Westermeyer Joseph, Thuras Paul
Minneapolis VAMC, University of Minnesota, Minneapolis, Minnesota, USA.
Am J Drug Alcohol Abuse. 2005;31(1):93-110.
The aims were to determine among patients with substance use disorder (SUD) whether those with antisocial personality disorder (ASPD) manifest less, the same, or more of the following: 1) temporal course of substance use, 2) severity of substance-related symptoms and problems, 3) familial SUD, 4) number and type of SUD diagnoses, and 5) extent of SUD treatment, as compared to patients without ASPD. DESIGN AND DEFINITION: Scheduled interviews using Diagnostic and Statistical Manual (DSM) criteria were used to determine ASPD, which required childhood conduct disorder plus adult antisocial behavior. Clinicians blind to the ASPD assessment collected the remainder of the data.
Alcohol-drug treatment programs were located in two university medical centers.
Six hundred and six voluntary patients aged 18 and older met diagnostic criteria for SUD.
SUD patients with ASPD reported more substance-related problems in seven out of eight areas of the interview-based Minnesota-Substance Abuse Problems scale. On a self-rated scale, the Michigan Assessment Screening Test/Alcohol-Drug, the difference was unremarkable. The ASPD group reported slightly, but significantly, more relatives with SUD. Lifetime use of tobacco and most illicit drugs was greater in the ASPD group. Age at first use of alcohol and tobacco was less in the ASPD group, but age at first use of other substances did not show a difference. Indicators of SUD course, such as years of use, days of use in the last year, duration of periods of abstinence, and number of self-help efforts showed no differences between the two groups. Types and numbers of SUD diagnoses showed no difference. However, all treatment indicators (i.e., lifetime number of admissions, modalities of care, days of care, and cost of care) were significantly higher in the ASPD group. A regression analysis revealed that family and legal problems remained strongly associated with ASPD, but other substance-related problems and SUD treatment dropped out.
Despite the many similarities in SUD among those with and without ASPD, the morbidity in the ASPD as measured by number and types of substance-related problems and by all treatment variables is considerably greater. Legal and family problems appear to be powerfully associated with ASPD and predictive of other problems as well as SUD treatment.
本研究旨在确定物质使用障碍（SUD）患者中，与无反社会人格障碍（ASPD）的患者相比，患有ASPD的患者在以下方面表现较少、相同还是更多：1）物质使用的时间进程；2）与物质相关的症状和问题的严重程度；3）家族性SUD；4）SUD诊断的数量和类型；5）SUD治疗的程度。
使用《诊断与统计手册》（DSM）标准进行定期访谈以确定ASPD，这需要童年期品行障碍加上成人反社会行为。对ASPD评估不知情的临床医生收集其余数据。
酒精-药物治疗项目位于两个大学医学中心。
606名18岁及以上的自愿患者符合SUD诊断标准。
在基于访谈的明尼苏达物质滥用问题量表的八个领域中，患有ASPD的SUD患者在其中七个领域报告了更多与物质相关的问题。在自我评定量表密歇根评估筛查测试/酒精-药物上，差异不显著。ASPD组报告有SUD的亲属略多，但差异显著。ASPD组烟草和大多数非法药物的终身使用率更高。ASPD组首次使用酒精和烟草的年龄更小，但首次使用其他物质的年龄没有差异。SUD病程指标，如使用年限、过去一年的使用天数、禁欲期持续时间和自助努力次数，两组之间没有差异。SUD诊断的类型和数量没有差异。然而，所有治疗指标（即终身入院次数、护理方式、护理天数和护理费用）在ASPD组中显著更高。回归分析显示，家庭和法律问题与ASPD仍密切相关，但其他与物质相关的问题和SUD治疗不再相关。
尽管有和没有ASPD的患者在SUD方面有许多相似之处，但通过与物质相关问题的数量和类型以及所有治疗变量衡量，ASPD患者的发病率要高得多。法律和家庭问题似乎与ASPD密切相关，并且可以预测其他问题以及SUD治疗。
