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

Wilson M. Compton, M.D., M.P.E.; Kevin P. Conway, Ph.D.; Frederick S. Stinson, Ph.D.; James D. Colliver, Ph.D.; and Bridget F. Grant, Ph.D., Ph.D.

Objective: The purpose of this study was to provide nationally representative data on the prevalence, sociodemographic correlates, and comorbidity of antisocial syndromes across alcohol and 8 specific drug use disorders, including sedative, tranquilizer, opiate, stimulant, hallucinogen, cannabis, cocaine, and inhalant/solvent abuse and dependence.

Method: This study is based on a nationally representative sample of adults. Lifetime prevalences of antisocial syndromes were estimated and logistic regression analyses were used to examine associations between antisocial syndromes and sociodemographic characteristics and substance use disorders. Diagnoses were made according to the criteria of the DSM-IV using the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version.

Results: The lifetime prevalences of antisocial personality disorder (APD), conduct disorder, and adult antisocial behavior were 3.6%, 1.1%, and 12.3%, respectively. Prevalences of alcohol use disorders and drug use disorders were 30.3% and 10.3%, respectively. In general, men and individuals who were younger, widowed/separated/divorced, of lower socioeconomic status, and living in urban areas or in the West were more likely to have antisocial syndromes. Native Americans were more likely and Asians and Hispanics were less likely to have APD and adult antisocial behavior. Virtually all of the associations between APD and adult antisocial behavior and specific substance use disorders were positive and statistically significant (p < .05). Significant associations between conduct disorder and substance use disorders were concentrated among women.

Conclusion: Comorbidity of specific substance disorders with antisocial syndromes is very common in the U.S. population. Further work in many directions is indicated by the results of this study, including the factors that give rise to the associations and the treatment and prevention implications of these conditions when comorbid.

(J Clin Psychiatry 2005;66:677-685)

Received Sept. 8, 2004; accepted Dec. 20, 2004. From the Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse (Drs. Compton, Conway, and Colliver), and the Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism (Drs. Stinson and Grant), National Institutes of Health, Department of Health and Human Services, Bethesda, Md.

The National Epidemiologic Survey on Alcohol and Related Conditions was funded by the National Institute on Alcohol Abuse and Alcoholism with supplemental funding from the National Institute on Drug Abuse.

The authors report no financial affiliation or other relationship relevant to the subject matter of this article.

The views and opinions expressed in this article are those of the authors and should not be construed to represent the views of any of the sponsoring agencies or the U.S. government.

Corresponding author and reprints: Bridget F. Grant, Ph.D., Ph.D., Laboratory of Epidemiology and Biometry, Room 3077, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, M.S. 9304, 5635 Fishers Ln., Bethesda, MD 20892-9304 (e-mail: bgrant@willco.niaaa.nih.gov).