Antisocial pathways associated with substance use disorders: characterizing etiological underpinnings and implications for treatment

The association between substance use disorders (SUDs) and crime is one of the most reliable themes in the SUDs literature. While SUDs undoubtedly contribute to crime, there is also good evidence that specific clinical syndromes place individuals at higher risk for SUDs. Of relevance, two subtypes of individuals, ‘antisocial-only’ and ‘psychopathic,’ are at elevated risk for SUDs. The former, which includes conduct disorder and antisocial personality disorder, involves a failure to regulate affective reactions, which overwhelms inhibitory controls. The latter, which includes antisocial behavior plus callousunemotional traits and psychopathy, involves a failure of attention to adequately integrate affective experiences to guide behavioral control. We describe how these potentially divergent etiologies can inform personalized treatments.