therapists who are experienced in treating antisocial personality disorder will be aware of their own feelings and will set limits to minimize the person’s manipulation. They will work patiently with the individual on negative, aggressive and controlling behaviors. 7
  • Group counseling. Group counseling can be effective for learning pro-social skills and sharing experiences with others.
  • Aftercare planning. Your treatment team will collaborate on an appropriate plan for you once you completed your recovery program. This will consist of ongoing treatment and relapse prevention. Examples of aftercare include:

Difficulties Treating Antisocial Personality Disorder

It may be more difficult to treat addiction in those with antisocial personality disorder than other mental health disorders. Typically, psychopaths or sociopaths don’t seek treatment on their own. They are more likely to enter a recovery program when treatment is mandated by a court.3 Additionally, those with antisocial personality disorder are more likely to drop out of substance addiction treatment and relapse.5 Court-mandated treatment may be the best option for those with a dual diagnosis. A specialized treatment plan may need to be developed to retain them in the program.5

Antisocial Personality Disorder Causes

Antisocial personality disorder is thought to be caused by both environmental and genetic influences. 3 Below are a few risk factors that may increase the odds that someone develops antisocial personality disorder or that childhood conduct disorder will evolve into psychopathy: 1

  • Erratic parenting.
  • Inconsistent discipline from parents.
  • Child neglect or abuse.
  • Having an alcoholic or antisocial parent.

Many more males than females develop antisocial personality disorder, and this disorder is often found among prisoners. 3

Find a Dual Diagnosis Recovery Center

Call today to find the best dual diagnosis recovery program that specializes in the treatment of substance addiction and antisocial personality disorder. A representative can confirm your insurance over the phone and help you find a recovery program based on your coverage.

If you don’t have insurance, call the Substance Abuse and Mental Health Services Administration’s (SAMHSA) national helpline at 1-800-662-HELP (4357). They can refer you to a treatment program in your area that helps those without insurance.

[1]. Diagnostic and statistical manual of mental disorders: DSM-5. (2013). Washington, D.C.: American Psychiatric Association.

[2]. Mueser, K. T., Crocker, A. G., Frisman, L. B., Drake, R. E., Covell, N. H., & Essock, S. M. (2005). Conduct Disorder and Antisocial Personality Disorder in Persons With Severe Psychiatric and Substance Use Disorders. Schizophrenia Bulletin 32(4), 626-636. Retrieved February 16, 2016.

[3]. National Library of Medicine. Antisocial personality disorder: MedlinePlus Medical Encyclopedia.

[4]. Messina, N., Wish, E., & Nemes, S. (1999). Therapeutic community treatment for substance abusers with antisocial personality disorder. Journal of Substance Abuse Treatment, 17, 121-128.

[5]. National Institute on Drug Abuse. (2009). Court Mandates Help Men With Antisocial Personality Disorders Stay in Treatment.

[6]. Meloy, J. R. (2007). Antisocial Personality Disorder (Vol. 51). Washington, DC: American Psychiatric Pub.

[7]. Beck A, Freeman A, Davis DD, et al. (2004). Antisocial personality disorder. In: Cognitive Therapy of Personality Disorders, 2nd ed, Guilford Press, New York 2004.