Don’t give up on difficult clients

Clients with behavioral problems often are expelled from substance abuse treatment programs because counselors assume they’re incapable of rehabilitation. But a new study shows clients diagnosed with antisocial personality disorder (APD) are just as likely to complete the programs successfully as those without the disorder.

"Our findings were not consistent with other studies in the literature," says Nena Messina, MA, research associate at the Center for Substance Abuse Research in College Park, MD, who conducted the study. "Most previous research has found that clients with APD don’t finish treatment, or if they do, don’t have successful outcomes. We found there was little or no difference in outcomes between clients with APD and those without."

The study was funded by the Substance Abuse and Mental Health Services Administration in Rockville, MD. Clients participating in the District of Columbia Treatment Initiative underwent diagnostic testing. Of 338 clients tested, 166 were diagnosed with APD, and 172 were not. Clients were assigned randomly to a program of 10 months of inpatient treatment then two months of outpatient, or a program of six months of inpatient treatment and six months of outpatient. Self-reports and objective measures of criminal activity and substance abuse were collected at pre- and post-treatment interviews. "Our first finding was that there was no difference in outcome between the standard program and the abbreviated inpatient program," Messina says. "Our second finding was that there was no difference in outcome between clients with APD and clients without APD."

For instance, the post-treatment arrest rate for APD clients who didn’t complete treatment was 63%, vs. 61% for non-APD clients. The rate was higher for non-APD clients who completed treatment (32%) than for APD clients (25%). Messina says the data should encourage case managers and substance abuse treatment providers to accept and retain APD clients.

The study has been accepted for publication in The Journal for Substance Abuse Treatment. For more details, visit the Web at