A Cochrane review [Abstract] 1 included 11 RCTs with a total of 471 participants with antisocial personality disorder (AsPD). Data were available from only 5 studies involving 276 participants with AsPD, only two studies focused solely on an AsPD sample. A total of 80% of the participants were males. Eleven different psychological interventions were examined, representing behaviour therapy, cognitive behaviour therapy, schema therapy, and social problem-solving therapy. The mean duration of interventions was 23.5 weeks. The control condition was treatment as usual in all trials. Primary and secondary outcomes were varied, only two studies reported on reconviction and one on aggression. Compared to the control condition, cognitive behaviour therapy (CBT) plus standard maintenance was superior for outpatients with cocaine dependence in one study (OR 8.00; 95% CI 1.13 to 56.79, n=27), but CBT plus treatment as usual was not superior for male outpatients with recent verbal/physical violence in another. Contingency management plus standard maintenance was superior for drug misuse for outpatients with cocaine dependence during one-year follow-up in one study (OR 10.00; 95% CI 1.44 to 69.26, n=26) but not in another (n=100), possibly because of differences in the behavioural intervention. However, in the latter trial, contingency management was superior in social functioning (MD -0.08; 95% CI -0.14 to -0.02) and counselling session attendance (OR 4.00, 95% CI 2.39 to 6.70, n=100). A multi-component intervention utilising motivational interviewing principles, the ‘Driving Whilst Intoxicated program', plus incarceration was superior to incarceration alone for imprisoned drink-driving offenders over the 24-month period (p<0.05).
Comment: The quality of the evidence is downgraded by study quality (unclear allocation concealment), inconsistency (heterogeneity in patients and outcomes) and imprecise results (limited study size for each comparison).
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