A new study has shed light on the relationship between antisocial personality disorder and substance use disorders, revealing that people with antisocial personality disorder are significantly more likely to struggle with alcohol, cannabis, and tobacco addiction. Published in Translational Psychiatry, the research also highlights a strong association between antisocial traits and hazardous substance use, which may help explain the increased severity of addiction seen in these individuals.
Antisocial personality disorder is characterized by traits such as manipulativeness, impulsivity, irritability, and a lack of remorse. People with this disorder often struggle with a variety of behavioral issues, including substance use disorders, which encompass problematic use of substances like alcohol, cannabis, tobacco, cocaine, and opioids.
Previous research has shown that individuals with substance use disorders are more likely to also have antisocial personality disorder, but the specifics of this relationship remained unclear. The researchers sought to fill this gap by investigating whether antisocial personality disorder was related to the severity of different substance use disorders and specific patterns of behavior associated with substance misuse.
“One of my research interests is to understand comorbidities affecting patients affected by psychiatric disorders,” said study author Renato Polimanti, an associate professor of psychiatry at Yale University School of Medicine. “With respect to addiction, we still know very little about differences among substance use disorders. Because Ms. Aislinn Low (a former postgraduate associate in my group, now a PhD student at Michigan State University) was interested in personality research, we decided to investigate the different relationships of substance use disorders with antisocial personality disorder.”
To carry out their study, the researchers analyzed data from the Yale-Penn cohort, a large sample of individuals selected to study addiction-related traits. The cohort included 1,660 participants diagnosed with antisocial personality disorder and 6,640 control participants without the disorder. These control participants were matched with the antisocial personality disorder group based on age, sex, and race/ethnicity to ensure comparability.
The researchers focused on five specific substance use disorders: alcohol, cannabis, cocaine, opioids, and tobacco. Each substance use disorder was analyzed for both diagnosis (whether a participant met the criteria for the disorder) and severity (whether the disorder was mild, moderate, or severe, based on the number of criteria met). They also examined individual diagnostic criteria for each substance use disorder, such as whether participants used the substance in hazardous situations, experienced cravings, or made attempts to quit.
The results showed that antisocial personality disorder was related to both the diagnosis and the severity of alcohol, cannabis, and tobacco use disorders. Individuals with antisocial personality disorder were nearly twice as likely to be diagnosed with alcohol use disorder, more than twice as likely to have cannabis use disorder, and one and a half times more likely to have tobacco use disorder compared to the control group. The severity of these disorders was also greater among people with antisocial personality disorder, meaning they tended to exhibit more problematic behaviors related to substance misuse.
The researchers also found that the relationship between antisocial personality disorder and substance use disorders extended beyond mere diagnosis to specific behaviors associated with these disorders. One particularly notable finding was that individuals with antisocial personality disorder were more likely to engage in “hazardous use” across all five of the substance use disorders examined. Hazardous use refers to the consumption of substances in dangerous situations, such as driving under the influence or engaging in risky behaviors while intoxicated.
Another interesting finding related to the “attempts to quit” criterion, particularly for cocaine use disorder. The study found that individuals with antisocial personality disorder were less likely to report making efforts to quit using cocaine, indicating that this population may struggle more with the motivation or ability to reduce or stop cocaine use. This finding was specific to cocaine and was not seen with the other substances studied.
“The main take-home message of this study is that there are both differences and similarities among substance use disorders that can lead to psychiatric comorbidities,” Polimanti told PsyPost. “With respect to antisocial personality disorder, we observed different patterns of associations when testing severity and diagnoses of alcohol, cannabis, cocaine, opioid, and tobacco use disorders. However, when looking at specific symptoms, hazardous use showed the strongest relationship with antisocial personality disorder across the five substance use disorders investigated.”
The study also highlighted sex differences in the relationship between antisocial personality disorder and substance use disorders. Even though the researchers matched participants by sex, they found that sex continued to play a significant role in how antisocial personality disorder related to substance use disorder severity and specific criteria.
Controlling for internalizing disorders helped explain some of the observed sex differences. For instance, when the researchers included these disorders in their regression models, they found that the role of sex in the relationship between antisocial personality disorder and substance use disorders was somewhat attenuated. This suggests that part of the sex differences observed in the antisocial personality disorder and substance use disorder relationship could be attributed to internalizing conditions, which tend to differ between men and women.
“A surprising finding related to our study is the potential role of internalizing disorders (i.e., anxiety, depression, and posttraumatic stress disorder) in contributing to the sex differences observed in the comorbidity between substance use disorders and antisocial personality disorder,” Polimanti explained. “This is an interesting hypothesis that will need further efforts to be completely understood.”
The study adds to the growing body of evidence suggesting that antisocial personality disorder and substance use disorders are closely intertwined. But there are some caveats to consider. One limitation is that the study’s sample was specifically selected to include individuals with substance use disorders and related traits, which means the findings may not be representative of the general population.
“Our study is based on a cohort enriched for participants with lifetime diagnoses of substance use disorders,” Polimanti noted. “For instance, 64% and 39% of our participants have lifetime diagnoses of cocaine and opioid use disorders, respectively. In the United States, the prevalence of these substance use disorders is less than 5%. Accordingly, the results observed in our study may not be generalizable to population groups with different characteristics.”
“This study is part of a larger study where we are investigating comorbidity trajectories among substance use disorders using longitudinal information. Additionally, we will assess how genetic and epigenetic factors contribute to psychiatric comorbidities among substance use disorders.”
The study, “Association patterns of antisocial personality disorder across substance use disorders,” was authored by Aislinn Low, Brendan Stiltner, Yaira Z. Nunez, Keyrun Adhikari, Joseph D. Deak, Robert H. Pietrzak, Henry R. Kranzler, Joel Gelernter, and Renato Polimanti.
