Antisocial Personality Disorder: Treatment
ASPD is extremely difficult to treat, and at present, the prognosis for antisocial individuals typically is considered poor. The empirical treatment literature bearing on ASPD is in its infancy, with few controlled studies having been conducted. In addition, research in this area tends to examine the outcomes of interventions for behaviors associated with ASPD, such as substance abuse and violence, rather than treatments aimed at altering the underlying personality features of the disorder. In addition, relatively little research has examined intervention outcomes with women—and when women are included in samples, results typically are not disaggregated by gender. Nevertheless, the body of literature on this topic has grown over the past decade, and some broad trends are apparent.
Several studies have investigated the outcomes of substance abuse treatment among individuals with ASPD. Most results indicate that persons with cooccurring substance abuse problems and ASPD make treatment gains on par with those of individuals in substance abuse treatment without ASPD. However, other studies on this topic suggest less improvement in individuals with ASPD than in others. Furthermore, research suggests that broad classifications such as “substance abuser” may be too generic and that differences based on an individual’s drug of choice and the severity of the impact on daily functioning may be important to treatment outcome.
Given the nature of the diagnosis, it is not surprising that most treatment outcome studies on ASPD have been conducted with offender samples. Although at this time, research data do not endorse a specific type of treatment for ASPD, there is strong empirical support for the effectiveness of certain guiding principles. The principles of risk, need, and responsivity indicate that treatment outcome will be maximized as a function of a treatment program’s match with an individual’s level of risk, criminogenic needs (changeable risk factors), and learning style. Meta-analytic reviews indicate that the strongest predictor of success across different correctional programs and offender groups—including both men and women—is treatment that adheres to these three principles.
Another aspect of treatment with empirical support is the multimodal hypothesis, which suggests that correctional treatment is most effective when multiple need areas of an offender are targeted. Research demonstrates that multimodal programs that incorporate cognitive-behavioral and social learning strategies are associated with substantially larger treatment gains than are nonbehavioral interventions. In addition, there is a positive association between the number of criminogenic needs targeted for intervention and subsequent reductions in recidivism. In contrast, approaches that are contraindicated for treating ASPD because they are viewed as unresponsive to offenders’ criminogenic needs and/or learning style include traditional “talk” psychotherapy of the psychodynamic, client-centered, and insight-oriented ilk.
Programs that include a relapse prevention element are associated with enhanced reductions in recidivism. Relapse prevention is a cognitive-behavioral approach to self-management that entails teaching individuals alternate (more effective) responses to highrisk situations. Components of relapse prevention that seem to be especially effective in reducing recidivism include identifying one’s offense-chain and high-risk situations and, subsequently, role-playing alternate (more effective) ways of handling such situations.