In people with a diagnosis of antisocial / dissocial personality disorder, what is the most effective psychological intervention (including possible community treatment methods) in reducing emotional instability, risk and offending?
No definite clinical implications can be made from the available
evidence. The authors of a systematic review (SR) stated that
professionals will therefore have to rely on their clinical
experience, but recognise that good quality evidence supporting
whatever intervention is chosen is virtually non-existent. They
also stated that because it may be difficult to retain people with
anti-social personality disorder (ASPD) and substance misuse in a
treatment programme, contingency management may be useful. The
authors of a randomised controlled trial (RCT) stated that for
clients with a serious mental illness and a substance use disorder,
integrated treatment such as assertive community treatment or
standard clinical case management, should be provided by whatever
route can be implemented and sustained.
There was consensus among the included studies that further
research is needed in to clarify which psychological treatments are
effective for people with ASPD. The authors of the SR acknowledged
the difficulty in retaining this population group in a trial. They
recommended that treatments be assessed in individuals
incarcerated, and evaluate reconviction after release from prison
as a primary outcome. The authors of a RCT stated that future
studies should further examine the effectiveness of different types
of case management interventions and explore how the effectiveness
of these approaches may vary for clients with different
characteristics-for example, type and extent of substance use,
mental health diagnosis, and stage of readiness for treatment.
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