THE INTIMATE CONNECTION BETWEEN ANTISOCIAL PERSONALITY AND SUBSTANCE-ABUSE

There is a powerful association between antisocial behavior and substa nce abuse. What is still uncertain is whether the association between the two is causal, so that one disorder leads to the other, or is expl ained by shared symptoms or shared risk factors, or suggests that the two disorders are not distinct, but are actually variants of the same underlying disorder. Each of these hypotheses is shown to be plausible . The paper considers four criteria for causality: precedence, coheren ce with existing knowledge, dose-related liability, and understandabil ity of mechanisms. Problems are noted with each of these criteria. Con duct disorder as a cause of substance abuse fulfills these criteria mo re obviously than does substance abuse as a cause of antisocial behavi or, but both have plausibility. A similarity is noted between the task s of deciding whether ore disorder causes another and deciding whether early symptom patterns predict the later course of a single disorder. The dearth of information about effect of the early symptom profile o n the later course can be overcome with careful study design. Such stu dies promise important gains in patient management. The necessary data are outlined and instruments to collect such data are noted to be new ly published or in development.