Psycho-education for substance use and antisocial personality disorder: a randomized trial

Abstract

BackgroundAntisocial personality disorder often co-exists with drug and alcohol use disorders.MethodsThis trial examined the effectiveness of offering psycho-education for antisocial personality disorder in community substance use disorder treatment centers in Denmark. A total of 176 patients were randomly allocated to treatment as usual (TAU, n = 80) or TAU plus a psycho-educative program, Impulsive Lifestyle Counselling (ILC, n = 96) delivered by site clinicians (n = 39). Using follow-up interviews 3 and 9 months after randomization, we examined changes in drug and alcohol use (Addiction Severity Index Composite Scores), percent days abstinent (PDA) within last month, and aggression as measured with the Buss-Perry Aggression Questionnaire-Short Form and the Self-Report of Aggression and Social Behavior Measure.ResultsOverall engagement in psychological interventions was modest: 71 (76 %) of participants randomized to psycho-education attended at least one counselling session, and 21 (23 %) attended all six sessions. The Median number of sessions was 2. All patients reduced drug and alcohol problems at 9 months with small within-group effect sizes. Intention-to-treat analyses indicated significant differences between ILC and TAU in mean drugs composite score (p = .018) and in PDA (p = .041) at 3 months. Aggression declined in both groups, but no differences between ILC and TAU were observed in terms of alcohol problems or aggression at any follow-up.ConclusionsModerate short-term improvements in substance use were associated with randomization to Impulsive Lifestyle Counselling. The findings support the usefulness of providing psycho-education to outpatients with antisocial personality disorder.Trial registrationISRCTN registry, ISRCTN67266318, 17/7/2012Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-015-0661-0) contains supplementary material, which is available to authorized users.

Did you get any help? A post-hoc secondary analysis of a randomized controlled trial of psychoeducation for patients with antisocial personality disorder in outpatient substance abuse treatment programs

“…Our study was not powered to test such an association a priori, as the power analysis was conducted simply to assess the likelihood of finding a significant effect of the intervention [15]. The post hoc power analysis suggested the study did have the power to detect a mediation effect.…”

“…The details of the study are reported in two previous reports [15, 16]. Inclusion criteria to the study were: between 18 and 65 years old; met criteria for ASPD using the Mini International Neuropsychiatric Interview [24]; and able to provide written informed consent; seeking treatment or already in treatment for a SUD.…”

“…First, we assessed whether effects of the ILC program on self-rated help for ASPD mediated the effects of ILC on days abstinent, and then we assessed whether the effects of the ILC program on self-rated help for ASPD mediated the effects of ILC on the drugs composite score [15]. In mediation analysis, some of the effect of the independent variable, the IV, is transmitted to the dependent variable, the DV, through the mediator variable, the MV and some of the effect of the IV passes directly to the DV.…”

“…The trial found that ILC had significant effects on days abstinent from substance use and severity of drug use at the 3-month follow-up, and that aggression declined in both treatment as usual and ILC with no significant differences between interventions [15], and that the ILC program had significant effects on the risk of dropout from substance abuse treatment [16]. However, one question that has not been previously assessed in this study is the perceived helpfulness of treatments for mental health comorbidity.…”

“…The aims of this study were to assess perceived help for ASPD using secondary analyses based on a randomized clinical trial of six sessions of psychoeducation for comorbid SUD and ASPD [15, 16]. We predicted that randomization to the psychoeducational program would increase the perception of having received help for ASPD as part of the substance abuse treatment during the study period.…”