A Cochrane review of psychotherapies for ASPD was unable to draw firm conclusions from the available evidence [1550]. Of the 19 studies included in the review, eight were conducted among people with co-occurring ASPD and AOD use disorders [1551–1558]. No study found significant changes to specific ASPD behaviours (e.g., offending, aggression, impulsivity); however, several found significant reductions in AOD use following treatment [1553, 1554, 1556, 1557]. The addition of contingency management and/or CBT to standard methadone maintenance was found to be superior compared to standard methadone maintenance alone [1553]. Further, contingency management plus standard methadone maintenance has been associated with significantly greater counselling session attendance and improvements in social functioning compared to standard methadone maintenance alone [1555].
A driving whilst intoxicated program plus incarceration has also been shown to produce greater improvements compared to incarceration alone [1557]. This intervention utilised principles of MI and Fraser and colleagues [162] suggest that this may be indicative of a benefit of non-confrontational approaches over confrontational approaches in enhancing outcomes for people with ASPD.
There is some evidence supporting the use of brief psychoeducation interventions and cognitive remediation among people with co-occurring ASPD and AOD use. Impulsive Lifestyle Counselling is a brief psychoeducation intervention which aims to foster awareness about behavioural difficulties, increase personal accountability, and support clients to develop alternative coping strategies [1559]. Several RCTs have found that, relative to treatment as usual, four sessions of Impulsive Lifestyle Counselling delivered over four weeks with a booster session delivered 8 weeks later [1559], significantly reduces AOD use, improves abstinence from AOD use, increases self-rated help for ASPD symptoms at 3 months post-treatment [1560] and reduces AOD treatment dropout at 10 months post-treatment [1561]. Moreover, self-rated help for ASPD symptoms has been associated with improvements in abstinence from AOD use and treatment retention [1560].
Cognitive remediation aims to improve cognitive functioning by targeting factors such as attention and memory. Four weeks of cognitive remediation provided to people with an AOD use disorder, 25-35% of whom also had a lifetime diagnosis of ASPD, was associated with improvements in impulsivity, self-control, quality of life, and AOD use cravings relative to treatment as usual [961].