The Treatment of Substance Misuse in Psychopathic Individuals: Why Heterogeneity Matters

Abstract

Psychopathy is a personality syndrome characterized by egocentricity, grandiosity, remorselessness, callousness, impulsivity, and manipulativeness. It is also a disorder highly comorbid with substance use disorders ( Derefinko and Lynam, 2007 ; Smith and Newman, 1990 ; Tourian et al., 1997 ). However, unlike their other criminal counterparts, psychopaths' substance use related problems appear remarkably resilient despite treatment ( Smith and Newman, 1990 ) leading many to conclude the dually diagnosed psychopathic substance misuser is "untreatable." However, this pessimistic stance is predicated upon the notion that psychopathy is a homogeneous, categorical construct. Such a conclusion leaves little hope for treating substance use problems in this population, and has certainly attenuated efforts at developing effective clinical interventions ( Seto and Quinsey, 2006 ). In this review, we argue that conceptualizing psychopathy as a heterogeneous and dimensional construct reveals a common thread of negative emotionality (NEM) that may clarify the relations between psychopathy and substance use disorders as well as pave the way for more practical and viable treatment options.

Psychopathy in Bulgaria: The cross-cultural generalizability of the Hare Psychopathy Checklist

“…Consistent with the literature, relationships were observed between total PCL:SV scores and theoretically related indices of externalizing (Leistico, Salekin, DeCoster, & Rogers 2008; Salekin et al, 2004) and internalizing psychopathology (Stinson, Becker, & Tromp, 2005; Vitacco, 2003), addictive disorders (Gudonis, Derefinko, & Giancola, 2009; Hare, 2003; Smith & Newman, 1990), and personality traits (Morgan, Gray, & Snowden, 2011; Poythress & Hall, 2011). Discriminant relationships between PCL:SV factors and external variables at the partial correlation level indicate that the two factors of the Bulgarian instrument measures similar dimensions as the North American PCL-R and PCL:SV (Hare, 2003; Hart et al, 1995).…”

Neurocognitive and psychiatric dimensions of hot, but not cool, impulsivity predict HIV sexual risk behaviors among drug users in protracted abstinence

“…In contrast, psychopathy was not associated with sexual risk behaviors among polysubstance users in protracted abstinence after controlling for history of substance dependence. This result may be influenced by confounding of psychopathy and the tendency to misuse multiple drugs (77), such that controlling for polysubstance dependence may also parcel out variance associated with psychopathy. Among amphetamine users in protracted abstinence, psychopathy was associated with past 6-month sexual risk behaviors, but this relationship was not observed for lifetime sexual risk behaviors.…”

Examining the relationship among substance abuse, negative emotionality and impulsivity across subtypes of antisocial and psychopathic substance abusers

“…For example, Lykken (1995) hypothesized that primary psychopaths are less prone to the use of alcohol and other sedating drugs than secondary psychopaths. Gudonis et al (2009) similarly contended that negative emotionality plays a critical role in how psychopathic subtypes relate to substance use disorders, with a strong relationship between negative affect and substance abuse being particularly evident among secondary psychopaths relative to primary psychopaths. Somewhat consistent with these hypotheses, research suggests stronger associations between externalizing symptoms, including substance abuse, and features of secondary psychopathy than between externalizing symptoms and features of primary psychopathy (Patrick, Hicks, Krueger, & Lang, 2005;Smith & Newman, 1990;Sylvers, Landfield, & Lilienfeld, in press).…”