Top

BMC Psychiatry

Published in:

Open Access 01-12-2015 | Research article

Psycho-education for substance use and antisocial personality disorder: a randomized trial

Authors: Birgitte Thylstrup, Sidsel Schrøder, Morten Hesse

Published in: BMC Psychiatry | Issue 1/2015

Abstract

Background

Antisocial personality disorder often co-exists with drug and alcohol use disorders.

Methods

This trial examined the effectiveness of offering psycho-education for antisocial personality disorder in community substance use disorder treatment centers in Denmark. A total of 176 patients were randomly allocated to treatment as usual (TAU, n = 80) or TAU plus a psycho-educative program, Impulsive Lifestyle Counselling (ILC, n = 96) delivered by site clinicians (n = 39). Using follow-up interviews 3 and 9 months after randomization, we examined changes in drug and alcohol use (Addiction Severity Index Composite Scores), percent days abstinent (PDA) within last month, and aggression as measured with the Buss-Perry Aggression Questionnaire-Short Form and the Self-Report of Aggression and Social Behavior Measure.

Results

Overall engagement in psychological interventions was modest: 71 (76 %) of participants randomized to psycho-education attended at least one counselling session, and 21 (23 %) attended all six sessions. The Median number of sessions was 2. All patients reduced drug and alcohol problems at 9 months with small within-group effect sizes. Intention-to-treat analyses indicated significant differences between ILC and TAU in mean drugs composite score (p = .018) and in PDA (p = .041) at 3 months. Aggression declined in both groups, but no differences between ILC and TAU were observed in terms of alcohol problems or aggression at any follow-up.

Conclusions

Moderate short-term improvements in substance use were associated with randomization to Impulsive Lifestyle Counselling. The findings support the usefulness of providing psycho-education to outpatients with antisocial personality disorder.

Trial registration

ISRCTN registry, ISRCTN67266318, 17/7/2012

Available only for authorised users

Alterman AI, Rutherford MJ, Cacciola JS, McKay JR, Woody GE. Response to methadone maintenance and counseling in antisocial patients with and without major depression. J Nerv Ment Dis. 1996;184(11):695–702. doi:10.1097/00005053-199611000-00007.CrossRefPubMed

APA. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.

Ball SA. Comparing individual therapies for personality disordered opioid dependent patients. J Pers Disord. 2007;21(3):305–21. doi:10.1521/pedi.2007.21.3.305.CrossRefPubMed

Ball SA, Cobb-Richardson P, Connolly AJ, Bujosa CT, O'Neall TW. Substance abuse and personality disorders in homeless drop-in center clients: symptom severity and psychotherapy retention in a randomized clinical trial. Compr Psychiatry. 2005;46(5):371–9. doi:10.1016/j.comppsych.2004.11.003.CrossRefPubMed

Ball SA, Maccarelli LM, LaPaglia DM, Ostrowski MJ. Randomized trial of dual-focused vs. single-focused individual therapy for personality disorders and substance dependence. J Nerv Ment Dis. 2011;199(5):319–28. doi:10.1097/NMD.0b013e3182174e6f.PubMedCentralCrossRefPubMed

Banerjee P, Duggan C, Huband N, Watson N. Brief psychoeducation for people with personality disorder: a pilot study. Psychol Psychother. 2006;79:385–94. doi:10.1348/147608305x57987.CrossRefPubMed

Barnett AG, van der Pols JC, Dobson AJ. Regression to the mean: what it is and how to deal with it. Int J Epidemiol. 2005;34(1):215–20. doi:10.1093/ije/dyh29.CrossRefPubMed

Bateman A, Fonagy P. Comorbid antisocial and borderline personality disorders: mentalization-based treatment. J Clin Psychol. 2008;64(2):181–94. doi:10.1002/jclp.20451.CrossRefPubMed

Black DW, Gunter T, Loveless P, Allen J, Sieleni B. Antisocial personality disorder in incarcerated offenders: psychiatric comorbidity and quality of life. Ann Clin Psychiatry. 2010;22(2):113–20. Retrieved from < Go to ISI>://WOS:000277846400006.PubMed

10.

Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. Hillsdale, NJ: Erlbaum; 1988.

11.

Coid J, Yang M, Tyrer P, Roberts A, Ullrich S. Prevalence and correlates of personality disorder in Great Britain. Br J Psychiatry. 2006;188:423–31. doi:10.1192/bjp.188.5.423.CrossRefPubMed

12.

Colon HM, Perez CM, Melendez M, Marrero E, Ortiz AP, Suarez E. The validity of drug use responses in a household survey in Puerto Rico: comparison of survey responses with urinalysis. Addict Behav. 2010;35(7):667–72. doi:10.1016/j.addbeh.2010.02.006.CrossRefPubMed

13.

Compton WM, Conway KP, Stinson FS, Colliver JD, Grant BF. Prevalence, correlates, and comorbidity of DSM-IV antisocial personality syndromes and alcohol and specific drug use disorders in the United States: Results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2005;66(6):677–85. Retrieved from < Go to ISI>://WOS:000229989000002.CrossRefPubMed

14.

Compton WM, Cottler LB, Jacobs JL, Ben-Abdallah A, Spitznagel EL. The role of psychiatric disorders in predicting drug dependence treatment outcomes. Am J Psychiatry. 2003;160(5):890–5. doi:10.1176/appi.ajp.160.5.890.CrossRefPubMed

15.

Crawford MJ, Sahib L, Bratton H, Tyrer P, Davidson KM. Service provision for men with antisocial personality disorder who make contact with mental health services. Personal Ment Health. 2009;3(3):165–71.CrossRef

16.

Davidson KM, Tyrer P, Tata P, Cooke D, Gumley A, Ford I, et al. Cognitive behaviour therapy for violent men with antisocial personality disorder in the community: an exploratory randomized controlled trial. Psychol Med. 2009;39(4):569–77. doi:10.1017/S0033291708004066.CrossRefPubMed

17.

Delgadillo J, Gore S, Ali S, Ekers D, Gilbody S, Gilchrist G, et al. Feasibility randomized controlled trial of cognitive and behavioral interventions for depression symptoms in patients accessing drug and alcohol treatment. J Subst Abuse Treat. 2015. doi:10.1016/j.jsat.2015.02.008.PubMed

18.

Diamond PM, Magaletta PR. The short-form Buss-Perry Aggression Questionnaire (BPAQ-SF) - A validation study with federal offenders. Assessment. 2006;13(3):227–40. doi:10.1177/1073191106287666.CrossRefPubMed

19.

Faul F, Erdfelder E, Lang AG, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175–91. doi:10.3758/Bf03193146.CrossRefPubMed

20.

Fergusson DM, Horwood JL, Ridder EM. Show me the child at seven: the consequences of conduct problems in childhood for psychosocial functioning in adulthood. J Child Psychol Psychiatry. 2005;46(8):837–49. doi:10.1111/j.1469-7610.200400387.x.CrossRefPubMed

21.

Fridell M, Hesse M, Billsten J. Criminal behavior in antisocial substance abusers between five and fifteen years follow-up. Am J Addict. 2007;16(1):10–4. doi:10.1080/10550490601077734.CrossRefPubMed

22.

Fridell M, Hesse M, Jaeger MM, Kuhlhorn E. Antisocial personality disorder as a predictor of criminal behaviour in a longitudinal study of a cohort of abusers of several classes of drugs: relation to type of substance and type of crime. Addict Behav. 2008;33(6):799–811. Retrieved from http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=18258375.CrossRefPubMed

23.

Fridell M, Hesse M, Johnson E. High prognostic specificity of antisocial personality disorder in patients with drug dependence: results from a five-year follow-up. Am J Addict. 2006;15(3):227–32. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/16923669.CrossRefPubMed

24.

Gardiner C, Tsukagoshi S, Nur U, Tyrer P. Associations of treatment resisting (Type R) and treatment seeking (Type S) personalities in medical students. Personal Ment Health. 2010;4(2):59–63.

25.

Gibbon S, Duggan C, Stoffers J, Huband N, Vollm BA, Ferriter M, et al. Psychological interventions for antisocial personality disorder. Cochrane Database of Systematic Reviews 2010; (6), CD007668. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/20556783.

26.

Goldstein RB, Compton WM, Pulay AJ, Ruan WJ, Pickering RP, Stinson FS, et al. Antisocial behavioral syndromes and DSM-IV drug use disorders in the United States: Results from the national epidemiologic survey on alcohol and related conditions. Drug Alcohol Depend. 2007;90(2-3):145–58. doi:10.1016/j.drugalcdep.2007.02.023.PubMedCentralCrossRefPubMed

27.

Grant BF, Hasin DS, Stinson FS, Dawson DA, Chou SP, Ruan WJ, et al. Prevalence, correlates, and disability of personality disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2004;65(7):948–58. Retrieved from < Go to ISI>://WOS:000223283200011.CrossRefPubMed

28.

Hesse M. What should be done with antisocial personality disorder in the new edition of the diagnostic and statistical manual of mental disorders (DSM-V)? BMC Med. 2010;8:66. doi:10.1186/1741-7015-8-66.PubMedCentralCrossRefPubMed

29.

Hoertel N, Lopez S, Wang S, Gonzalez-Pinto A, Limosin F, Blanco C. Generalizability of pharmacological and psychotherapy clinical trial results for borderline personality disorder to community samples. Personal Disord. 2015;6(1):81–7. doi:10.1037/per0000091.CrossRefPubMed

30.

Hunter SB, Paddock SM, Zhou AN, Watkins KE, Hepner KA. Do client attributes moderate the effectiveness of a group cognitive behavioral therapy for depression in addiction treatment? J Behav Health Serv Res. 2013;40(1):57–70. doi:10.1007/s11414-012-9289-8.PubMedCentralCrossRefPubMed

31.

Lecrubier Y, Sheehan DV, Weiller E, Amorim P, Bonora I, Sheehan KH, et al. The Mini International Neuropsychiatric Interview (MINI). a short diagnostic structured interview: reliability and validity according to the CIDI. Eur Psychiatry. 1997;12(5):224–31. doi:10.1016/S0924-9338(97)83296-8.CrossRef

32.

Maccio A, Meloni FR, Sisti D, Rocchi MB, Petretto DR, Masala C, et al. Mental disorders in Italian prisoners: results of the REDiMe study. Psychiatry Res. 2015;225(3):522–30. doi:10.1016/j.psychres.2014.11.053.CrossRefPubMed

33.

McKay JR, Alterman AI, Cacciola JS, Mulvaney FD, O'Brien CP. Prognostic significance of antisocial personality disorder in cocaine-dependent patients entering continuing care. J Nerv Ment Dis. 2000;188(5):287–96. doi:10.1097/00005053-200005000-00006.CrossRefPubMed

34.

Messina N, Farabee D, Rawson R. Treatment responsivity of cocaine-dependent patients with antisocial personality disorder to cognitive-behavioral and contingency management interventions. J Consult Clin Psychol. 2003;71(2):320–9. doi:10.1037/0022-006x.71.2.320.CrossRefPubMed

35.

Mir J, Kastner S, Priebe S, Konrad N, Strohle A, Mundt AP. Treating substance abuse is not enough: comorbidities in consecutively admitted female prisoners. Addict Behav. 2015;46:25–30. doi:10.1016/j.addbeh.2015.02.016.CrossRefPubMed

36.

Murray-Close D, Ostrov JM, Nelson DA, Crick NR, Coccaro EF. Proactive, reactive, and romantic relational aggression in adulthood: measurement, predictive validity, gender differences, and association with intermittent explosive disorder. J Psychiatr Res. 2010;44(6):393–404. doi:10.1016/j.jpsychires.2009.09.005.PubMedCentralCrossRefPubMed

37.

Narvaez JCM, Jansen K, Pinheiro RT, Kapczinski F, Silva RA, Pechansky F, et al. Psychiatric and substance-use comorbidities associated with lifetime crack cocaine use in young adults in the general population. Compr Psychiatry. 2014;55(6):1369–76. doi:10.1016/j.comppsych.2014.04.021.CrossRefPubMed

38.

Nauth LL. Power and control in the male antisocial personality. Journal of Rational-Emotive & Cognitive-Behavior Therapy. 1995;13(4):215–24.CrossRef

39.

Neufeld KJ, Kidorf MS, Kolodner K, King VL, Clark M, Brooner RK. A behavioral treatment for opioid-dependent patients with antisocial personality. J Subst Abuse Treat. 2008;34(1):101–11. doi:10.1016/j.jsat.2007.02.009.PubMedCentralCrossRefPubMed

40.

Nielsen P, Rojskjaer S, Hesse M. Personality-guided treatment for alcohol dependence: a quasi-randomized experiment. Am J Addict. 2007;16(5):357–64. Retrieved from < Go to ISI>://WOS:000250333900005.CrossRefPubMed

41.

Pinninti NR, Madison H, Musser E, Rissmiller D. MINI international neuropsychiatric schedule: clinical utility and patient acceptance. Eur Psychiatry. 2003;18(7):361–4. doi:10.1016/j.eurpsy.2003.03.004.CrossRefPubMed

42.

Rikoon SH, Cacciola JS, Carise D, Alterman AI, McLellan AT. Predicting DSM-IV dependence diagnoses from addiction severity index composite scores. J Subst Abuse Treat. 2006;31(1):17–24. doi:10.1016/j.jsat.2006.03.003.CrossRefPubMed

43.

Rounsaville BJ, Glazer W, Wilber CH, Weissman MM, Kleber HD. Short-term interpersonal psychotherapy in methadone-maintained opiate addicts. Arch Gen Psychiatry. 1983;40(6):629–36. Retrieved from < Go to ISI>://WOS:A1983QS27700004.CrossRefPubMed

44.

Rummel-Kluge C, Kluge M, Kissling W. Frequency and relevance of psychoeducation in psychiatric diagnoses: results of two surveys five years apart in German-speaking European countries. BMC Psychiatry. 2013;13:170. doi:10.1186/1471-244x-13-170.PubMedCentralCrossRefPubMed

45.

Salthouse TA, Schroeder DH, Ferrer E. Estimating retest effects in longitudinal assessments of cognitive functioning in adults between 18 and 60 years of age. Dev Psychol. 2004;40(5):813–22. doi:10.1037/0012-1649.40.5.813.CrossRefPubMed

46.

Scott S, Briskman J, O’Connor TG. Early prevention of antisocial personality: long-term follow-up of two randomized controlled trials comparing indicated and selective approaches. Am J Psychiatry. 2014;171(6):649–57. doi:10.1176/appi.ajp.2014.13050697.CrossRefPubMed

47.

Sheehan DV, Lecrubier Y, Sheehan KH, Janavs J, Weiller E, Keskiner A, et al. The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. Eur Psychiatry. 1997;12(5):232–41. doi:10.1016/S0924-9338(97)83297-X.CrossRef

48.

Siqueland L, Crits-Christoph P, Gallop R, Barber JP, Griffin ML, Thase ME, et al. Retention in psychosocial treatment of cocaine dependence: predictors and impact on outcome. Am J Addict. 2002;11(1):24–40. doi:10.1080/10550490252801611.CrossRefPubMed

49.

Thylstrup B, Hesse M. The impulsive lifestyle counseling program for antisocial behavior in outpatient substance abuse treatment. Int J Offender Ther Comp Criminol. 2011. doi:10.1177/0306624X11416331.PubMed

50.

Tyrer P, Mitchard S, Methuen C, Ranger M. Treatment rejecting and treatment seeking personality disorders: Type R and Type S. J Pers Disord. 2003;17(3):263–8. doi:10.1521/pedi.17.3.263.22152.CrossRefPubMed

51.

Van Dorn RA, Desmarais SL, Young MS, Sellers BG, Swartz MS. Assessing illicit drug use among adults with schizophrenia. Psychiatry Res. 2012;200(2-3):228–36. doi:10.1016/j.psychres.2012.05.028.PubMedCentralCrossRefPubMed

52.

Vitale SG, van de Mheen H, van de Wiel A, Garretsen HF. Substance use among emergency room patients: is self-report preferable to biochemical markers? Addict Behav. 2006;31(9):1661–9. doi:10.1016/j.addbeh.2005.12.011.CrossRefPubMed

53.

Walters GD. Recidivism in release lifestyle change program participants. Crim Justice Behav. 2005;32(1):50–68.CrossRef

54.

Watkins KE, Hunter SB, Hepner KA, Paddock SM, de la Cruz E, Zhou AJ, et al. An effectiveness trial of group cognitive behavioral therapy for patients with persistent depressive symptoms in substance abuse treatment. Arch Gen Psychiatry. 2011;68(6):577–84. Retrieved from < Go to ISI>://WOS:000291319700005.PubMedCentralCrossRefPubMed

55.

World Medical Association."Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects". JAMA. 2013; 310(20):2191–194.

56.

Zanarini MC, Frankenburg FR. A preliminary, randomized trial of psychoeducation for women with borderline personality disorder. J Pers Disord. 2008;22(3):284–90. doi:10.1521/pedi.2008.22.3.284.CrossRefPubMed

57.

Zwarenstein M, Treweek S, Gagnier JJ, Altman DG, Tunis S, Haynes B, et al. Improving the reporting of pragmatic trials: an extension of the CONSORT statement. Br Med J. 2008;337:a2390. doi:10.1136/bmj.a2390.CrossRef

Title: Psycho-education for substance use and antisocial personality disorder: a randomized trial
Authors: Birgitte Thylstrup
Sidsel Schrøder
Morten Hesse
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: BMC Psychiatry / Issue 1/2015
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-015-0661-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Psycho-education for substance use and antisocial personality disorder: a randomized trial

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2015

Barriers to the sustainability of an intervention designed to improve patient engagement within NHS mental health rehabilitation units: a qualitative study nested within a randomised controlled trial

Psychometric properties of the Chinese version of the Obsessive Beliefs Questionnaire-44 (OBQ-44)

Cost effectiveness and budgetary impact of the Boston University approach to Psychiatric Rehabilitation for societal participation in people with severe mental illness: a randomised controlled trial protocol

Positive Emotions Program for Schizophrenia (PEPS): a pilot intervention to reduce anhedonia and apathy

The effects of parental components in a trauma-focused cognitive behavioral based therapy for children exposed to interparental violence: study protocol for a randomized controlled trial

Prevalence and predictors of antenatal depressive symptoms among Chinese women in their third trimester: a cross-sectional survey