Abstract
Among criminal offenders, two subtypes of antisocial traits, psychopathy and externalizing-only, are associated with an especially elevated risk for substance use disorders (SUDs). The present study examined the associations of these traits with patterns of substance misuse. In a sample of 1410 male offenders, we used diagnoses for alcohol, cannabis, opioids, and stimulants to examine the association between antisocial traits and SUD severity, as well as, age at substance use initiation. Results indicated that externalizing-only, but not psychopathic, traits predicted greater severity of SUDs (i.e. increased likelihood of dependence) across all substances. By contrast, psychopathic, but not externalizing-only, traits predicted earlier initiation of use across all substances. These differential patterns of substance misuse may be a reflection of distinct psychobiological processes. Ultimately, parsing the patterns of substance use across a continuum of clinically heterogeneous samples, rather than within circumscribed diagnostic categories, might help to refine the phenotype and improve the prediction of substance-related problems.
