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DSM-III-R antisocial personality disorder and first lapse to drugs among participants in residential relapse prevention/health education treatment for drug abuse
Abstract
The study examined the association of antisocial personality disorder (ASPD), compared to syndromal adult antisocial behavior without childhood conduct disorder, with time to and severity of first posttreatment lapse to drugs among clients in residential relapse prevention/health education treatment. It also investigated gender differences in ASPD symptom patterns, subtypes of ASPD defined by presence vs. absence of remorse, and validity of self-reported posttreatment abstinence measured against results of hair analysis. Data were drawn from the baseline and first follow-up assessments of Project IMPACT, a federally funded study of the efficacy of residential drug abuse treatment in reducing HIV risk. Participants' baseline demographics, drug behaviors, psychiatric comorbidity, and circumstances of index admission were examined in bivariate analyses to determine their association with ASPD. ASPD and variables associated with it at baseline were subjected to bivariate and multivariable survival analyses to determine their associations with lapse risk. Differences in symptom patterns by gender and remorse, severity of first lapse, and validity of self-reported drug behavior were investigated using contingency table approaches. ASPD was associated with a small increase in lapse risk among subjects followed within 180 days after treatment exit, but was not the most important determinant of first lapse. The nature of the data precluded meaningful evaluation of the contribution of lack of remorse to risk. Individuals entering treatment at the prompting of the legal system and because of "wanting to get clean" were at increased risk; females, nonwhites, older clients, those staying longer in treatment, and those with longer previous voluntary abstinences from drugs were at decreased risk. Neither ASPD nor lack of remorse was associated with severity of lapse. Gender differences in ASPD symptom patterns mainly resembled those found in the general population, although some may have reflected factors selecting clients into treatment. Associations of the likelihood of lapse with age, race, and time in treatment, and variations in ASPD symptom patterns with gender, suggest implications for the design of treatment programs. Participants with ASPD were less likely than others to have self-reported abstinence corroborated by hair analysis.
Subject Area
Public health
Recommended Citation
Goldstein, Rise Belle, "DSM-III-R antisocial personality disorder and first lapse to drugs among participants in residential relapse prevention/health education treatment for drug abuse" (1994). Doctoral Dissertations Available from Proquest. AAI9420629.
https://scholarworks.umass.edu/dissertations/AAI9420629