A behavioral treatment for opioid-dependent patients with antisocial personality.
Antisocial personality disorder (APD) is associated with increased problem severity in treatment-seeking opioid-dependent patients. Treatment studies have reported mixed results but generally show that patients with APD make progress that is often comparable to drug-dependent patients without the personality disorder. Much of this work is based on secondary analyses of studies evaluating responses to a variety of drug abuse treatment interventions. This study reports on a randomized prospective trial evaluating a behavioral approach for managing opioid-dependent patients with APD. Subjects (N = 100) met Diagnostic and Statistical Manual of Mental Disorders criteria for opioid dependence and APD using a structured clinical interview and were randomly assigned to either an experimental condition (n = 51), which used a highly structured contingency management intervention, or a control condition (n = 49), which reflected standard methadone treatment. Subjects in the experimental group had significantly better counseling attendance and some indication of lower psychosocial impairment compared to the control group. The experimental intervention increased attendance in subjects with low and high levels of psychopathy and with and without other psychiatric comorbidity. These findings support the development of interventions more tailored to drug-dependent patients with APD.
Neufeld
Karin J
KJ
Department of Psychiatry and Behavioral Science, The Johns Hopkins School of Medicine, Baltimore, MD, USA
Kidorf
Michael S
MS
Kolodner
Kenneth
K
King
Van L
VL
Clark
Michael
M
Brooner
Robert K
RK
D000328:Adult; D000987:Antisocial Personality Disorder / Q000453:epidemiology*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003710:Demography; D005260:Female; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D009294:Narcotics / Q000627:therapeutic use*; D009293:Opioid-Related Disorders / Q000453:epidemiology* / Q000628:therapy*; D010349:Patient Compliance / Q000706:statistics & numerical data; D016896:Treatment Outcome
D009294:Narcotics; D008691:Methadone