RESUMEN
OBJECTIVES: To assess the impact of a short psychoeducation intervention for antisocial personality disorder on offending after randomization to treatment. DESIGN: Multicentre, superiority, non-blinded randomized controlled trial. Random assignment was conducted in blocks of varying sizes at a central randomization centre. Participants were followed using national register data until 365 days after randomization, migration, or death, whichever occurred first. SETTING: Thirteen outpatient uptake areas in Denmark. PARTICIPANTS: Patients with antisocial personality disorder in treatment for substance use disorders were randomized to treatment as usual (TAU, n = 80) or Impulsive Lifestyle Counselling (ILC, n = 96). A total of 165 patients could be linked to criminal records (TAU, n = 74; ILC, n = 91). INTERVENTION: ILC is a brief psychoeducational program targeting antisocial behavior. The trial was conducted between January 2012 and June 2014. OUTCOMES: Number of criminal offences leading to convictions based on national registers. RESULTS: The mean number of offences was 2.76 in the TAU group (95% Poisson confidence interval [CI] = 2.39, 3.16) and 1.87 in the ILC group (95% CI = 0.97, 1.43). Negative binomial regression was used to assess total number of convictions, as well as convictions for violent, property, driving under the influence, and drug-related crimes. In both adjusted and unadjusted analyses, random assignment to ILC was associated with a lower number of total offences (incidence rate risk ratio [IRR] = 0.43, p = .013; adjusted IRR = 0.45, p < .001) and convictions related to violence (IRR = 0.19, p = .001 adjusted IRR = 0.19, p = .007) and property offences (unadjusted IRR = 0.30, p = 0.003, adjusted IRR = 0.42, p = 0.010). Differences between conditions were not significant for driving under the influence (unadjusted IRR = 0.49, p = .370; adjusted IRR = 0.53, p = .417) or drug offences (unadjusted IRR = 1.06, p = .907; adjusted IRR = 0.55, p = .223). CONCLUSIONS: The ILC program shows promise in reducing offending behavior in people with comorbid substance use and antisocial personality disorder. TRIAL REGISTRATION: ISRCTN registry, ISRCTN67266318 , 15/10/2012.
Asunto(s)
Trastorno de Personalidad Antisocial , Trastornos Relacionados con Sustancias , Trastorno de Personalidad Antisocial/complicaciones , Trastorno de Personalidad Antisocial/terapia , Consejo , Humanos , Conducta Impulsiva , Estilo de Vida , Trastornos Relacionados con Sustancias/complicaciones , Trastornos Relacionados con Sustancias/terapiaRESUMEN
Background: Antisocial personality disorder (ASPD) incurs a high cost to society due to the high risk of violent and nonviolent offenses associated with this personality disorder, thus making the examination of the etiology and the onset of ASPD an important public health concern. Method: The present study consisted of five waves of data collection of the Harlem Longitudinal Development Study (N = 674). In the Cox proportional hazard model, latent multiple substance use trajectories from mid-adolescence to emerging adulthood (mean age 14 to mean age 24) were used as a predictor for the onset of ASPD during emerging adulthood to the mid-thirties (mean age 24 to mean age 36). The control variables were gender, ethnicity, problem behaviors, and victimization. Results: In the multiple Cox proportional hazard model, the high (HR = 2.74, p < 0.001) and the increasing frequency of (HR = 2.55, p < 0.001) use on alcohol, cigarette, and cannabis latent trajectory groups were associated with an increased hazard of ASPD onset as compared with the no or low frequency of use on alcohol, cigarette, and cannabis latent trajectory group after controlling for demographic factors and earlier problem behaviors as well as victimization. Conclusions: The implications of this study for the prediction of adult ASPD onset time may focus on the early use of alcohol, cigarette, and cannabis from mid adolescence to emerging adulthood.
Asunto(s)
Trastorno de Personalidad Antisocial , Trastornos Relacionados con Sustancias , Adolescente , Adulto , Negro o Afroamericano , Trastorno de Personalidad Antisocial/epidemiología , Hispánicos o Latinos , Humanos , Estudios Longitudinales , Trastornos Relacionados con Sustancias/epidemiología , Adulto JovenRESUMEN
Offenders with antisocial personality disorder (ASPD) may be characterized by a lack in emotional functioning that manifests in irritability and a lack of remorse. The proposed link between ASPD and negative emotionality led to the question of emotional processing anomalies in ASPD. Furthermore, the effect of childhood maltreatment/abuse on emotional processing was tested in the present study. Violent and sexual offenders with ASPD (n=35), without ASPD (n=34), and healthy non-criminal controls (n=24) were compared in an Emotional Stroop Task (EST) using neutral, negative, and violence-related words. Secondary analyses focused on the effect of psychopathic traits and childhood maltreatment. Offenders with ASPD showed a stronger attentional bias to violence-related and negative words as compared to controls. Comparable results were obtained when grouping offenders to high, medium, and low psychopathic subgroups. Offenders with childhood maltreatment specifically showed stronger violence-related attentional bias than non-maltreated offenders. The data suggest that enhanced attention to violence-related stimuli in adult criminal offenders is associated with adverse developmental experiences and delinquency but to a lesser extent with antisocial or psychopathic traits.