Antisocial personality disorder – Drug policy and court mandated addiction treatment

gavelA recent study conducted by a group at the University of Maryland found that court-mandated addiction treatment is especially helpful for those with Antisocial personality disorder (ASPD).

Using 236 men, it was found the overall success for participants without ASPD was high (85%) whether the treatment was court mandated or not. However, for those with ASPD, a whopping 94% remained in court-mandated treatment, though only 63% stayed in voluntary programs!

ASPD is relatively rare in the general population, but it’s estimated that its prevalence is relatively high (some estimate the prevalence as high as 50%) among addicts in drug treatment programs. I personally doubt that ASPD prevalence is that high even among treated addicts but it is certainly higher.

The Maryland team’s findings have two important implications for substance abusers with ASPD that should be noted:

  1. Judicial mandates offer a way to keep them in addiction treatment programs.
  2. Voluntary participants may require special interventions to keep them actively engaged in therapy.

Recently, a colleague shared with me some great insight about research into the effectiveness of mandated treatment: Mandated treatment can be effective if implemented well, which may sound simple but isn’t within a system that is used to putting down prisoners and not building them up. However, without aftercare, even the best mandated treatment loses its impact quickly. When it comes to aftercare, when trying to determine the best form of it (outpatient, residential , intensive, medical, etc.) the best thing to do is to ask the released client – if the match between the client’s desires and the treatment provided is high, the results are significantly better.

Citation:

The interactive effects of antisocial personality disorder and court-mandated status on substance abuse treatment dropout. Journal of Substance Abuse Treatment 34(2):157-164, 2008

Lindsay Lohan not drinking – cleared of false SCRAM bracelet alert

Here’s a little follow-up to last month’s post about Lindsay Lohan:

Lindsay Lohan’s SCRAM bracelet went off at an after party for the MTV Movie Awards on June 6, leading authorities to believe she had violated her probation and consumed alcohol.

Lindsay was ordered to come in at 10AM the next morning for a urine test. The results came back clean. She is still in full compliance with her probation and she continues to take court-ordered alcohol education classes. Linday’s next court hearing is scheduled for July 6th. Hopefully she can stay out of trouble until then. Violating her probation could land her up to 6 months in jail.

Addiction and the media – a stigma made in heaven

The sad truth is media outlets jump at the chance to make celebrities look bad. Celebrity addiction is usually brought up when someone gets arrested, checks into rehab, or overdoses. As a result, many people find it hard to believe that celebrities can stay sober. In the case of Lindsay Lohan, all sorts of rumors are flying around that she tampered with her SCRAM bracelet or that she paid off the testing lab.

Celebrities don’t always mess up. We just don’t get to see it when they succeed. To paint a more balanced picture of celebrity addiction, we will be featuring posts about famous individuals who have been able to overcome their addiction to drugs. Look for these in the weeks to come!

Contributing co-author: Andrew Chen

Lohan at it again – gets new SCRAM bracelet

Lindsay LohanIt seems that Lindsay Lohan got  herself in some trouble again, this time because she failed to show up to a court hearing and was partying on a yacht in France instead. An irate judge wanted her arrested, but when her lawyer posted bail for her, she got to walk in to court herself and face her punishment.

Lindsay is going to have to wear a SCRAM bracelet that will monitor her drinking through her skin at all times during the day. The SCRAM bracelet provides Lohan’s supervisor with more than 48 daily alcohol tests to make sure that the actress can’t drink at all.

Everyone (almost) knows about Lohan’s repeat visits to different California addiction-treatment facilities (most recently Promises), and it’s important to note that this recent incident doesn’t necessarily mean that Lindsay is having serious drug, or alcohol, problems. All we know is that she has a hard time showing up to court on time and is paying the price.

I think it’s sad that we only get to hear from people like Lindsay when she gets herself in trouble and that we don’t get to hear about her successes, which, given the fact that she hasn’t been arrested since 2007, must exist. True, she’s seemed to have some trouble obeying court orders, but I’d be interested to know how her own personal battle with bad-decisions-brought-on-by-alcohol-and-drugs has been going…

When you fall… Failing at rehab and trying again

When my life started seriously veering off track, a few of my friends sat me down and told me that they want to help me. At the time, drugs were paying my rent, and they literally offered me their couch to help me lower my cost of living. They were good friends and they really meant it. I didn’t take them up on it; I thought I was fine.

My first try at rehab

Fast forward 4 years, and my first attempt at rehab. I still didn’t really think I needed help, but my lawyer insisted that unless I wanted to spend the rest of my life behind state-sponsored bars, I should give this thing a try. I went in as a way out. I’d been living on drugs, mostly crystal meth, for the previous 5 years or so. I was a daily user, everyone I knew used, I was paying my rent with ounces of coke, but somehow, I thought everything was going well.

Two months or so after entering rehab, sitting at my recording studio pretending to work, I ran across a baggie that had apparently been left behind. It took me less than 15 minutes to find something to smoke it with.

I only used a little bit that day. I’d been off the stuff for almost 3 months, and I didn’t need a lot to get high. I also wanted to save enough for my next “workday.” I was back to using daily within 5 minutes. By New Year’s Eve that year, I was smoking with an ex-customer in the corner of her bedroom before her guests showed up for the yearly party. I ended the night bored at an ecstasy party with half-naked friends giving each other backrubs. This time, I knew something was wrong.

Another attempt at rehab

Needless to say, I got kicked out of that rehab facility. I spent the following two weeks sleeping on a friend’s couch looking for another treatment option. It was on my way to a meeting at noon on a sunny day in Santa Monica that I saw where I really was. Passing a homeless vagabond on the promenade, I did a double take. I knew the guy; we used to party together. I’m one misstep away from being homeless. I need help.

As I write this today, I am five years into a well-respected graduate program in psychology. I’m writing a book about my experiences, and by the time it comes out, I’ll have a Dr. posted in front of my name. But that wasn’t always my story, and as recently as 5 years ago, it was the unlikely ending to my tale.

Addiction demoriliizationThe reason I’m sharing it with you here is because I want you to know that there is no magic number. There’s no right way to find your escape from the life, and there’s no necessary mindset when you try to save yourself. No one knows what is going to work for you yet. We’re working hard on figuring out a way to tailor treatment to specific people based on their drug use, their family history, their genes, and anything else we can think of. As of right now, we have no better answer than this:

Keep trying. No matter how many times you fall down, pick yourself up again. If AA doesn’t work for you, try something else. There are options, a lot of them. If you don’t know about any others, ask me, ask anyone. If you keep trying, keep believing in yourself, keep giving yourself a chance, you’ll find the way out eventually.

Until then, keep your head above water and come back here to learn more. As always, feel free to email me with any questions. I’ll keep answering.