Help for Those with Antisocial Personality Disorder and Co-Occurring Addiction

Render illustration of "ANTISOCIAL PERSONALITY DISORDER" title on head silhouette with cloudy sky as a background

According to the book Theories of Personality, the term personality is used by most people to refer to the types of characteristics that an individual normally displays across most situations. This is also a general description of what defines personality in terms of a formal psychological definition. Personality is considered to be that set of characteristics that an individual will display across most situations and results in some predictability in an individual’s behavior once these particular characteristics are identified.

The branch of psychology known as personality psychology attempts to identify and refine the types of characteristics that can be used to identify different types of personalities. Numerous theories of personality have been developed, and it is generally considered that there are at least three to five (or more) main dimensions associated with personality across most individuals, and these five dimensions can be further broken down into numerous subcomponents.

What Are Personality Disorders?

Personality disorders, like most of the mental health disorders that are identified in the Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition (DSM-5), the diagnostic manual for the American Psychiatric Association (APA) consist of different personality types that violate or clash with cultural expectations or societal norms/expectations. These types of personalities or patterns of thinking, emotional reactions, and behaviors that are expressed by the individual in numerous situations have been present since early in the person’s development, are resistant to change (rigid), and result in significant impairment, dysfunction, or distress.

Individuals who are diagnosed with personality disorders often have significant issues with their everyday functioning; however, many of these individuals see others as being the problem and often do not view their own behavior as being problematic. Thus, it is very unlikely that a person with a personality disorder will seek treatment for their personality disorder, but instead will seek treatment for other issues that are related to the dysfunction associated with their personality disorder, such as substance abuse, depression, relationship issues, work issues, or legal issues. Very often, individuals diagnosed with personality disorders are referred by others or mandated to get treatment as a result of some issue related to aspects of the specific personality disorder.

The personality disorders identified in the DSM-5 have not changed significantly from previous versions of the DSM despite significant dissatisfaction with the way these disorders are conceptualized by APA and significant issues in their diagnosis. When the DSM-5 was being developed, APA had released information stating that it would reorganize the diagnostic criteria for personality disorders; however, the disorders in this category remained virtually unchanged from previous editions. Alternative conceptualizations of different types of personality disorders have been offered by other organizations, but the formal diagnosis of these disorders remains the domain of APA.

Despite the controversy surrounding the way personality disorders are conceptualized by APA, one of the most longstanding conceptualizations of a particular type of personality disorder is the notion of sociopathy (the sociopath), the psychopath, or what is now referred to as antisocial personality disorder.

Antisocial Personality Disorder

Sad teenage girl sitting near window in a room

It should be understood that the different aspects of personality disorders represent extreme and rigid manifestations of characteristics that can be also identified in people without these disorders. For instance, many people will often display self-centered or selfish behavior, but may not qualify for a diagnosis of narcissistic personality disorder or antisocial personality disorder because the types of self-centeredness and self-indulgence that occurs within these disorders is extreme, rigid, and nearly always dysfunctional. Only licensed and trained mental health professionals can diagnose a personality disorder in any person.

The major feature of antisocial personality disorder (APS) is a pervasive disregard for the rights of others and a lack of empathy for others. Individuals with APS often manipulate other people for their own ends, but this manipulation is extreme and pervasive. Individuals with APS rarely view other individuals as “people” but instead view others as a means for them to achieve whatever they want. The inability of individuals with APS to empathize with others (understand another’s feelings from that person’s point of view) is responsible for much of the behavior that these individuals engage in.

It is important to note that most people use others to obtain personal goals at one time or another in their life, and that individuals diagnosed with APS use others to obtain their goals on a regular basis. These individuals are unable to conceptualize other people as feeling individuals; instead, they see them as a means to an end for themselves.

Individuals with APS will typically display issues with self-centeredness and conduct problems before they are 15 years old. Very often, these issues involve the lack of empathy that they often display later, such as abuse or aggression toward people or animals, destruction of property, stealing, or additional violations of others’ rights.

In general, people with antisocial personality disorder display these types of symptoms:

  • Aggressiveness, irritability, or impulsive behaviors
  • A chronic pattern of attempting to deceive others, including lying, the use of fake names, or cheating
  • Repeatedly engaging in unlawful acts
  • Repeated problems sustaining important personal obligations, such as those related to personal relationships, work, school, or other important areas of the person’s life
  • Chronic issues with reckless or irresponsible behaviors
  • A consistent lack of remorse or consistent indifference regarding their own actions and how they affect others
  • A pattern of behavior that has been established early in the person’s development (before the age of 15)

A person who is younger than 18 and demonstrates the types of behaviors that occur with APS would not be diagnosed with a personality disorder but would be diagnosed with some other type of mental health disorder, such as a conduct disorder. Conduct disorders are diagnosed in adolescents who display significant APS-like behaviors. Individuals who are diagnosed with APS are typically adults, male, and have been referred for treatment or assessment due to some other issue, such as being involved in the legal system, having repeated conflicts with coworkers or family members, or in an attempt to maintain their employment.

Personality disorders affect all areas of functioning, including behavior, emotions, and thinking (cognition). Someone diagnosed with APS will deal with unique issues.

  • They often have feelings of entitlement or inflated feelings of self-worth that are so pervasive that they may also be diagnosed with narcissistic personality disorder.
  • They may seek out immediate gratification and have issues with waiting for satisfaction.
  • They may seek out activities that they find extremely stimulating, such as engaging in sex with multiple partners, extreme sports, criminal actions, and other forms of stability activities.
  • Their sense of entitlement drives them to engage in behaviors that satisfy their own perceived needs, no matter how it affects other people.
  • They are often unable to understand normal social boundary guidelines regarding what defines an appropriate means to achieve goals and what defines an inappropriate way to seek out goals.
  • They often display a disturbing lack of conscience that is so pervasive that they either do not want or are totally unable to conceptualize the rights or needs of other people when it comes to achieving their own ends.

There is no identified cause for antisocial personality disorder, although it is strongly suspected that all of the personality disorders have a significant genetic component to them, and this component interacts with experience. Thus, APS will often run in families and also be associated with significant abuse or trauma, particularly as a child.

Substance Abuse and APS

Many people diagnosed with antisocial personality disorder often have significant criminal records, whereas others may wind up in careers that are suited to their special talent or perceptions. It should be understood that there are numerous other issues that can contribute to criminality; however, individuals with APS are very likely to become involved in the legal system.

According to APA, the highest prevalence of APS occurs in males who have been diagnosed with severe alcohol use disorders; over 70 percent of males with severe alcohol use disorders are also diagnosed with APS. Antisocial personality disorder is also diagnosed disproportionately in individuals who come from the lower socioeconomic status situations. Even though personality disorders like APS are considered to be longstanding and chronic, APA reports that after the age of 40, as these individuals mature, their symptoms become less intense.

The bulk of the research regarding APS and substance abuse has indicated that a large proportion of individuals who receive a diagnosis of APS will engage in some form of substance abuse during their lifetime. Some figures suggest that as many as 90 percent of individuals diagnosed with APS have had some type of substance abuse issue at one time or another.

Individuals with APS are susceptible to becoming involved in any form of substance abuse: however, high rates of alcohol use disorders and tobacco use disorders are prevalent in this particular group. Because many of the features of APS, including significant impulsivity, being self-centered, having problems with delaying gratification, and not being concerned with the rights of others, are also characteristics of individuals who are at risk to develop problems with substance abuse, it is not surprising that substance abuse is extremely prevalent in this group. Other types of addictive behaviors are also prevalent in individuals diagnosed with APS, including compulsive gambling and multiple sex partners.

Treatment for APS

An individual therapeutic session between a psychologist and a withdrawn troubled teenage boy sitting in a closed position with his arms crossed across his chest Due to the nature of the disorder, APS can be very difficult to treat. Individuals with antisocial personality disorder do not generally seek out treatment for their antisocial tendencies. They also have trouble following rules and regulations. They may become involved in treatment as a condition of employment, relationship issues, or legal entanglements, but because of their extreme self-centeredness and lack of insight, it would be very rare for a person with APS to consider their behavior to be problematic for them. Instead, they view others as a means to an end and most often seek out treatment when it benefits their self-centered needs.

Moreover, there are no medications that can treat APS. Certain symptoms that may accompany APS, such as depression or anxiety, may be treated by medications; however, the disorder cannot be medically managed. This means that the formal treatment of APS must include some form of behavioral therapy or intervention.

Therapy can be applied to the treatment of individuals with APS; however, unless there are certain conditions made that are designed to keep the person in treatment, there is the possibility that the individual will skip numerous treatment sessions or stop coming to treatment altogether. Individuals involved in the legal system must often attend treatment sessions or be penalized (e.g., incarceration), and this is often sufficient to keep the individual in treatment as long as they are involved in the legal system. Other types of external motivators can be successful in helping to keep these individuals in treatment since they will only remain in treatment as long as they feel it is benefiting their needs.

Therapists treating individuals with APS and co-occurring substance abuse issues need to help the individual explore their perceptions of the world around them and their perception of their own self-importance. Typically, this involves understanding the specific person’s belief system (often referred to in psychology as schemas). Thus, forms of Cognitive Behavioral Therapy (CBT) can often be used to help individuals to conceptualize their perceptions of the world and how they fit in it, help them understand how their perceptions are dysfunctional for them, and then help them to change these perceptions and their behaviors in a manner that is beneficial to them.

The substance abuse treatment portion of the program will involve all of the traditional components of substance use disorder therapy, including withdrawal management (medical detox), group or individual therapy, support group participation, and additional therapies. Any individual diagnosed with co-occurring APS and substance abuse would need both issues addressed together in order for the treatment to be successful.

These individuals often need to have numerous rules and regulations regarding adherence to treatment practices due to their natural tendency to stretch boundaries in order to benefit themselves. Therapists have to be firm yet understanding of these individuals at the same time. When treatment can be implemented, it is often successful in helping these individuals to adjust; however, certain aspects of the person’s personality will always be present, including natural aversions to authority, a tendency to try to be as individualistic as possible, and a tendency to attempt to satisfy their own needs at the expense of others.

Therapists can work with these individuals and capitalize on their strengths to help them function in a manner that is less divisive. The substance use disorder component of the treatment should extend for many years following the person’s initial abstinence in order to maintain a successful long-term recovery program. This is where support groups, such as Alcoholics Anonymous, Narcotics Anonymous, and others, can be very beneficial. They can express their own self-sufficiency in these groups by engaging with others who have similar problems and at the same time get what they need from others to help them maintain recovery.

Last updated on October 5, 20182018-10-05T16:23:30
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