DRINKING OUTCOMES OF ALCOHOL ABUSERS DIAGNOSED AS ANTISOCIAL PERSONALITY-DISORDER

Clinical research and wisdom suggest that alcoholics with antisocial p ersonality (ASPs) disorders have poorer drinking outcomes after treatm ent than alcoholics without this disorder. The present study challenge s this wisdom, suggesting that poor prognosis and response to treatmen t have been confounded by not covarying on pretreatment drinking measu res. Thirty-one ASPs are compared with 118 non-ASPs randomly assigned to extended cognitive behavioral and relationship enhancement treatmen ts. Thirteen to 18 months after treatment initiation, ASPs average mor e abstinent days than do non-ASPs. Drinking intensity is a function of a patient-treatment matching effect: ASPs treated with cognitive beha vioral treatment (CB) drink less/drinking day than do either non-ASPs treated in CB or ASPs treated in relationship enhancement. This findin g is supportive of a comparable matching effect for CB and ASP found b y Kadden et al. (1989). Examination of the process indicates that, irr espective of drinking index, ASPs respond poorly when they experience high posttreatment support for abstinence, whereas no?ASPs respond bet ter with support. We conclude that early pessimism for successful trea tment of ASP alcoholic drinking outcomes may be unwarranted.