Antisocial personality disorder and opioid treatment outcomes: A review

The purpose of this review is to examine treatment outcomes for opiate dependent drug users meeting the criteria for comorbid antisocial personality disorder (ASPD). Peer-reviewed papers were identified searching Medline, PsycInfo and bibliographies of seminal papers. Twenty-two studies from nine different cohorts of participants are presented, the majority of which were conducted within community-based methadone maintenance programs. Few differences were observed for those with and without ASPD receiving treatment of opioid dependence with respect to retention, reductions in HIV risk behaviors and drug use. Results were also quite consistent across treatment modalities. However, subgroups of treatment-refractory opiate users with ASPD were found, including those continuing to use cocaine and benzodiazepines while enrolled in a methadone program. Compared with those without ASPD, treatment response to psychotherapy and pharmacologic therapy was lower among opiate users with comorbid ASPD. Implications for future research and substance abuse treatment are discussed.