A basic question in the proposed research is what are the features which characterize antisocial/psychopathic alcohol dependent patients who benefit from conventional treatment and differentiate them from those who do not benefit from treatment? In this connection, we propose to conduct three studies concerned with this issue. The first study attempts to determine whether a group of antisocial and psychopathic (A+P+) alcohol dependent patients will respond more favorably to conventional treatment than a group of antisocial,nonpsychopathic (A+P-) alcohol dependent patients. Secondary questions in this study test the hypotheses that the A+P+ patients will be less likely to qualify for 'neurotic' disorders, will be less able to establish a satisfactory helping alliance with a counsellor, and will show poorer treatment response than the group of A+P- patients. Two other studies will examine important psychometric properties of the SCID antisocial personality disorder (ASP) diagnosis (using RDC and DSM-IIIR criteria) and the Psychopathy Checklist (PCL) developed by Hare to assess the personality construct of psychopathy. Thus, study two will examine short-term interrater reliability of the above measures comparing the findings of assessments completed at baseline and four weeks afterwards; while the third study will evaluate the diagnostic stability of these assessments by comparing the findings for baseline and six months post- entry into the study. The proposed research project will also include an analysis of the predictive validity, interrater reliability, and diagnostic stability of individual items and combinations of items found in the ASP and PCL evaluations. The findings of the study may help to differentiate between antisocial alcohol dependent patients who respond more or less favorably to conventional treatments. The information obtained should also serve as a frame of reference for the development of specialized treatment programs for antisocial alcoholics who do not respond favorably to conventional treatment. The study results should provide important theoretical information concerning the validity of the current ASP diagnosis for substance abusers and possibly lead to an improved revision in the diagnostic approach.
|McLellan, A T; O'Brien, C P; Metzger, D et al. (1992) How effective is substance abuse treatment--compared to what? Res Publ Assoc Res Nerv Ment Dis 70:231-52|