Regular article Followup of cocaine-dependent men and women with antisocial personality disorder Christine E. Grella, Ph.D. * , Vandana Joshi, Ph.D., Yih-Ing Hser, Ph.D. UCLA Drug Abuse Research Center/Integrated Substance Abuse Programs, 1640 S. Sepulveda Blvd., Suite 200, Los Angeles 90025, USA Abstract Long-term outcomes following drug treatment were examined for cocaine-dependent men (N = 453) and women (N = 254) with and without antisocial personality disorder (ASP). In-depth assessments were conducted at treatment intake in 1991 – 93 and at 1 and 5 years following treatment discharge. Overall, 47.2% of the males and 34.3% of females were diagnosed with ASP using DSM-III-R criteria derived from the Diagnostic Interview Schedule. All groups reduced their cocaine, marijuana, and alcohol use; reduced their levels of psychological distress; and improved in functioning (e.g., employment, arrests, residential status). At Year 5 ASP was associated with an increased likelihood of heavy alcohol use and additional substance abuse treatment among men, whereas women with ASP were more likely to report psychological problems and to receive mental health treatment and other services than either women without ASP or men with ASP. The findings suggest the need to address the specific treatment needs of male and female cocaine abusers with ASP. D 2003 Elsevier Inc. All rights reserved. Keywords: Antisocial personality disorder; Cocaine dependence; Gender; Drug treatment outcomes; Service utilization 1. Introduction Both clinical and epidemiological studies have docu- mented high rates of co-occurrence of adult antisocial personality (ASP) disorder and substance use disorders among individuals in drug treatment (Alterman & Cacciola, 1991; Flynn, Craddock, Luckey, Hubbard, & Dunteman, 1996; Kleinman et al., 1990; Rounsaville et al., 1991) and in the general population (Kessler et al., 1996). Studies have also shown that the rates of comorbidity of ASP with substance use disorders differ by gender. Men with ASP are three times as likely to abuse alcohol and five times as likely to abuse drugs as men without ASP. These ratios are even higher for women with ASP compared to women without ASP: 13 times for alcohol and 12 times for drugs (Robins, Tipp, & Przybeck, 1991). Since the rates of ASP among individuals in drug treatment are consistently high, there is considerable interest in the prognostic significance of ASP for drug treatment response. Previous research with male opiate users showed that a diagnosis of ASP predicted poorer outcomes to psychotherapy, although patients with both ASP and de- pression responded more favorably (Woody, McLellan, Luborsky, & O’Brien, 1985). Antisocial personality disorder has also been associated with higher rates of treatment drop- out among substance abusers in an inpatient dual diagnosis unit (Greenberg, Otero, & Villanueva, 1994) and with poorer outcomes at 1 year after inpatient treatment for alcoholism (Hesselbrock, 1991). The characteristic behav- iors and personality traits associated with ASP, such as lack of motivation, disruptiveness, impulsivity, and general dis- regard for others, are assumed to conflict with the ability to engage in and respond positively to treatment, resulting in lower rates of treatment retention and completion and poorer posttreatment outcomes. Several studies have shown that greater severity of psy- chopathology and drug use are associated with poorer treat- ment outcomes among cocaine abusers (Carroll, Power, Bryant, & Rounsaville, 1993), yet findings regarding the relationship of ASP with treatment outcomes for cocaine abusers are mixed. McKay, Alterman, Cacciola, Mulvaney, and O’Brien (2000) showed that a diagnosis of ASP among cocaine-dependent males did not differentiate rates of treat- ment retention, substance use outcomes, social functioning outcomes, or responses to two types of continuing care 0740-5472/03/$ – see front matter D 2003 Elsevier Inc. All rights reserved. doi:10.1016/S0740-5472(03)00127-2 * Corresponding author. Tel.: +1-310-445-0874, ext. 243; fax: +1-310- 473-7885. E-mail address: grella@ucla.edu (C.E. Grella). Journal of Substance Abuse Treatment 25 (2003) 155 – 164