Attribution of antisocial symptoms in coexistent antisocial personality disorder and substance abuse

Two methods for diagnosing antisocial personality disorder (ASPD) were compared based on whether antisocial symptoms that occurred when subjects also experienced alcohol- or other drug-related problems were counted toward the diagnosis of ASPD. From a family study of alcoholism and ASPD, 93 male subjects who met ASPD criteria in the absence of substance-related problems were contrasted with 312 subjects who were diagnosed with ASPD regardless of whether criterion symptoms occurred along with substance-related problems. Subjects did not differ in types of antisocial behaviors, age of onset of behaviors, or comorbid psychiatric disorders except for alcoholism and drug abuse. A subgroup was contrasted on family history of psychiatric illness, with no differences noted between groups. Counting antisocial symptoms toward the diagnosis of ASPD regardless of whether symptoms occur during periods of substance abuse increases the observed population prevalence of the disorder, but does not change the observed phenomenology of ASPD or affect commonly accepted indicators of validity of diagnosis.