Data from a recent epidemiologic survey of more than 43,000 U.S. adults show that antisocial syndromes-marked by little concern for the rights of others and violations of age-appropriate societal rules-are more common among people with substance abuse disorders than those without these disorders.
The study by researchers from the National Institute on Drug Abuse (NIDA) and National Institute on Alcohol Abuse and Alcoholism (NIAAA), National Institutes of Health, is published in the June 2005 issue of The Journal of Clinical Psychiatry.
"The strong and significant association between substance abuse or addiction and conditions such as antisocial personality disorder, conduct disorder, and adult antisocial behavior, suggests that prevention and treatment strategies need to apply an integrated approach," says NIDA Director Dr. Nora D. Volkow. "By also treating antisocial syndromes, particularly those that develop in adolescence or persist over time, we may be able to substantially reduce substance abuse and addiction."
Antisocial personality disorder, conduct disorder, and adult antisocial behavior are characterized by differing degrees or severity of lying, impulsivity, physical aggression, reckless disregard for one's own safety and the safety of others, indifference regarding pain inflicted on others, destructive behavior, and stealing.
"This is the first time in which we see that virtually every single drug abuse disorder is associated with an antisocial personality disorder," says Dr. Wilson Compton, Director of NIDA's Division of Epidemiology, Services, and Prevention Research. "We also observed stronger links between the antisocial syndromes and specific substance abuse or addiction in women compared to men, and drug addiction was more likely than abuse to be linked with these psychiatric conditions."
The scientists from NIDA and NIAAA examined data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a representative survey of the U.S. civilian noninstitutionalized population aged 18 years and older. "The NESARC is the largest study ever conducted of the co-occurrence of psychiatric disorders among U.S. adults," says Dr. Bridget Grant, Chief, Laboratory of Epidemiology and Biometry, NIAAA, and NESARC principal investigator.
The analysis showed lifetime prevalence of 3.6 percent of adults diagnosed with antisocial personality disorder, 1.1 percent with conduct disorder only and more than 12 percent with adult antisocial behavior only while the lifetime prevalence for any drug abuse disorder was 10.3 percent. Lifetime prevalence of alcohol use disorders was 30.3 percent. The most common drug abuse disorders involved marijuana, followed by cocaine, amphetamines, hallucinogens, opioids, sedatives, tranquilizers, and inhalants.
In addition, the scientists calculated the odds ratios-an estimation of the relative risk-of having a particular antisocial syndrome and a specific substance abuse disorder. They found that for antisocial personality disorder and adult antisocial behavior the odds of having a substance abuse disorder were very high overall, and were higher for women than for men.
For antisocial personality disorder the odds ratios were most striking for tranquilizer dependence, sedative dependence, marijuana dependence, inhalant abuse, and hallucinogen dependence. For adult antisocial behavior the odds ratios were highest for sedative abuse, amphetamine abuse, alcohol use disorders, cocaine dependence, and hallucinogen abuse.
Results of other investigations have pointed to impairments in executive decision-making as a fundamental characteristic in substance abuse disorders that may be associated with impaired development of certain brain structures and function. Therefore, the authors speculate that substance abuse disorders and antisocial personality syndromes share common underlying physiologic features that may be related to the same neural systems involved in decision-making.
Previous research using the same NESARC data showed that almost 48 percent of people who abused drugs also had at least one personality disorder.
"Future studies will be necessary to uncover the genetic and environmental mechanisms involved in the progression of these co-occurring conditions and how possible interactions may relate to drug abuse and addiction vulnerability," says Dr. Volkow.