Drug and Alcohol Dependence 52 (1998) 63–69 Antisocial personality disorder, psychopathy and injecting heroin use Shane Darke a, *, Sharlene Kaye a,b , Robert Finlay-Jones b a National Drug and Alcohol Research Centre, Uniersity of New South Wales, Sydney 2052, NSW, Australia b Department of Psychiatry, Uniersity of New South Wales, Sydney, NSW, Australia Received 28 October 1997; received in revised form 6 February 1998; accepted 11 March 1998 Abstract Two hundred community-based methadone patients (CM); 200 prison inmates enrolled in prison methadone programs (PM); and 150 prison inmates with no history of heroin use (PNH) were interviewed to obtain diagnoses of antisocial personality disorder (ASPD) and Psychopathy Checklist-defined psychopathy. Large proportions of subjects in all three groups met the criteria for a diagnosis of ASPD (CM 44%, PM 65%, PNH 31%), with the two methadone groups having significantly higher proportions of ASPD diagnoses than non-heroin users. There were no differences between groups in the proportions diagnosed as psychopathic (CM 4%, PM 9%, PNH 4%). For each group, the proportions diagnosed as ASPD were significantly higher than the proportions diagnosed as psychopathic. Implications for the diagnosis of ASPD are discussed. © 1998 Elsevier Science Ireland Ltd. All rights reserved. Keywords: Antisocial personality disorder; Psychopathy; Injecting drug use 1. Introduction A diagnosis of antisocial personality disorder (ASPD) is one of the most common psychiatric diag- noses made among injecting drug users (IDU). Previous studies have reported the prevalence of ASPD among IDU as ranging from 35 to 61% (e.g. Khantzian and Treece, 1985; Brooner et al., 1990, 1993; Darke et al., 1994). In contrast, the life-time prevalence among the general population has been estimated to be 4% (Robins et al., 1991). A diagnosis of ASPD in IDU has been associated with higher levels of injecting and sexual risk-taking, as well as a higher HIV seropreva- lence (Brooner et al., 1990, 1993). The distinguishing features of ASPD are a series of antisocial behaviours, first manifested in childhood and continuing into adulthood (American Psychiatric Asso- ciation, 1987, 1994). Symptoms include performing ille- gal acts, an inability to sustain consistent work behaviour, and frequent lying. It is the presence of these antisocial behaviours that constitutes the core of this conceptualisation. Indeed, the sole psychological criterion for a diagnosis of ASPD in both DSM-III-R and DSM-IV is absence of remorse. An alternative conceptualisation and assessment of the antisocial personality was presented by Hare (1980). Hare argued that the concept of psychopathy has evolved from a pathological personality type into being synonymous with criminality and social deviance. As such, he argued, the diagnosis of ASPD is over-inclu- sive. Using the criteria originally outlined by Cleckley (1941), Hare developed the Psychopathy Checklist (PCL) (Hare, 1980), and later the Revised Psychopathy Checklist (PCL-R) (Hare, 1991) as instruments that would measure psychopathy according to traditional clinical conceptions. Factor analyses indicate that the PCL-R has separate psychological and behavioural fac- tors (Harpur et al., 1988). Of the 20 symptoms of psychopathy in the PCL-R, 10 could be designated psychological symptoms (e.g. glibness, grandiose sense of self-worth, proneness to boredom). * Corresponding author. Fax: +61 29 3997143. 0376-8716/98/$19.00 © 1998 Elsevier Science Ireland Ltd. All rights reserved. PII S0376-8716(98)00058-1