Impulsive Lifestyle Counselling Versus Treatment as Usual to Reduce Offending in People with Co-Occurring Antisocial Personality Disorder and Substance Use Disorder: A Post Hoc Analysis - BMC

Abstract

\n Objectives: To assess the impact of a psychoeducation for antisocial personality disorder on offending after randomization to treatment.Design: Multicentre, superiority, non-blinded randomized controlled trial. Random assignment was conducted in blocks of varying sizes at a central randomization centre.Setting: Nine outpatient uptake areas in Denmark.Participants: One hundred and seventy six patients with antisocial personality disorder in treatment for substance use disorders were randomized to treatment as usual or ILC (n=80; n=96). A total of 165 patients could be linked to criminal records collected between randomization and November 2019 (n=91; n=74).Intervention: The Impulsive Lifestyle Counselling program (ILC), is a brief psycho-educational program targeting antisocial behavior. The trial was conducted between January of 2012 and June 2014, and participants were tracked until December 2018, migration, or death, whichever occurred first. Outcomes: Number of offences in the 12 months following trial randomization from official national registers.Results: The mean number of offences was 2.76 in the TAU group (95% Poisson confidence interval [CI]=2.39, 3.16) and 1.87 in the ILC group (CI=0.97, 1.43). Negative binomial regression was used to assess number of convictions within the first year; violent, property, driving under the influence, and drug-related convictions. In both adjusted and unadjusted analyses, random assignment to ILC was associated with a lower number of total (incremental risk ration [IRR]=0.43, p=.013; adjusted IRR=0.33, p<.001), violent (IRR=0.19, p=.001; adjusted IRR=0.16, p=.018). Results were not significant for driving under the influence (unadjusted IRR=0.60, p=.371; adjusted IRR=0.87, p=.521), or drug offences (unadjusted IRR =1.06, p=.905; adjusted IRR=0.50, p=.180).Conclusions: The ILC program shows promise in reducing offending behavior in people with comorbid substance use and antisocial personality disorder.Trial registration: ISRCTN registry, ISRCTN67266318, 17/7/2012, https://doi.org/10.1186/ISRCTN67266318.