Antisocial Personality Disorder as a Risk Factor for Opioid Use: The Dual Mediating Roles of Antisocial Attitudes and Self-Control

• DOI: 10.1177/0022042620979630
• Author: Thomas Wojciechowski
• Date: 01 April 2021
• Published date: 01 April 2021
• Subject Matter: Articles

https://doi.org/10.1177/0022042620979630

Journal of Drug Issues

2021, Vol. 51(2) 264 –279

© The Author(s) 2020

Article reuse guidelines:

sagepub.com/journals-permissions

DOI: 10.1177/0022042620979630

journals.sagepub.com/home/jod

Article

Antisocial Personality Disorder as

a Risk Factor for Opioid Use: The

Dual Mediating Roles of Antisocial

Attitudes and Self-Control

Thomas Wojciechowski1

Abstract

Antisocial personality disorder is a risk factor for opioid use. There is a dearth of research which

examines self-control and moral disengagement as potential mediators of this relationship. This

study utilized data from the Pathways to Desistance study in analyses. Generalized structural

equation modeling was utilized to test for mediation of the relationship between antisocial

personality disorder and opioid use. Bootstrapped standard errors were computed so that

a Clogg Z test could be estimated to determine if identified mediation effects significantly

differed. Results indicated that a likely diagnosis of antisocial personality disorder increased risk

for opioid use. Inclusion of moral disengagement and self-control into the model resulted in

attenuation of this effect to non-significance and reduced the magnitude of the effect by around

45%. The contribution of both constructs to the total indirect effect did not significantly differ

and only the total indirect effect was significant.

Keywords

antisocial personality disorder, opioids, moral disengagement, self-control

Introduction

Opioids and opiates belong to a class of drugs that cause euphoria and pain relief, among other

effects. Opiates specifically are naturally derived from the poppy plant, whereas opioids are syn-

thetic and constructed in a lab to produce similar effects to opiates. The term opioids will be used

throughout the article to describe both for ease of reading. Antisocial personality disorder (ASPD)

is a psychiatric illness that can be pervasive in its impact on social functioning. To meet the cri-

teria for ASPD, individuals must demonstrate a disregard for the rights of others,1 have evidence

of onset of conduct disorder prior to age 15, be at least 18 years old, and occurrence cannot

exclusively happen during the course of schizophrenia or bipolar disorder (Diagnostic and

Statistical Manual of Mental Disorders [5th ed.; DSM-5]; American Psychiatric Association,

2013). ASPD afflicts between 0.2% and 3.3% every year (American Psychiatric Association,

2013). This pervasive disorder is associated with increased risk for opioid use (Kidorf et al.,

2004; Manseau & Compton, 2018; Smith et al., 2017). For example, Smith et al. (2017) found

1Michigan State University, East Lansing, USA

Corresponding Author:

Thomas Wojciechowski, School of Criminal Justice, Michigan State University, 655 Auditorium Road, East Lansing,

MI 48824, USA.

Email: wojcie42@msu.edu

979630JODXXX10.1177/0022042620979630Journal of Drug IssuesWojciechowski

research-article2020

Wojciechowski 265

that ASPD sufferers in rural areas who also used drugs were more likely to report past 30-day

heroin use than healthy counterparts. ASPD has also been found to be associated with increased

risk of comorbid opioid use disorder and sedative use disorder (Ellis et al., 2020). In these ways,

the disorder is contributing to the opioid crisis observed in the present day in the form of elevated

opioid use prevalence rates and elevated mortality rates (Vadivelu et al., 2018). Addressing the

disorder via programming may offer a means of mitigating the relationship between the disorder

and opioid use. While this would seem to entail a relatively straightforward approach, targeting

the specific aspects of ASPD that are more distinctly predictive of opioid use may provide a more

efficient means of addressing this issue. However, there is a dearth of research focused on iden-

tifying the characteristics of ASPD that actually lead to increased risk for opioid use.

Two characteristics of ASPD that may help to understand increased risk for opioid use among

this group are self-control and moral disengagement. Individuals with ASPD generally report

lower levels of self-control and more serious antisocial attitudes that are consistent with moral

disengagement (American Psychiatric Association, 2013; Bulten et al., 2009; Swann et al., 2009;

Umut et al., 2017). Both of these constructs have been identified as risk factors predicting height-

ened risk for substance use also. Despite these links, there is a dearth of research examining these

mechanisms as potential mediators of the ASPD–opioid use relationship. Relatedly, there is little

understanding of whether one of these constructs acts as a significantly stronger mediator of this

relationship. This is a major omission, as identifying whether or not one of these constructs offers

a more important pathway from ASPD to opioid use would allow for more efficient targeting of

resources for addressing the contribution of ASPD to the opioid crisis. This study sought to

address these gaps in the literature by examining this proposed direct effect of ASPD on opioid

use and testing for mediation through the identified dual pathways model.

One’s level of moral disengagement refers to psychological mechanisms by which individuals

can justify their perpetration of antisocial behavior (Bandura, 1991). There is largely an align-

ment between the concept of moral disengagement and techniques of neutralization (Sykes &

Matza, 1957), as both sets of concepts represent justifications and rationalizations that may be

deployed to explain away one’s violation of norms and the law as necessary. Eight dimensions of

moral disengagement have been identified: moral justification, euphemistic language, advanta-

geous comparison, displacement of responsibility, diffusion of responsibility, disregarding or

distorting the consequences of action, dehumanization, and attribution of blame. Endorsement of

such justifications or rationalizations is consistent with the symptomatic antisocial attitudes of

individuals afflicted with ASPD and justifications that they may use to disregard the rights of

others (e.g., Some people deserve to be treated like animals; It is okay to treat badly somebody

who behaved like a “worm” or a “low life.”; American Psychiatric Association, 2013). Research

has provided evidence of such a link between moral disengagement and behavior, as individuals

who report endorsement of more moral disengagement mechanisms are at greater risk for engage-

ment in a range of criminal behaviors (Ishoy, 2017; Risser & Eckert, 2016; Wang et al., 2017).

For example, Wang et al. (2017) found that moral disengagement mediated the relationship

between childhood maltreatment and bullying behaviors. This makes sense, as individuals who

report endorsement of more mechanisms seemingly would be more likely to deploy these justifi-

cations to rationalize their antisocial behavior and overcome issues associated with norm-break-

ing. In terms of opioid use specifically, there is currently a dearth of research which has examined

moral disengagement as a predictor. However, moral disengagement has been found to be a

predictor of other forms of psychoactive substance use (Jang, 2019; Newton et al., 2012; Passini,

2012), including performance and cognitive-enhancing drugs (Boardley et al., 2014, 2017; Heyes

& Boardley, 2019). Newton et al. (2012) found that higher moral disengagement scores were

associated with increased odds of ever drinking alcohol, past 3-month binge drinking, and ever

trying marijuana. Passini (2012) found that moral disengagement predicted both heavy drug use

and delinquency. For substance use generally, this would seem to operate in a manner consistent