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Dual Diagnosis: Antisocial Personality And Alcohol Use Disorders

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The aggressive and impulsive behaviors that go hand in hand with Antisocial Personality Disorder (ASPD) may be intensified while a person is under the influence of alcohol. Alcohol use disorder that co-exists with an antisocial personality disorder is referred to as a dual diagnosis, comorbidity, or co-occurring disorder.

An alcohol use disorder (AUD) is defined as a chronic relapsing brain disease characterized by compulsive alcohol use, loss of control over alcohol intake, and a negative emotional state when not using. Alcoholism and alcohol use are both considered AUD.

Alcoholism is also referred to as alcohol addiction or alcohol dependence. A person doesn’t have to be addicted to alcohol to use it, but they may still struggle with some of the same consequences. In either case, alcohol can be a major contributor to an antisocial personality disorder.

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Some of the common attitudes and behaviors of the dual diagnosis of alcohol use disorder and antisocial personality disorder are:

  • frequently becoming angry
  • hostile, aggressive, and violent behavior
  • using alcohol at times that are considered inappropriate
  • disregard for the safety of self and others
  • repeatedly breaking the law—drinking, and driving
  • in and out of jails or prisons
  • egocentrism and sense of unwarranted authority
  • unhealthy and abusive relationships
  • manipulating other people’s emotions
  • lying, stealing, and fighting
  • not showing guilt, empathy or remorse for hurting others

Understanding Antisocial Personality Disorder

An antisocial personality disorder is a mental health condition in which a person has a long-term pattern of manipulating, exploiting, or violating the rights of others.

A person suffering from ASPD may also be emotionally unavailable and may have a knack for talking their way out of trouble. They often show little regard for the law, and may put others in harm’s way for their own benefit, and show little remorse in the process.

Statistically, men are more likely to have antisocial personality disorder than women. An estimated one percent of the United States population is suffering from ASPD, and about 46 percent of those people ever receive treatment for it.

Many of the behaviors characteristic of antisocial personality disorder arise in early childhood/adolescence and carry on into adulthood.

A person is diagnosed with ASPD if they carry three of the following characteristics or traits:

  • repeated criminal acts
  • repeated fights or assault
  • deceit and manipulation
  • disregard for the safety of others
  • impulsiveness
  • irresponsibility
  • lack of guilt and remorse

In the past century, antisocial personality disorder has also been referred to as moral insanity, psychopathy, sociopathic personality disorder, and sociopathy. Someone who shows signs of ASPD may be struggling with a mental illness.

The National Institute on Alcohol Abuse and Alcoholism (NIAAA) reports, “the symptoms considered to be the key elements of psychopathy or an antisocial personality have evolved from a focus on the lack of emotional attachment in relationships with others to a greater focus on external behaviors, especially aggressive, and impulsive behaviors.”

Can Alcohol Make Antisocial Personality Disorder Worse?

The exact cause of ASPD isn’t always understood, but it’s believed to be a combined effort of an individual’s genetics and environmental factors. For most people, alcohol can be a direct or indirect cause of antisocial personality disorder.

Alcohol use changes the chemistry in a person’s brain. Most of these changes are complex, and may not be completely understood, but behavioral changes due to alcohol use are certain.

Alcohol alters the activities of several of the brain’s neurotransmitters, including gamma-aminobutyric acid (GABA) and serotonin. Both GABA and serotonin have been linked to aggressive behavior, thus linking alcohol use to ASPD.

A study by the U.S. National Library of Medicine found that people suffering from ASPD were more likely to have been used as a child. Other common factors included having a parent who was antisocial, or addicted to alcohol.

Setting fires and animal cruelty are often seen as a precursor to antisocial personality disorder. ASPD is common among prison populations.

Consequences Of Alcohol Use And Antisocial Personality Disorders

Not every person who develops an alcohol use disorder will comorbidly develop an antisocial personality disorder, but they will be at a greater risk. On the other hand, people suffering from ASPD are believed to be more likely to meet the criteria for alcohol use and alcoholism.

Studies also show that people with a past history of aggressive behavior may be more likely to have elevated aggressiveness when they drink alcohol.

Alcohol use and alcoholism often contribute to the reckless, aggressive, and impulsive behaviors of ASPD. These behaviors often result in complications, which may include:

  • spouse abuse, child abuse, or neglect
  • comorbid mental illnesses like depression or anxiety
  • using an alcoholic blackout as leverage for manipulation
  • low social and economic status
  • gang participation
  • homelessness
  • homicidal or suicidal behaviors
  • premature death as a result of violence

People suffering from ASPD may not recognize when they’ve done something wrong. People with ASPD lack the anxiety, punishment, or negative feeling that someone without ASPD experiences when they do something wrong. As a result, those with ASPD may not alter their behavior to an appropriate level.

A prime example of the dual diagnosis of AUD and ASPD is a person with alcoholism who drives home drunk every night with their children in the car and never gets caught. If they received appropriate treatment for these disorders early on, their behavior may look different.

Antisocial Personality Disorder And Alcohol Treatment

An antisocial personality disorder is one of the hardest personality disorders to overcome, partly because the sufferer may not see their signs and symptoms as a problem, and therefore may not seek treatment.

Any measure of treatment for antisocial personality and alcohol use disorders is better than none at all. Treating each disorder at the same time is crucial to recovery success.

Rehabilitation required by a court, or enforced by family members, is a common approach to help a person with co-occurring antisocial personality and alcohol use disorders. Treating an issue with ASPD should be done effectively, at as young an age as possible.