Psychopathy dimensions and substance use: evidence from a non-institutionalized adult population

Mental health in Lebanon has been profoundly affected by recent crises, altering the patterns of substance use and psychiatric presentations. In this context, the link between psychopathy and substance use is relevant, but is underexplored in Arab cultural settings. This study aimed to assess the relationship between psychopathy and substance use in the Arab world, focusing on whether individuals in a Lebanese non-institutionalized population who use substances have higher psychopathy traits than those who do not.

This is a cross-sectional study conducted among 534 non-institutionalized Lebanese adults between May and June 2021. Participants completed a self-administered questionnaire including the validated Levenson Self-Report Psychopathy (LSRP) scale, TAPS (the Tobacco, Alcohol, Prescription medication, and Other substance use screener), the short version of the Urgency, Premeditation (lack of), Perseverance (lack of), Sensation Seeking, Positive Urgency, Impulsive Behavior scale (S-UPPS-P), and the Adverse Childhood Experiences (ACE) questionnaire. Bivariate analysis and multivariable regression were used to assess the association between psychopathy traits and substance use, adjusting for relevant factors.

The mean age of the participants was 36.58 ± 11.94 years, and approximately 80% were women. Callousness was linked with tobacco, alcohol, and illicit drug use, while antisocial traits were associated with tobacco and prescription drug misuse. The regression analyses revealed that the antisocial factor was robustly associated with overall substance use (OR = 1.07, 95% CI = 1.01-1.14, p = 0.02), including tobacco use (OR = 1.13, 95% CI = 1.05-1.21, p = 0.001) and prescription drug misuse (OR = 1.28, 95% CI = 1.14-1.43, p < 0.001). Moreover, it showed that callousness significantly increased the odds of alcohol (OR = 1.15, 95% CI = 1.05-1.26, p = 0.003) and illicit drug use (OR = 1.13, 95% CI = 1.03-1.24, p = 0.01).

This is the first study that examined the relationship between substance use and psychopathy traits in a Lebanese population. These results argue for trait-specific interventions to improve the efficacy and cost-effectiveness of substance use prevention and rehabilitation programs.