Alcohol Use Disorder and Antisocial Personality Disorder

Genetics and harmful behavioral traits increase the risk of alcohol misuse when you have antisocial personality disorder, but you can overcome both with the right treatment.

What You’ll Learn:

• The traits and behaviors that increase alcohol risks with antisocial personality disorder.

• How the prevalence of antisocial personality disorder has grown.

• What the research has found about alcohol use among people with ASPD.

• The role that genetics plays in antisocial personality disorder and alcohol use disorder.

• Ways to effectively treat both ASPD and AUD for the best outcomes possible.

The name can be misleading, because antisocial personality disorder (ASPD) isn’t about being an introvert that doesn’t like group events. It’s much more about rebelling against social norms even if it’s going to cause harm or be dangerous.

Alcohol use disorder is more common across every personality disorder, not just this one. Our guide to alcohol use disorder and personality disorders breaks down the risk and the research for each one.

Not surprisingly, heavy alcohol use is a common occurrence for people with ASPD.

And while it may seem like few people have the disorder, the NESARC-III wave study using DSM-5 criteria found ASPD prevalence at 4.3%, plus they found a broader "adulthood antisocial behavioral syndrome" (antisocial behavior without documented childhood conduct disorder) at a rate of 20.3%.

Those numbers are much higher than previously believed and have to be taken into consideration because people with antisocial personality disorder are much more likely to misuse alcohol.

What Are the Traits of Antisocial Personality Disorder

ASPD is a personality disorder that’s known for dysfunctional traits that are destructive.
The 7 marquee traits of antisocial personality disorder are:

• Repeated law-breaking

• Deceitfulness

• Impulsivity/failure to plan

• Irritability and aggressiveness

• Reckless disregard for safety of self or others

• Consistent irresponsibility

• Lack of remorse

Having just three of the traits is all that’s needed for an ASPD diagnosis. Misconduct before age 15 is another factor that defines antisocial personality disorder. So, ASPD is a condition that presents itself at a very young age.

What Research Has Found About the Connection Between ASPD and AUD

An antisocial personality disorder diagnosis means that you should be very mindful about alcohol use.

Time and time again studies have found a very strong connection between ASPD and AUD. In fact, it has the strongest correlation of all the personality disorders.

The landmark NESARC epidemiological study from 2005 provided a wealth of information, and since then, other studies have expanded on the research.

The findings have been very consistent: antisocial personality disorder is linked to a significantly higher risk of alcohol use disorder.

• The reanalyzed NESARC data found ASPD had the highest lifetime alcohol dependence comorbidity of all personality disorders measured: 49.19% (original diagnostic method) rising to 52.09% under a revised, stricter method.

• The original NESARC analysis found alcohol use disorders were most strongly associated with ASPD of any personality disorder studied, giving it again the highest odds ratio of any PD in that analysis.

• A 2020 review summarizing the epidemiological and clinical literature put AUD prevalence among people with ASPD at approximately 68%.

• Among people with a current AUD or alcohol dependence diagnosis in clinical samples, ASPD prevalence runs 19–22%, which is slightly higher than BPD's 12–17% in the same population.

• A 2024 cross-sectional clinical study of 100 consecutive alcohol-dependence patients found 35% met criteria for comorbid ASPD, and noted that NESARC data show people with ASPD are roughly 7-8 times more likely to have alcohol dependence than people without a personality disorder.

The research makes it undeniably clear that ASPD can lead to AUD. But it is another landmark study that found unique ties between the two.

The Reasons Why Antisocial Personality Disorder Increases Alcohol Risks

Unlike other personality disorders, there’s a genetic/etiological model that has linked ASPD and AUD. It was a discovery that was made during the Minnesota Twin Family Study.

The 2002 paper noted that conduct disorder, adult antisocial behavior, alcohol dependence and drug dependence all load onto a single, highly heritable "externalizing" factor.

This means the same underlying genetic factor for behavioral disinhibition appears to predispose people to both antisocial behavior and substance dependence simultaneously, rather than one directly causing the other. They run in parallel

This separates ASPD from other personality disorders. While alcohol is commonly used by people with other personality disorders to self-medicate, with ASPD there’s actual behavioral-genetics involved.

Self-medication to cope with ASPD can be an issue, but it’s woven into a more intricate landscape where there are genetic factors at play.

How People With Antisocial Personality Disorder Can Get Drinking Under Control

ASPD has an unfair reputation for being untreatable. In reality, motivated individuals can be treated with as much or more success than people without ASPD.

And it’s been proven many times over that with the right treatment program people with personality disorders can overcome alcohol use disorder as well.

It’s not a matter of willpower or morality with antisocial personality disorder. It’s usually a matter of genetics that requires evidence-based treatments to overcome.

Trait-Matched Treatment

When you’re dealing with co-occurring disorders that feed into one another it’s important to fully address both conditions. Studies have shown that for ASPD trait-matched treatment is often the most effective option.

This type of treatment zeros in on the specific traits that are problematic rather than using disorder-specific talk therapy alone.

Extra Support With Medication-Assisted Treatment

Naltrexone prescription medication can make getting control over your drinking easier when you’re dealing with antisocial personality disorder.

It’s FDA-approved to help curb alcohol cravings simply by taking naltrexone either each day at the same time or an hour before drinking.

If there’s a chance you may be around alcohol unexpectedly it’s best to take naltrexone daily so there’s one less thing you have to manage in the moment, especially if you’re prone to impulsive behavior.

If you’d like to know more about using prescription naltrexone medication to help you get a handle on alcohol use while you’re addressing antisocial personality disorder Choose Your Horizon can help.

Take the Alcohol Use Assessment as a first step in better understanding your behaviors and whether naltrexone should be part of your treatment plan.