Antisocial Personality Disorder and Alcohol & Drug Involvement during Childhood & Adolescence

Historical Perspective  Antisocial personality is innate (Hobbes)  Antisocial personality is learned (Locke & Rousseau)  Both perspectives are probably valid  Multiple pathways to antisocial personality (equifinality)  Divergent outcomes for youth (multifinality)

Definitions  Activities that violate societal norms, laws, or the rights of others  Criminal acts – theft, fraud, assault, DUI, drug use  Noncriminal acts – deceitfulness, irresponsibility  Person must be 18 or older; otherwise, consider Conduct Disorder (CD)  Antisocial behavior began before age 15  Sociopathy – old name for antisocial personality

Definitions (cont’d)  Psychopathy – subtype of Antisocial Personality Disorder (APD)  Personality traits – callousness, shallow affect, lack of interpersonal connectedness, superficial charm  Chronic antisocial behavior  Assessed using the Psychopathy Checklist-Revised (PCL-R; Hare)  80% of incarcerated persons meet ASPD criteria, but ASPD represents a heterogeneous group (which includes psychopathy)

Prevalence  3.63% lifetime in an epidemiological sample  Three times greater risk among men Risk factors  Childhood conduct problems – 54% of CD boys were diagnosed with ASPD at age 18 or 19 Minor physical anomalies (MPAs) – low-seated ears, adherent ear lobes, and furrowed tongues (prenatal/perinatal trauma) Low autonomic arousal Persistent antisocial behavior has a genetic component

Developmental progression  Low parental involvement in middle childhood is associated with persistent antisocial behavior in adulthood  Peer rejection in childhood predicts ASPD because these children adapt by forming friendships that support deviance  Combination of well-organized peer interactions and high levels of deviancy training predict ASPD (e.g., gangs)  Substance abuse facilitates development of ASPD

Protective factors  Age (> 45)  Attachment to social institutions (marriage, employment)  Decreased impulsivity and sensation seeking  Parenthood and increased family responsibilities  Academic success

Etiological formulations  Individual differences  Psychopathy is primarily biological or temperamental, present at or near birth, persists throughout life course  Early starters versus late starters o Early starters – coercive parenting, school failure, early antisocial behavior o Late starters – poor parental monitoring, oppositionality, deviant peer involvement starting in adolescence

 Environmental and relationship factors  Coercive parenting – intrusive demands, compliance refusals, escalating distress, negative affect, withdrawal of demand  Peer influences o Antisocial behavior interferes with positive peer relations o Children act as models and a source of reinforcement for this behavior o Opportunity for this behavior within networks of deviant peers  Social bonding – job stability and marital attachment predict lower rates of crime and deviance  Transactional process – bidirectional effects between individuals and their social environments

Comorbidity  ADHD – 30-50% meet criteria for ODD or CD  Substance abuse – ASPD men three times as likely to abuse alcohol and five times as likely to abuse drugs; ASPD women times as likely to abuse alcohol and 12 times as likely to abuse drugs  Anxiety disorders and Depression

Cultural considerations – amplified by SES and neighborhood risk factors Physical spanking less problematic in African American community African American children receive more negative feedback for school behavior and performance, more likely held back and placed in special-education African Americans have higher arrest and re-arrest rates despite similar rates of antisocial behavior to European Americans

Important moderators of antisocial behavior  Self-regulation – high effortful control  Less vulnerable to deviant peer influence  Need for cultural rituals and daily routine and chores  Biosocial factors – gene-environment interactions  Sociocultural factors – evaluate systems-level policies  Improve behavior-management practices of teachers  Improve academic instruction

Prevalence  12 th grade – 80% have tried alcohol  Adolescents drink half as often as adults but consume 4.9 drinks per occasion compared to 2.6 drink per occasion for adults  10% of 4 th graders and 29% of 6 th graders have had more than a sip of alcohol  Greatest escalation occurs between ages 12 and 15  12 th grade – 60% have tried nicotine  12 th grade – 50% have tried marijuana  Problematic substance involvement predicts truancy, suspensions, and expulsions

Abuse and dependence: Criteria and diagnostic issues (p. 410)  Psychological dependence – subjective feeling of needing the substance to function adequately  Physical dependence – physiological and psychological adaptations  Tolerance – need to ingest larger amounts to achieve same effect  Withdrawal – consumption ends abruptly  Abuse and dependence are non- overlapping diagnoses

Diagnostic criteria and issues (cont’d)  Withdrawal and physiological dependence less prevalent but cognitive and affective withdrawal more prevalent among children and adolescents  Criteria might mot be sensitive enough to identify adolescents with substance use problems

Risk factors – nested in certain contexts  Temperament – high sensation seeking, behavioral disinhibition, impulsivity, aggression, lack of behavioral control, negative affectivity, antisocial patterns, trait anxiety, anxiety sensitivity  Childhood behavior problems – hyperactivity, aggression, CD, comorbid psychiatric disorders (self- medicating; 60%)  Externalizing disorders – CD, ADHD, ODD  Internalizing disorders – depression, anxiety

 Alcohol and drug expectancies  Peer and parental modeling and media exposure produces more expected global positive effects, increased social facilitation, enhancement of cognitive and motor performance  Mediational model = family history of SUD  expectancies  SUD  Age of onset – the earlier the age, the worse the prognosis  Family influences  Family history = four-to-nine-fold risk of SUDs in males, two-to-three-fold risk in females  Parental deviance and psychopathology

 Peers  Greater access to substances  Adoption of beliefs and values consistent with drug-use lifestyle  Mediating variable between family history and conflict and SUD  Stress  Moderator of economic adversity on development of SUD  Bidirectional association (physical, academic, legal, peer, familial, emotional)  Neurocognitive functioning – poor executive functioning, which causes reduced ability to appreciate abuse consequences  Sleep difficulties – between ages 3 and 5

Protective factors – temperament, high intelligence, social support, involvement with conventional peers, religiosity, low-risk taking, competence skills, and psychological wellness.

Developmental pathways to Substance Use Disorders  Deviance – prone pathway  Reduced ability to self-regulate emotional distress and inhibit behaviors  Emotional distress caused by family history, ineffective parenting  Negative affectivity pathway – deficient regulation of negative affect  Temperamental negative emotionality  Environmental stressors  Enhanced reinforcement pathway – less sensitive to substances’ effects  Genetically influenced  Based on physiological response differences to SUD effects

Sex, race, and ethnic differences  Few sex differences  Native Americans most prone; Asian Americans least prone

Developmentally dependent effects  Adolescent animals less sensitive to alcohol’s adverse effects than adults  Adolescent animal exposure causes greater social facilitation than adults  Adolescents have greater long-term behavioral and brain impairment than adults  Adolescent animals have more tolerance, craving, and motor impairment than adults  Adolescent frontal brain regions that control executive planning and reasoning processes continue to mature into adulthood