|Year : 2019 | Volume
| Issue : 1 | Page : 8-14
Antisocial personality disorder and its associated factors among incarcerated offenders at a maximum-security prison in Nigeria
Adetunji Obadeji1, Oluyinka Emmanuel Majekodunmi1, Lateef Olutoyin Oluwole1, Ayodele Fela-Thomas2
1 Department of Psychiatry, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
2 Department of Clinical Services, Neuropsychiatric Hospital, Aro, Abeokuta, Nigeria
|Date of Submission||02-Nov-2019|
|Date of Decision||14-Nov-2019|
|Date of Acceptance||11-Feb-2020|
|Date of Web Publication||21-Jul-2020|
Department of Psychiatry, Ekiti State University Teaching Hospital, PMB 5535, Ado-Ekiti
Source of Support: None, Conflict of Interest: None
Background: Although previous studies from Western nations had reported elevated rates of antisocial personality disorder (ASPD) among incarcerated offenders, there are limited studies from the developing nations like ours. The study was aimed at determining the prevalence of ASPD in a prison population and its association with social and substance use variables. Methods: Using a cross-sectional survey, 277 randomly selected incarcerated offenders were assessed using a sociodemographic questionnaire and Structured Clinical Interview using the Mini-International Neuropsychiatric Interview plus to assess ASPD and substance use disorders. Diagnoses were made based on the Diagnostic and Statistical Manual of Mental Disorders-4th edition and the 10th revision of the International Statistical Classification of Diseases and Related Health Problems. Results: The prevalence of ASPD in this population of offenders was 13.5%. The most common offense was armed robbery. Offenders with ASPD were more likely to be unemployed prior to imprisonment and have a father who uses or abuses alcohol or cannabis. Significantly, those with ASPD were more likely to meet criteria for alcohol and cannabis use disorders. Conclusion: There is an elevated rate of ASPD among incarcerated offenders, and such offenders need to be evaluated for alcohol and substance use disorders to ensure smooth rehabilitation.
Keywords: Antisocial personality disorder, Nigeria, offenders, prevalence, substance use disorders
|How to cite this article:|
Obadeji A, Majekodunmi OE, Oluwole LO, Fela-Thomas A. Antisocial personality disorder and its associated factors among incarcerated offenders at a maximum-security prison in Nigeria. Saudi J Forensic Med Sci 2019;2:8-14
|How to cite this URL:|
Obadeji A, Majekodunmi OE, Oluwole LO, Fela-Thomas A. Antisocial personality disorder and its associated factors among incarcerated offenders at a maximum-security prison in Nigeria. Saudi J Forensic Med Sci [serial online] 2019 [cited 2022 May 25];2:8-14. Available from: https://www.sjfms.org/text.asp?2019/2/1/8/290351
| Introduction|| |
There is increased evidence to suggest a strong association between personality disorders and significant risks for violence.,, This group of offenders often present greater challenge in the rehabilitation of inmates. Of the various personality disorders associated with criminal behavior, antisocial personality disorder (ASPD) has been described as one of the best predictors of criminal behavior.,
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-V), by the American Psychiatric Association, personality disorders, generally, represent a significant impairment in personality (i.e. self and interpersonal functioning) that is relatively stable across the lifespan, with onset in adolescence or early adulthood. Such behavior is usually at variance with cultural norms or expectations, and often time accompanied by distress or impairment of either the individual or the people around him. People with ASPD, on the other hand, present with the pattern of socially irresponsible behavior (such as violating or disregarding rights of others) alongside repeated criminal behavior, impulsivity, aggressiveness, and exploitative and guiltless behavior., According to the social control theory, such individuals break the law due to a breakdown with their societal bond., The four dimensions of social bonding, i.e. attachment, commitment, involvement, and belief, restrain individuals from satisfying their natural appetites for pleasure by becoming more sensitive to how others are affected by behaviors. As moral codes are internalized and individuals are attached to their community, the propensity to commit deviant acts is limited. Self-control has been described as the most proximate factor to crime and deviance, and individuals with low self-control tend to seek immediate gratification, are impulsive, are self-centered, and are generally insensitive to the feelings of others. This may explain the major features of ASPD and its relationship with criminal behaviors.
The prevalence of people with ASPD in the general population is quite low, usually between 2% and 5%., In prison population, however, ASPD is overrepresented,,, with the prevalence of people with ASPD in the criminal justice population increasing to about 50%. Black et al. reported that over 35% of newly incarcerated offenders in the USA met the criteria for ASPD, and approximately one in two male prisoners and one in five female prisoners had ASPD, and relative to other mentally ill offenders, this group of offenders is more likely to re-offend after discharge from the prison.
In addition, majority of the people with ASPD also meet the criteria for another psychiatric diagnosis, with up to 90% having another mental illness. More importantly, ASPD is associated with significant psychosocial impairment, depression, schizophrenia and other psychotic disorders, substance misuse, borderline personality disorder, domestic violence and increased risk of suicide, and medical comorbidity.,,
The risk for substance use disorders is often increased by the presence of ASPD.,, This is not limited to just those in the prison but also to those with mood disorders and schizophrenia. According to Mueser et al., ASPD is strongly related to all measures of substance use problems and disorders, as well as fathers' history of substance use disorder. Among drug abusers, it has been noted that the presence of comorbid ASPD predicts criminal behavior following treatment compared with substance abusers without such a diagnosis,, however, other studies had refuted this observation., Alongside the challenges of substance misuse, offenders with ASPD also present with considerable management problems due to their irritability, aggression, disregard for the rights of others, and lack of remorse.
Studies looking at psychiatric morbidity among incarcerated offenders in Nigeria have reported high rates of psychiatric morbidity, with over half of the population presenting with one mental disorder or the other, most importantly substance use disorders.,, This is likely because ASPD is one of the most common co-occurring psychiatric diagnoses among people with a substance use disorder. There are limited studies examining ASPD among incarcerated offenders in Nigeria using a structured instrument. This study aimed to determine the prevalence of ASPD and its association with social and drug use variables among inmates at a maximum-security prison in Nigeria.
| Methods|| |
A cross-sectional survey was adopted in this study to assess inmates at the maximum-security Federal Prison in Abeokuta, Nigeria, for variables of interest.
The sample for the study was drawn from a prison population consisting of 489 awaiting trial (including 28 females) and 282 convicted inmates (including 5 females), Who were serving various prison terms at the Federal Prison, Abeokuta. Using Cochrane's minimum sample size formula, the estimated sample size was 286. Participants for this study population were selected using a simple random sampling, using a table of random numbers, and the probability proportional to size method was used to determine the number of participants based on their prison status, i.e., either awaiting trial or convicted inmates. An additional 10% was added to accommodate for those who may leave the prison before they were evaluated or who may decline.
Due to limited number of female inmates, they were all excluded from the study. Those with severe physically illness as well as inmates those with learning disability or those who understands neither Yoruba nor English languages were also excluded from the study.
Each participant was interviewed with a pro forma containing information on sociodemographic variables, forensic details, and details of parental alcohol and substance use; ASPD was assessed using the Mini-International Neuropsychiatric Interview English version 5.0 (MINI plus 5). Similarly, alcohol abuse/dependence and other psychoactive substance use disorders were assessed using their respective modules of the MINI plus 5, a short, structured diagnostic interview, developed by psychiatrists and clinicians in the United States and Europe, for evaluating psychiatric disorders based on the DSM-IV and the 10th revision of the International Statistical Classification of Diseases and Related Health Problems criteria. Validity and reliability studies comparing the Structured Clinical Interview for the DSM-IV (SCID-IV) and the Composite International Diagnostic Interview with the MINI plus 5 show high validation and reliability scores (kappa scores for all diagnoses were above 0.70, with about 70% being above 0.90, indicating high interrater reliability) and in comparison with the SCID-IV, its sensitivity is above 0.70 and specificity is 0.85 and above for most diagnoses.,
Data generated from the questionnaires were analyzed using Statistical Package for the Social Sciences program version 18 (IBM Corporation, Armonk, New York, USA). Presentations of data were done using frequency distribution tables or chart; univariate analysis using t-test was employed for continuous variables, whereas Pearson's Chi-square test was used for qualitative variables with Fisher's exact or Yate's correction applied, as applicable. This analysis has been removed during the course of revision, thus the statement was no longer necessary. The level of significance was set at 5%.
All procedures performed in study were in accordance with the ethical standards of the institutional Ethics and Research Committee of the Federal Neuropsychiatric Hospital, Aro, Abeokuta, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Official permission was granted by the Controller of Prisons, Ogun State Command. A written informed consent was obtained from all the participants after informing them about the research aims and objectives. Confidentiality and privacy of information were ensured. The participants were also assured of that their choice of participating or not will not affect their trial, sentence, or treatment by the prison staff in anyway.
| Results|| |
A total of 277 inmates finally participated in the interview. Of these, 169 (61.0%) were awaiting trial, whereas 108 (39.0%) were convicted of various offenses. The mean age of the participants was 34.77 ± 10.28 years. Majority of the participants had some level of primary or high school education (75.45%) and were employed (88.1%) prior to imprisonment. Those who were convicted were serving time-specific imprisonment (27 [9.7%]), life imprisonment (21 [7.6%]), or were sentenced to death (60 [21.7%]). Twelve (4.3%) of the 277 inmates had previous imprisonment, of which 3 (25.0%) had ASPD. Seven (2.6%) of the inmates had a family history of imprisonment, with first-degree relatives in 3 (1.1%) and second-degree relatives in 4 (1.5%) inmates.
Type of inmates' offenses
Among these offenders, armed robbery was the most common offense either charged with or convicted of, accounting for 153 (55.2%) of the inmates. This was followed by murder, stealing, fraud, rape, and kidnapping, representing 53 (19.1%), 28 (10.1%), 11 (4.0%), 7 (2.5%), and 6 (2.2%) of the cases, respectively. Other offenses were manslaughter in 4 (1.4%); illegal possession of firearms, assault, and conspiracy, each representing 1.1%; fighting in 2 (0.7%); and drug trafficking, impersonation, bribery, and aiding and abetment, each representing 0.4% of the inmates.
Types of offense and antisocial personality disorder
[Table 1] shows the relationship between the types of offense and ASPD. The rate of ASPD was highest among those charged with armed robbery (19.5%), followed by rape and stealing accounting for 16.7% and 11.1%, respectively. The proportions of ASPD in relation to other offenses are shown in [Table 1].
|Table 1: Proportion of antisocial personality disorder in various offenses|
Click here to view
Antisocial personality disorder and inmates' sociodemographic characteristics
[Table 2] shows the relationship between inmates' sociodemographics and ASPD. Higher proportions of those who were not employed prior to their incarceration (8 [24.2%]) compared with those who were employed (29 [11.9%]) had ASPD (P = 0.050). Twenty-four (17.7%) of the inmates whose fathers were alive compared with 12 (9.22%) of those whose fathers were dead had ASPD (P = 0.039). Similarly, those whose fathers use/abuse alcohol or cannabis were more likely to have ASPD (P = 0.033). There was no statistically significant relationship between ASPD and other sociodemographic variables (P > 0.05).
|Table 2: Relationship between sociodemographic variables and antisocial personality disorders|
Click here to view
Antisocial personality disorder and alcohol and substance use disorders
[Table 3] describes the relationship between alcohol use disorders (AUDs) and drug use disorders and ASPD. A greater proportion of those who met the criteria for current AUDs (37.5%) compared with those who did not (11.9%) had ASPD, and this is statistically significant (P = 0.030). Similarly, those who met the criteria for a lifetime AUDs, lifetime and current cannabis use disorders (CUDs) were more likely to have ASPD (P < 0.05). The relationship between other substances and ASPD is shown in [Table 3].
|Table 3: Antisocial personality disorder in relation to alcohol and substance use disorders|
Click here to view
| Discussion|| |
In this study, we examined ASPD and its associated factors among incarcerated offenders in a maximum-security prison in Nigeria. The prevalence of ASPD in this population of offenders was 13.4%, which was relatively lower than 18% and 19.2% earlier reported in Nigeria and India, respectively., In Brazil, about twice this value (26.9%) was reported by Pondé et al. among 497 prisoners studied using the Portuguese version of the MINI. In the USA, on the other hand, Black et al. reported a prevalence of 35.3% among randomly selected prisoners using the same instrument. Although similar instrument was used in these studies, other background characteristics such as nature of the prison, the presence of other psychiatric disorders, and the prevalence of ASPD in the general population studied may possibly explain these variations. Nevertheless, one common feature is that the prevalence of ASPD is quite higher compared with that of the general population from which the prisoners were drawn.
The relatively higher proportion of people with ASPD in the prison relative to the general population may be due to the fact that people with ASPD are likely to commit crime,, and consequently apprehended and imprisoned. Besides, the higher prevalence can be explained based on the disinhibition theory. Exposure to inhumane condition of the prison and repeated exposure to aggressive behavior from other prisoners lead to loss of normal restraints; as a result, aggressive behavior becomes normalized with alteration in the norm-governing behavior. With this, aggression and other antisocial behaviors are seen as norms in certain circumstances among incarcerated offenders.
With respect to the offenses committed, armed robbery was the most common offense, accounting for over half of the total offenses. Of these, a higher proportion had an ASPD compared with the proportions of ASPD in other offenses. Studies have shown that people with serious mental illness have significantly higher rates of both violent and serious nonviolent misconduct. This may possibly explain why a relatively higher proportion of offenders with ASPD were found among those charged with armed robbery, rape, and murder. However, ASPD has been shown to moderate the relationship between serious mental illness and serious nonviolent charges, but not the relationship between serious mental illness and violent charges.
Most of the sociodemographic characteristics of the inmates do not predict ASPD; however, when compared with those without ASPD, a majority of those with ASPD were unmarried and were not employed prior to incarceration. Marriage has been described as a moderating variable. As noted in a review by Black, being married aids the improvement of antisocial symptoms. It has been shown that ASPD alongside other cluster B disorders was more prevalent in men, separated or divorced, and those from lower social class. Similarly, offenders whose parents abuse alcohol or other substances of abuse were four times more likely to be diagnosed with ASPD than those whose fathers did not. As reported by earlier studies, there is an increased rate of mental disorders or presence of psychopathology among children of parents with substance use disorders.,, The prevalence of some specific mental disorders such as conduct disorder, attention deficit hyperactivity disorder (ADHD), major depressive disorder, and anxiety disorders has been observed to be higher among children of parents with substance use disorders than those whose parents do not abuse substances. As noted by Clark et al., parents with substance use disorders often have other mental disorders similar to those found in their children.
Oftentimes, those parents have childhood histories of conduct disorder, ADHD, major depressive disorder, or anxiety disorders. This may explain the association between parental substance use and ASPD observed in this study.
In this study, significantly higher rates of offenders with ASPD met the criteria for substance use disorders, notably AUDs and CUDs. ASPD has been shown to be a significant risk factor for AUDs and other substance use disorders, not just in the prison,,,,,,,, but also among patients with either mood disorders or schizophrenia. Among drug abusers, the presence of comorbid ASPD tends to predict criminal behavior following treatment., As reported by Fridell et al., offenders with a diagnosis of ASPD, based on clinical observation, were substantially more criminally active than substance abusers without such a diagnosis. This may account for the association between ASPD and substance use disorders noted in this study and the elevation of both ASPD and substance use disorders in the prison compared with the general population. Substance abusers diagnosed with ASPDs were twice more likely to be charged with theft only and about two and half times more likely to be charged committing multiple types of crime during an observational year. In contrast, some studies had refuted the association between criminality and ASPD.,, Reporting or publication bias could possibly account for these inconsistent findings.
In this population of offenders, nearly half of the inmates with ASPD met the criteria for lifetime CUDs and over 50% of those with the diagnosis of ASPD met the criteria for current CUDs. In a study looking at cannabis use and CUDs among people that were mentally ill, cannabis use and CUDs were particularly associated with bipolar disorder, substance use disorders, and personality disorders, especially antisocial, dependent, and histrionic personality disorders. In their study, persons with a mental illness in the past 12 months represented 72% of all cannabis users. Similarly, in a population-based study, personality disorders were found to explain a higher part of variance in problematic cannabis use symptoms in adolescents, and individual differences in the liability to cannabis use and CUDs appeared to be linked to genetic risks correlated with antisocial and borderline personality disorder traits.
| Conclusion|| |
The prevalence of ASPD among incarcerated offenders in this study was higher than those reported for most general populations and relatively lower compared with those reported in other prisoners' population elsewhere. Among this population, the diagnosis of ASPD is associated with fathers' substance use, fathers being alive, current or lifetime AUDs, and current or lifetime CUDs. There is an elevated rate of ASPD among offenders in this prison population, and offenders with ASPD are more likely to have substance use disorders including alcohol while in the prison, therefore there is a need for adequate intervention and rehabilitation programs that should address ASPD, AUDs, and substance use disorders among offenders.
There are some limitations to the current study. First, the sample was limited to offenders from a single prison, thus making it difficult to extrapolate the findings to the general prison population. Again, the participants need to recall past drug usage, which may affect the accuracy of the information given. In addition, disclosing information about alcohol and other illicit drugs in prison is considered an offense, and this may affect the extent to which inmates reported their substance use. However, with the assurance of confidentiality of the information given, this, we believe, should limit the extent of distortion of the information given. The strength of this article is that it is one of the few studies; if not, the first on ASPD from the most populated African country and even from this continent.
We acknowledge the support of federal prison's staff at Abeokuta, Ogun State, Nigeria, during data collection.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Esbec E, Echeburúa E. Violence and personality disorders: Clinical and forensic implications. Actas Esp Psiquiatr 2010;38:249-61.
DeLisi M, Drury AJ, Elbert MJ. The etiology of antisocial personality disorder: The differential roles of adverse childhood experiences and childhood psychopathology. Compr Psychiatry 2019;92:1-6.
Black DW. The natural history of antisocial personality disorder. Can J Psychiatry 2015;60:309-14.
Dunsieth NW Jr., Nelson EB, Brusman-Lovins LA, Holcomb JL, Beckman D, Welge JA, et al
. Psychiatric and legal features of 113 men convicted of sexual offenses. J Clin Psychiatry 2004;65:293-300.
Fazel S, Danesh J. Serious mental disorder in 23000 prisoners: A systematic review of 62 surveys. Lancet 2002;359:545-50.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th
ed. Arlington: American Psychiatric Association; 2013.
Black DW, Gunter T, Loveless P, Allen J, Sieleni B. Antisocial personality disorder in incarcerated offenders: Psychiatric comorbidity and quality of life. Ann Clin Psychiatry 2010;22:113-20.
Vowell PR. A partial test of an integrative control model: Neighborhood context, social control, self-control, and youth violent behavior. Western Criminol Rev 2007;8:1-15.
Lemert EM. Human Deviance, Social Problems and Social Control. 2nd
ed. Englewood Cliffs, NJ: Prentice-Hall; 1972.
Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, et al
. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the national comorbidity survey. Arch Gen Psychiatry 1994;51:8-19.
Coid J, Yang M, Tyrer P, Roberts A, Ullrich S. Prevalence and correlates of personality disorder in Great Britain. Br J Psychiatry 2006;188:423-31.
Fridell M, Hesse M, Jaeger MM, Kühlhorn E. Antisocial personality disorder as a predictor of criminal behaviour in a longitudinal study of a cohort of abusers of several classes of drugs: Relation to type of substance and type of crime. Addict Behav 2008;33:799-811.
Abdulmalik JO, Adedokun BO, Baiyewu OO. Prevalence and correlates of mental health problems among awaiting trial inmates in a Prison facility in Ibadan, Nigeria. Afr J Med Med Sci 2014;43:193-9.
Hatchett GT. Treatment guidelines for clients with antisocial personality disorder. J Ment Health Couns 2015;37:15-27.
Goldstein RB, Dawson DA, Saha TD, Ruan WJ, Compton WM, Grant BF. Antisocial behavioral syndromes and DSM-IV alcohol use disorders: Results from the national epidemiologic survey on alcohol and related conditions. Alcohol Clin Exp Res 2007;31:814-28.
Yakeley J, Williams A. Antisocial personality disorder: New directions. Adv Psychiatr Treat 2014;20:132-43.
Mueser KT, Rosenberg SD, Drake RE, Miles KM, Wolford G, Vidaver R, et al
. Conduct disorder, antisocial personality disorder and substance use disorders in schizophrenia and major affective disorders. J Stud Alcohol 1999;60:278-84.
Parmar A, Kaloiya G. Comorbidity of personality disorder among substance use disorder patients: A narrative review. Indian J Psychol Med 2018;40:517-27.
] [Full text]
Davison S, Janca A. Personality disorder and criminal behaviour: What is the nature of the relationship? Curr Opin Psychiatry 2012;25:39-45.
Bovasso GB, Alterman AI, Cacciola JS, Rutherford MJ. The prediction of violent and nonviolent criminal behavior in a methadone maintenance population. J Pers Disord 2002;16:360-73.
Hernandez-Avila CA, Burleson JA, Poling J, Tennen H, Rounsaville BJ, Kranzler HR. Personality and substance use disorders as predictors of criminality. Compr Psychiatry 2000;41:276-83.
McKay JR, Alterman AI, Cacciola JS, Mulvaney FD, O'Brien CP. Prognostic significance of antisocial personality disorder in cocaine-dependent patients entering continuing care. J Nerv Ment Dis 2000;188:287-96.
Armiya'u AY, Audu MD, Obembe A, Adole O, Umar MU. A study of psychiatry morbidity and co-morbid physical illness among convicted and awaiting trial inmates in Jos prison. J Forensic Leg Med 2013;20:1048-51.
Amdzaranda PA, Fatoye FO, Oyebanji AO, Ogunro AS, Fatoye GK. Factors associated with psychoactive substance use among a sample of prison inmates in Ilesa, Nigeria. Niger Postgrad Med J 2009;16:109-14.
Brooner RK, Disney ER, Neufeld KJ, King VL, Kidorf M, Stoller, KB. Antisocial personality disorder in patients with substance use disorders. In: Nunes EV, Selzer J, Levounis P, Davies CA, editors. Substance Dependence and Co-occurring Psychiatric Disorders: Best Practices for Diagnosis and Treatment. Kingston, New Jersey: Civic Research Institute Inc; 2010. p. 1-26.
Cochran WG. Sampling Techniques. 3rd
ed. London: John Wiley and Sons; 1999. p. 72-82.
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al
. The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998;59 Suppl 20:22-33.
Adewuya AO, Afolabi MO, Ola BA, Ogundele OA, Ajibare AO, Oladipo BF. Psychiatric disorders among the HIV-positive population in Nigeria: A control study. J Psychosom Res 2007;63:203-6.
Pondé MP, Freire AC, MendWonça MS. The prevalence of mental disorders in prisoners in the city of Salvador, Bahia, Brazil. J Forensic Sci 2011;56:679-82.
Huang Y, Kotov R, de Girolamo G, Preti A, Angermeyer M, Benjet C, et al
. DSM-IV personality disorders in the WHO World Mental Health Surveys. Br J Psychiatry 2009;195:46-53.
Mullins-Sweatt SN, DeShong HL, Lengel GJ, Helle AC, Krueger RF. Disinhibition as a unifying construct in understanding how personality dispositions undergird psychopathology. J Res Pers 2019;80:55-61.
Matejkowski J. The moderating effects of antisocial personality disorder on the relationship between serious mental illness and types of prison infractions. The Prison Journal 2017;97:202-23.
Clark DB, Moss H, Kirisci L, Mezzich AC, Miles R, Ott P. Psychopathology in preadolescent sons of substance abusers. J Am Acad Child Adol Psychiatry 1997;36:495-502.
Hill SY, Muka D. Childhood psychopathology in children from families of alcoholic female probands. J Am Acad Child Adolesc Psychiatry 1996;35:725-33.
Clark DB, Cornelius J, Wood DS, Vanyukov M. Psychopathology risk transmission in children of parents with substance use disorders. Am J Psychiatry 2004;161:685-91.
Clark DB, Kirisci L, Tarter RE. Adolescent versus adult onset and the development of substance use disorders in males. Drug Alcohol Depend 1998;49:115-21.
Compton WM, Conway KP, Stinson FS, Colliver JD, Grant BF. Prevalence, correlates, and comorbidity of DSM-IV antisocial personality syndromes and alcohol and specific drug use disorders in the United States: Results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 2005;66:677-85.
Verheul R. Co-morbidity of personality disorders in individuals with substance use disorders. Eur Psychiatry 2001;16:274-82.
Krieger DM, Benzano D, Reppold CT, Fialho PO, Pires GB, Terra MB. Personality disorder and substance related disorders: A six-month follow-up study with a Brazilian sample. J Bras Psiquiatr 2016;65:127-34.
Sher L, Siever LJ, Goodman M, McNamara M, Hazlett EA, Koenigsberg HW, et al
. Gender differences in the clinical characteristics and psychiatric comorbidity in patients with antisocial personality disorder. Psychiatry Res 2015;229:685-9.
Fridell M, Hesse M, Johnson E. High prognostic specificity of antisocial personality disorder in patients with drug dependence: Results from a five-year follow-up. Am J Addict 2006;15:227-32.
Lev-Ran S, Le Foll B, McKenzie K, George TP, Rehm J. Cannabis use and cannabis use disorders among individuals with mental illness. Compr Psychiatry 2013;54:589-98.
Gillespie NA, Aggen SH, Neale MC, Knudsen GP, Krueger RF, South SC, et al
. Associations between personality disorders and cannabis use and cannabis use disorder: A population-based twin study. Addiction 2018;113:1488-98.
[Table 1], [Table 2], [Table 3]