Magazine article Addiction Professional

Change the Approach for Antisocial Patterns

Magazine article Addiction Professional

Change the Approach for Antisocial Patterns

Article excerpt

Treatment as an alternative to prison is attractive not only to our clients, but also to our programs, our politicians, and our taxpayers. As more and more people are being sent to rehab rather than prison, addiction treatment providers face new challenges. Our traditional substance use treatment tools are proving to be less effective in dealing with clients' antisocial characteristics.

Treatment providers have spent many years developing successful programs to deal with substance abuse, but many of our tools are not as useful in dealing with "criminal thinking," or the DSM's "antisocial personality disorder." For lis example, cognitive-behavioral therapy (CBT) can be highly effective for substance abuse clients who are committed to a goal of abstinence. Counselor and client work together to identify and change unhelpful thoughts and patterns of behavior. But CBT has no chance of succeeding with clients who won't tell you what they're really thinking.

So programs need to identify clients with the heaviest antisocial characteristics and use different tools or maybe even create a separate track for them. Those who are diagnosed with full-blown antisocial personality disorder can be very disruptive of treatment, and it might be best to deal with them in a totally separate program in a different location.

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Comparing characteristics

Let's consider what individuals with substance use issues and those with antisocial personality disorder have in common. Both groups are often highly intelligent and can make a very good first impression. Neither group is very good at dealing with frustration, and both continue making the same choices despite not getting the intended results. Sadly, premature death is associated with both groups.

But those diagnosed with substance abuse and those with antisocial personality disorder differ in at least four important ways:

1) The pattern of substance abuse often reveals a lot about which diagnosis applies. Those with a primary diagnosis of anti-social personality disorder are usually chronic abusers, but not addicts. They usually don't use over a period of years on a daily basis. That's why it might be easier for them in the early days of treatment to go without using.

2) The pattern of relationships with other people is also very different. Those with antisocial personality disorder don't usually experience the anxiety that our more traditional clients do--they lack the capacity for truly intimate human relationships. They have few or no long-term relationships, because they manipulate and exploit others without remorse. On the other hand, the use of substances causes many conflicts in the interpersonal relationships of those with addiction problems. Addicts do have the ability to maintain long-term relationships, and they care--maybe too much--about what other people think of them.

3) Differences in the thoughts of the two groups are the most reliable indicator, but also the hardest to ascertain accurately. Thought patterns of our traditional clients reflect worthlessness, shame, guilt, self-doubt, fear and hurt. Thought patterns of the antisocial personality disorder client are more narcissistic, with no sense of responsibility for consequences. There are often violent and even murderous thoughts.

4) Finally, there are differences in emotional makeup. Those with antisocial personality disorder don't experience empathy, love, fear, anxiety, depression, or remorse as the rest of the population does. …

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