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National Institute on Drug Abuse -  NIDA NOTES
Treatment Advances
Volume 11, Number 4
September/October 1996

Do APD Patients Use More Drugs?

The results of a recent study led researchers to wonder if antisocial personality disorder (APD)* leads to heavy drug use, which, in turn, leads to poor drug abuse treatment results.

In examining outcome data from the study, which tested a voucher-based treatment with injecting heroin abusers in methadone treatment who also had a history of heavy cocaine abuse, Dr. Kenneth Silverman of Johns Hopkins University, Dr. Kenzie Preston of NIDA's Division of Intramural Research, and their colleagues found that half of the patients had achieved sustained periods of abstinence from cocaine. However, reexamination of the data indicated that patients with a diagnosis of APD and patients whose urine tests had the highest concentrations of cocaine during the study's baseline period had not responded to this behavioral intervention.

"The issue was whether or not APD leads to increased levels of cocaine use, and it is these increased levels of use [not the personality disorder by itself] that predict poor outcomes," says Dr. Charles Schuster, now at Wayne State University in Detroit, who helped conduct the voucher study. Dr. Schuster conducted a subsequent analysis of these two factors - heavy baseline cocaine use and APD - and their relation to treatment outcomes that showed that the APD patients were not among the group of highest cocaine users. "Many of the APD patients had low levels of cocaine metabolites in their urines during the baseline period, and they still didn't do very well," Dr. Schuster says. Thus, it appears that the heavy use of cocaine during the baseline period and APD are independently linked to a poor treatment outlook, he says.

* Also abbreviated ASP


Schuster, C.R.; Silverman, K.; Harrell, S.; Brooner, R.; Cone, E.; and Preston, K. ASP as a predictor of treatment outcome in a contingency management program for cocaine abusers. Poster presented at the Annual Meeting of the American College of Neuropsychopharmacology, San Juan, Puerto Rico, December 1995.

From NIDA NOTES, September/October, 1996

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