Psychopathy Facets Differentially Predict Drug- and Alcohol-Related Problems Following Violent Injury.

Psychopathy is a multidimensional personality construct associated with substantial personal, familial, and societal burden. Among the various forms of psychopathology that co-occur with psychopathy, substance misuse represents one of its most prominent comorbidities. Despite growing interest in the psychopathy-substance misuse association, most facet-level studies have been cross-sectional or have relied on lifetime indices of substance involvement, limiting understanding of whether distinct psychopathy facets uniquely predict subsequent substance-related problem severity. The present study prospectively examined whether the four psychopathy facets uniquely predicted six-month drug- and alcohol-related problem severity among adults recovering from a violent injury. Participants (N = 106) completed baseline assessments of the four psychopathy facets using the Self-Report Psychopathy Scale-Short Form (SRP-SF) and drug- and alcohol-related problem severity using the Drug Abuse Screening Test (DAST-10) and Alcohol Use Disorders Identification Test (AUDIT), with drug- and alcohol-related problem severity reassessed six months later. Separate multiple regression models examined whether the interpersonal, affective, lifestyle, and antisocial psychopathy facets uniquely predicted six-month drug- and alcohol-related problem severity after controlling for baseline drug and alcohol use severity, age, sex, race, posttraumatic stress disorder (PTSD), history of head injury, and the substantial covariance among psychopathy facets. Affective psychopathic traits uniquely predicted greater six-month drug-related problem severity, whereas antisocial psychopathic traits uniquely predicted greater six-month alcohol-related problem severity. The remaining psychopathy facets were not uniquely associated with either outcome. These findings suggest that the psychopathy facets most strongly associated with substance misuse in cross-sectional research may differ from those that uniquely predict the persistence of drug- and alcohol-related problems over time, underscoring the importance of prospective facet-level research to inform etiological models, risk assessment, and targeted prevention and intervention.