Although several studies have examined pharmacological interventions among people with ASPD as a single disorder, a Cochrane review concluded that the limited evidence available does not provide enough support for strong recommendations [1562]. These studies have investigated the use of antiepileptics (carbamazepine, phenytoin, sodium valproate, divalproex sodium and tiagabine); antidepressants (desipramine, fluoxetine and nortriptyline); dopamine agonists (bromocriptine and amantadine); central nervous system agonists (methylphenidate); and opioid antagonists (naltrexone).
Despite the limited evidence, there has been some research conducted among people with co-occurring ASPD and AOD use. A Cochrane review examining pharmacological treatments for ASPD found that two drugs (nortriptyline and bromocriptine) were associated with improved outcomes compared to placebo control conditions among those with co-occurring conditions [1562]. Compared to placebo, those with ASPD and AOD use disorder who were taking nortriptyline illustrated a greater reduction in alcohol use and dependence [1563]. In the same study, the use of bromocriptine was found to reduce anxiety symptoms for those with depression/anxiety and AOD use disorders [1563]. However, no changes to ASPD symptoms were observed. An additional study found that people with antisocial traits demonstrated greater reductions in alcohol use when administered naltrexone relative to people low on antisocial traits [1564].
Based on the lack of consistent evidence, the UK NICE Guidelines do not recommend treating ASPD, nor co-occurring ASPD and AOD use disorders, with pharmacological interventions. They also advise against treating underlying behavioural symptoms with pharmacotherapy [1565].