Rehab: Don’t give up on difficult SA clients

Even clients with APD succeed, study finds

Clients with behavioral problems are often kicked out of substance abuse treatment programs because counselors assume they’re not capable of successful rehabilitation. But a new study finds that clients diagnosed with antisocial personality disorder (APD) are just as likely to complete substance abuse programs successfully as those without the disorder.

"Our findings were not consistent with other studies in the literature," notes Nena Messina, MA, research associate at the Center for Substance Abuse Research (CESAR) 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 the 338 clients tested, 166 were diagnosed with APD and 172 were not. Clients were randomly assigned to either a standard program which included 10 months of inpatient treatment followed by two months of outpatient follow up, or an abbreviated inpatient program which included six months of inpatient treatment and six months of outpatient treatment.

Self-reports and objective measures of criminal activity and substance abuse were collected at pre- and post-treatment interviews.

Messina says the data should encourage case managers and substance abuse treatment providers to accept and retain clients with APD.

The study has been accepted for publication in a future issue of The Journal for Substance Abuse Treatment. For more information, visit CESAR’s Web site at