Variations in psychopathic state among in-patient substance abusers

Abstract

Research has indicated that substance abuse in-patients have a stable psychopathic personality trait which is a prominent factor in relapse. The purpose of this study was to determine if a recently developed state measure of psychopathy, the Psychopathic State Inventory (PSI), would predict psychopathic episodes defined as relapse to drugs after two weeks of in-patient psychiatric treatment for substance abuse. The patient's professed reason for using or craving a drug, either "to get high" or "to feel better" was also predicted on the basis of PSI scores. Psychopathic state was hypothesized to decrease during treatment. Fifty adult substance-abuse patients in a private psychiatric facility with severely elevated psychopathic trait scores on the MMPI were administered the PSI on three occasions--at admission, following the first week of treatment, and following the second week of treatment just prior to the first weekend pass away from the hospital. Discriminant analysis was computed to predict relapse to drugs or abstinence during the pass which was then tested by urinalysis as well as the reason for using or craving a drug. Decreases in psychopathic state during the first two weeks of treatment were tested for significance by multiple t-tests. Results disclosed that measurement of variations in psychopathic state differentiated patients by reason for drug use or craving and by drug use or abstinence at the .001 level of significance. External validity of the PSI is supported by these results, and the instrument shows promise in predicting psychopathic episodes and short-term changes in psychopathic disorders. Decreases in psychopathic state, particularly hypophoria, were statistically significant during the first week of treatment but not during the second week suggesting that the recovery process may begin rapidly and level off. A 30% relapse rate during the first pass emphasizes the importance of focusing directly on the control of impulsive behavior in psychotherapy with substance abusers.