Antisocial behavioral syndromes and return to drug use following residential relapse prevention/health education treatment

This study compared residential addiction treatment clients meeting full DS M-III-R criteria for antisocial personality disorder (ASPD) with those repo rting syndromal levels of antisocial behavior only in adulthood (AABS) on t ime to and severity of first post-treatment drug use. Antisocial syndrome a nd selected other mental disorders were assessed using the Diagnostic Inter view Schedule, Revised for DSM-III-R, and validity of self-reported posttre atment drug behavior was measured against results of hair analysis. Among s ubjects followed within 180 days after treatment exit, individuals with ASP D were at modestly increased risk of a first lapse episode compared to thos e with AABS. However, the two groups did not differ in severity of lapse. P articipants with ASPD demonstrated poorer agreement between self-reported p osttreatment drug behavior and hair data. These results add to the evidence suggesting that the DSM requirement for childhood onset in ASPD may be cli nically important among substance abusers in identifying a severely antisoc ial and chronically addicted group at elevated risk for early posttreatment recidivism. Our findings support the importance of careful classification of antisocial syndromes among substance abusers and the identification of c haracteristics of these syndromes that underlie clients' risks for post-tre atment return to drug use to provide optimally individualized treatment pla nning.