Antisocial Personality Disorder (ASPD) and Addiction

Antisocial personality disorder (ASPD) is a mental health condition that involves a pattern of disregard for, and violation of, the rights of others.¹ It is common for people with ASPD to also suffer from addiction.²

This page will discuss ASPD and its signs, the link between addiction and ASPD, and how treatment can help.

What is Antisocial Personality Disorder (ASPD)?

A person with ASPD chronically displays a pattern of behaviors, which can include exploiting, manipulating, or ignoring the rights and needs of other people.²

People with ASPD tend to be callous and cynical and display a lack of empathy. They often have an inflated sense of self-esteem and seem unconcerned about current or future problems.¹

ASPD is classified as a Cluster B personality disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).¹ Cluster B personality disorders are characterized by exhibiting problems with emotion regulation, impulsivity, and interpersonal conflicts.³ People with a Cluster B disorders can appear dramatic and overly emotional, and they typically display erratic and unpredictable behavior.⁴

A review of 7 epidemiological studies found the median prevalence of the prevalence of ASPD to be 3.6%. The highest prevalence (greater than 70%) was found in samples of men with severe alcohol use disorder (AUD) and from substance use clinics, prisons, or other forensic settings.¹ ASPD tends to occur with a higher frequency in men, and often peaks in prevalence between the ages of 24-44.⁵

Signs and Symptoms of Antisocial Personality Disorder

A mental health professional may diagnose someone with antisocial personality disorder if they display a pervasive pattern of disregard for and violation of the rights of others, as indicated by 3 or more of the following criterion outlined in the DSM-5:¹

• Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
• Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
• Impulsive behaviors or failure to plan ahead.
• Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
• Reckless disregard for safety of self or others.
• Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
• Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

To be diagnosed with ASPD, the person must be at least 18 years old and have displayed evidence of the onset of a conduct disorder before age 15, and the criteria exhibited must not exclusively occur with episodes of schizophrenia or bipolar disorder.¹

People with antisocial personality disorder can display certain behaviors, such as:^1,2

• Acting witty or superficially charming.
• Exhibiting a lack of empathy.
• Arrogance.
• Being callous, cynical, and contemptuous of the feelings, rights, and sufferings of others.
• Being excessively opinionated.
• Using technical terms or jargon to impress others.
• Manipulating the emotions of others, such as through excessive flattery.
• Breaking the law multiple times.
• Cheating or lying.
• Not apologizing or showing awareness of having done something wrong to someone else.
• Frequent anger.
• Depression.
• Inability to tolerate boredom.

What is Substance Use Disorder?

Substance use disorder (SUD) is the diagnostic term for addiction.¹ The DSM explains that a SUD is characterized by continued use of a substance despite it causing clinically significant impairment in one’s life.¹

Addiction is a treatable, chronic medical condition that involves a complex interaction among a person’s brain circuits, genetics, the environment, and their life experiences.⁶

People with SUDs often have other mental health conditions, such as ASPD, in which case they are said to have a co-occurring disorder, or dual diagnosis.⁷ Research shows high rates of co-occurring disorders like ASPD and addiction.⁷ 

The Link Between Substance Use and ASPD

Antisocial personality disorder and substance use can be related for different reasons.

Contributing factors leading to the development of SUD and co-occurring disorders are multifaceted, and they can both be influenced by a complex set of interactions between genes, environment, biology, and other risk factors. However, having a risk factor does not mean that a person is guaranteed to develop either disorder, and having one disorder also does not mean that a person will develop the other.⁸

According to some data, rates of co-occurring ASPD and SUD range from about 14% to almost 35%.⁴

Some of the possible risk factors for both SUDs and ASPD can include:

• Shared genetic factors. Research has proposed that SUD and mental health conditions like ASPD may share common genetic and epigenetic (environmental effects on genes) vulnerabilities.⁸
• Environmental influences. People with ASPD and SUD may have had trauma or adverse childhood experiences, or experiences of excessive stress, especially in early life, which could influence the development of both disorders.⁴
• A mental illness like ASPD can influence substance use. People with ASPD are much more likely to use substances, which can influence the development of SUDs.⁹
• Substance use and addiction can influence the development of a mental illness. Substance use can create brain changes, and both disorders may be impacted by changes to similar areas of the brain.⁹

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), research has shown that having a 12-month or lifetime DSM-5 drug use disorder (meaning a substance use disorder excluding alcohol) has been associated with 1.4 to 2 increased odds of having ASPD. The prevalence of ASPD is 7-40% percent in men with existing SUDs, and ASPD is significantly associated with persistent SUDs.⁴

Treatments for Antisocial Personality Disorder with Co-Occurring Substance Use Disorders

There are no empirically-supported treatments for ASPD nor are there any approved medications to treat the disorder. However, integrated treatment that addresses addiction and the symptoms of ASPD can benefit people with both conditions. This approach can result in improved outcomes, such as negative drug screens and reduced substance misuse, and may help improve a person’s interpersonal and coping skills.^4,10

Psychotherapy, behavioral therapies, and other interventions that benefit people with mental illness and co-occurring SUD can include:^4,10

• Cognitive behavioral therapy (CBT). This teaches people ways to identify and change harmful beliefs and maladaptive behaviors.
• Contingency management (CM). CM provides positive reinforcements in the form of tangible rewards to people who achieve target goals.
• Motivational interviewing (MI). This can help improve a person’s resistance to change and help them develop the internal motivation that is needed to make healthy life changes.
• Mutual-support groups. This can include 12-step groups like Alcoholics Anonymous (AA) or Narcotics Anonymous (NA), SMART Recovery, or groups specific to those in recovery from co-occurring disorders.

Treatment for co-occurring disorders can take place in different settings and may include one or more of the following:

• Detox, also known as withdrawal management. This can help people safely and comfortably undergo withdrawal, often with the use of medications to reduce withdrawal symptoms, in a medically-supervised, supportive environment.¹¹
• Inpatient care or residential treatment. This means a person lives onsite at a rehab for the duration of treatment and receives 24/7 care. People who may benefit from inpatient treatment programs include those with severe SUDs and co-occurring disorders, those without stable homes, and those who lack supportive friends or family.¹¹
• Outpatient care. This means that a person can continue to live at home but they will need reliable transportation to be able to attend treatment on a regular schedule. People who may benefit from outpatient rehab include those with stable and supportive home environments and who are willing to attend regular treatment sessions.¹¹

If you suspect that you or a loved one have co-occurring ASPD and SUD, help is available. Please call to speak to a knowledgeable admissions navigator at American Addiction Centers (AAC) to learn about your rehab options and how AAC treatment centers can help support you on the path to recovery.

Frequently Asked Questions