New research suggests that criminal substance abusers with antisocial personality disorders just want to be understood.
"We need to go beyond the research that sees offenders as guinea pigs, and start to make their voices heard, and to get a better understanding of what they want," study author Morten Hesse, associate professor at the Centre for Alcohol and Drug Research at Aarhus BSS, said during an interview. "Saying this, I don’t mean just that they want to avoid prison or that they want a house and a well-paid job, but what kind of dreams they have for themselves, and what kind of treatment they would be willing to engage in.”
Hesse and colleagues examined 175 individuals with substance abuse problems and antisocial personality disorders. Eighty were offered a "standard treatment program for substance use disorders," but of those selected, 54% dropped out. The researchers supplemented the standard treatment program with an “impulsive lifestyle counseling program” for the remaining 95 participants. As a result, the percentage of those dropping out three months later fell to 42%.
The additional program consisted of six structured sessions on the following topics:
- Thoughts and behavior related to antisocial personality structure.
- Impulsive behavior and immediate consequences.
- Impulsive behavior in relation to pride and self-worth.
- Values that may support or prevent changes.
- Social support.
- Follow-up.
Seventy-six percent of participants attended at least one counseling session, with 23% attending all six of them. All patients reduced drug and alcohol problems at nine months.
While the extra program itself was helpful, the researchers were unable to separate factors that predicted its efficacy, Birgitte Thystrup, another associate professor from the same school, said via email. "What we think, as clinicians and researchers, is that the counselors we trained to conduct the program in clinical practice appreciated learning about a rather simple way they could offer these people targeted qualified support. They [the clinicians] became engaged with the model and changed their view of the patients. These patients are some of the least liked, and a diagnosis of antisocial personality disorder is very often a diagnosis that means that there is nothing for you."
She added: "This is very understandable because nobody likes to be lied to, manipulated with, or threatened. So it’s very understandable that clinicians and administrators wish to avoid having too many of these patients in their clinics. Still, we cannot ignore these people.
Both the social sector and the prison probation service offer only a limited amount of treatment programs for people with antisocial personality disorders. The researchers are hoping that the results of their study can be used to open up more opportunities to these individuals.
"Using the diagnosis of antisocial personality disorder is seen as stigmatizing the patients, so nobody builds programs for them," Hesse said. "We think it is very valuable to try to avoid stigmatizing people, because when individuals or groups become identified with stigmatized labels, it does not create hope or incentive for change. But there is a balance. This is essentially similar to alcohol, drugs, or even obesity. Pointing fingers at people doesn’t make them consider change, it just makes them more resistant. When we tell someone their drinking will kill them, they just want a drink. When we tell people that they are fat and disgusting, they will go home and seek out the comfort of a huge desert. But we need to develop our approaches so that they help people seeing the potential for change, and this is where self-understanding comes into it."
"We also need research to develop and try out a wide variety of approaches that target these people within a variety of settings," Hesse said. "There is considerable research on case management within the criminal justice system, but there is much more to changing a life of crime and offending behavior: housing, coping with addiction, improving interpersonal relations, formulating and pursuing dreams - all of this need to be the focus of treatment approaches and social casework."
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