Drinking Outcomes of Alcohol Abusers Diagnosed as Antisocial Personality Disorder


  • This work was supported by the U.S Public Health Service Grants ROIA007812 and ROIAA 05827 from the National Institute on Alcohol Abuse and Alcoholism. A report of these findings was presented at the annual meeting of Research Society on Alcoholism, San Diego, CA, June 1992.

Reprint requests: Richard Longabaugh, Ed. D., Center for Alcohol and Addiction Studies. Brown University, Box G-BH, Providence, RI 02912.


Clinical research and wisdom suggest that alcoholics with antisocial personality (ASPs) disorders have poorer drinking outcomes after treatment than alcoholics without this disorder. The present study challenges this wisdom, suggesting that poor prognosis and response to treatment have been confounded by not covarying on pretreatment drinking measures. Thirty-one ASPs are compared with 118 non-ASPs randomly assigned to extended cognitive behavioral and relationship enhancement treatments. Thirteen to 18 months after treatment initiation, ASPs average more abstinent days than do non-ASPs. Drinking intensity is a function of a patient-treatment matching effect: ASPs treated with cognitive behavioral treatment (CB) drink less/drinking day than do either non-ASPs treated in CB or ASPs treated in relationship enhancement. This finding is supportive of a comparable matching effect for CB and ASP found by Kadden et al. (1989). Examination of the process indicates that, irrespective of drinking index, ASPs respond poorly when they experience high posttreatment support for abstinence, whereas non-ASPs respond better with support. We conclude that early pessimism for successful treatment of ASP alcoholic drinking outcomes may be unwarranted.