Antisocial Personality Disorder, Alcohol, and Aggression

F. Gerard Moeller, M.D., and Donald M. Dougherty, Ph.D.

Epidemiologic studies and laboratory research consistently link alcohol use with aggression. Not all people, however, exhibit increased aggression under the influence of alcohol. Recent research suggests that people with antisocial personality disorder (ASPD) may be more prone to alcohol- related aggression than people without ASPD. As a group, people with ASPD have higher rates of alcohol dependence and more alcohol-related problems than people without ASPD. Likewise, in laboratory studies, people with ASPD show greater increases in aggressive behavior after consuming alcohol than people without ASPD. The association between ASPD and alcohol-related aggression may result from biological factors, such as ASPD-related impairments in the functions of certain brain chemicals (e.g., serotonin) or in the activities of higher reasoning, or “executive,” brain regions. Alternatively, the association between ASPD and alcohol-related aggression may stem from some as yet undetermined factor(s) that increase the risk for aggression in general. KEY WORDS: antisocial personality disorder; aggressive behavior; AODR (alcohol or other drug [AOD] related) behavioral problem; personality trait; AODR violence; expectancy theory of AODU (AOD use, abuse, and dependence); disinhibition theory of AODU; neurobiological theory of AODU; brain function; AODE (effects of AOD use, abuse, and dependence) on emotion

umerous studies indicate an Characteristics of ASPD psychopathy or an antisocial personality association between alcohol have evolved from a focus on the lack Nconsumption and aggressive According to the Diagnostic and Statistical of emotional attachment in relationships behavior. Not all people who consume Manual of Mental Disorders, Fourth with others (Cleckley 1964) to a greater alcohol, however, become aggressive. Edition (DSM–IV) by the American focus on external behaviors, especially In trying to elucidate the relationship Psychiatric Association (APA) (1994), aggressive and impulsive behaviors between alcohol consumption and ASPD is characterized by a pervasive (APA 1994). The current criteria for aggression, researchers have suggested disregard for, and violation of, other ASPD, as described in DSM–IV, include that people with a psychiatric condition people’s rights. The concept of such a a behavioral pattern that begins before called antisocial personality disorder personality type is not new. For example, (ASPD) may be particularly susceptible Theophrastus, a student of the ancient F. GERARD MOELLER, M.D., AND DONALD to alcohol-related aggression. This arti­ Greek philosopher Aristotle, described M. DOUGHERTY, PH.D., are associate cle explores that association in more a personality type that he termed the professors in the Department of Psychiatry detail. First, the article describes the “unscrupulous man” and which included and Behavioral Sciences, University of distinguishing features of ASPD. Then behaviors that are significant elements Texas—Houston, Houston, Texas. it reviews the findings of epidemiologic of the current concept of ASPD (Millon and laboratory studies that have inves­ et al. 1998). The research conducted by Drs. Moeller tigated the link between ASPD and During the past century, researchers and Dougherty as described in this article aggression. Finally, the article presents and clinicians have used numerous was supported by National Institute on several mechanisms that may contribute terms to describe ASPD, including Alcohol Abuse and Alcoholism grants to differences between people with and “moral insanity,” “psychopathy,” and R01–AA–10828, R01–AA–12046, and without ASPD with respect to alcohol- “sociopathy.” Likewise, the symptoms R29–AA–10095 and National Institute related aggression. considered to be the key elements of on Drug Abuse grant K02–DA–00403.

Vol. 25, No. 1, 2001 5 age 15 and comprises at least three of gating the association between alcohol ulation and (2) people with ASPD who the following behaviors: and violence, studying people with drink to excess are more likely to expe­ ASPD is particularly appropriate. rience alcohol-related problems than • Repeated criminal acts other alcoholics. As previously discussed, at least • Deceitfulness Epidemiologic Studies some people with ASPD exhibit violent of Alcohol and Violence behavior. Without controlled laboratory • Impulsiveness studies, however, researchers cannot Research on the epidemiology of vio­ determine whether people with ASPD • Repeated fights or assaults lence has consistently linked alcohol are more susceptible to alcohol-related intoxication and violence (Murdoch et aggression than other people, because • Disregard for the safety of others al. 1990). For example, a positive cor­ confounding variables may affect epi­ relation exists between the quantity of demiologic studies on alcohol-related • Irresponsibility alcohol consumed and the frequency of aggression. For example, the positive a wide variety of violent acts, including correlation between the amount of • Lack of remorse. sexual assault, child abuse, and homicide. alcohol consumed and increased involve­ (For more information on this correla­ ment in acts of violence holds for both Because a diagnosis of ASPD accord­ tion, see other articles in this issue.) perpetrators and victims of violent ing to the DSM–IV criteria requires the Epidemiologic studies also have noted crimes (Murdoch et al. 1990). presence of only three of the aforemen­ an association between ASPD and alcohol tioned behaviors, considerable variability abuse and dependence. For example, (i.e., heterogeneity) exists among people in the Epidemiologic Catchment Area Laboratory Studies diagnosed with the disorder. Thus, some Survey, which surveyed 20,291 persons of Aggressive Behavior ASPD patients may be nonviolent, living at 5 sites across the United States, whereas others may be extremely violent. the people who met the DSM criteria Laboratory studies (i.e., studies that use Some evidence suggests that ASPD for ASPD were 21 times more likely to laboratory measures of human aggression) patients with histories of violence begin­ develop alcohol abuse and dependence can control for many of the confound­ ning in childhood may differ from other at some point during their lives than ing variables that affect epidemiologic ASPD patients with respect to certain were the people who did not have ASPD studies, thereby allowing for a direct biological and behavioral characteristics. (Regier et al. 1990). measurement of the association between (This evidence is discussed in more detail Some of the behaviors included in alcohol and aggression. In these stud­ in the section Potential Mechanisms the criteria for ASPD (e.g., repeated ies, the participant typically is paired Contributing to Alcohol-Related criminal acts, including driving while with a fictitious opponent with whom Aggression, p. 9.) Accordingly, clini­ intoxicated) could result from alcohol the participant competes in performing cians and scientists may find it helpful dependence rather than be symptoms a certain task. To win the competition, to study ASPD patients who exhibit of ASPD. To exclude this possibility the participant can subject the oppo­ repeated violent behaviors as a separate when examining the relationship between nent to actions that most people would group from other ASPD patients. ASPD and problem drinking, researchers consider unwanted or unpleasant (e.g., ASPD is a relatively common disorder; have specifically studied people who taking away money from the opponent in fact, it is more common than many met the criteria for ASPD before they or exposing the opponent to an electric other psychiatric disorders, such as bipo­ developed drinking problems. For shock or a loud noise). The quantity or lar, or manic-depressive, disorder (APA example, Schuckit (1985) assessed the intensity of the unpleasant act performed 1994). Overall, approximately 3 per- relationship between ASPD and drinking on the opponent serves as the measure cent of men and 1 percent of women behaviors in 577 people who entered of the participant’s level of aggression. in the general population meet the cri­ an alcoholism treatment program. The One widely used example of a labo­ teria for ASPD (APA 1994). Perhaps study found that those people who had ratory measure of aggression is the not surprisingly, the prevalence of the ASPD before they developed drinking Point Subtraction Aggression Paradigm© disorder is even higher in selected pop­ problems consumed significantly more (Cherek 1992). In this experimental ulations, such as people in prisons drinks per day and experienced signifi­ design, each study participant sits in (who include many violent offenders) cantly more alcohol-related problems front of a computer monitor and a (Hare 1983). Similarly, the prevalence (e.g., being fired or demoted or spending mechanical box that has two buttons of ASPD is higher among patients in time in jail) compared with people who on it. The researchers tell the partici­ alcohol or other drug (AOD) abuse did not meet the criteria for ASPD. pants that they must press one of the treatment programs than in the general When analyzed together, these findings buttons on their mechanical box as fast population (Hare 1983), suggesting a suggest that (1) people with ASPD as possible to earn money, the amount link between ASPD and AOD abuse and experience higher rates of alcohol abuse of which is displayed on their com­ dependence. Accordingly, when investi­ and dependence than the general pop­ puter screen. The subjects are also told

6 Alcohol Research & Health Antisocial Personality Disorder, Alcohol, and Aggression

that they each have been paired with In addition to their validity, these the participants received no alcohol another person, or “opponent” (who is laboratory measures allow researchers to demonstrated that people with histories actually fictitious). The so-called oppo­ study aggression in a controlled envi­ of behaviors associated with ASPD were nents can ostensibly take money away ronment. Therefore, this approach also more aggressive than were people without from the subjects through a computer has been used to investigate the associa­ such histories. Similarly, male prisoners connection. In turn, the subjects can tion between alcohol and aggression. incarcerated for violent crimes demon­ press the second button on their boxes strated more aggressive behavior in lab- in order to retaliate and take money oratory tests than did age-matched col­ from the paired opponents. Periodically, lege students (Wolfe and Baron 1971).1 the researchers provoke the participants The influence of a history of aggres­ by having money taken from their High variability sive behavior also was demonstrated in a accounts, ostensibly by the opponents exists in the extent study of cocaine-dependent people who with whom they are paired. The num­ had stopped using cocaine within 2 ber of times a participant retaliates by to which alcohol weeks of participating in the study. In this pressing the second button in order to is related with study Moeller and colleagues (1997) take money from his or her opponent measured aggression using the Point serves as a measure of the participant’s aggression as Subtraction Aggression Paradigm and level of aggression. measured in such recorded the participants’ self-reported Although some researchers have quantity of cocaine used, duration of argued that these types of laboratory laboratory studies. abstinence from cocaine, severity of with­ measures are artificial and too far removed drawal symptoms, and history of aggres­ from ordinary experience (Tedeschi and sive behavior. The study found that a Quigley 1996), numerous studies have history of aggression beginning in established the validity of this approach Laboratory Studies of Alcohol childhood was the most important pre­ in distinguishing between violent and and Aggression dictor of current aggressive behavior in less violent people, as follows: Bushman and Cooper (1990) reviewed the participants, whereas the amount of the results of 30 laboratory studies that • Male parolees convicted of violent cocaine used was a less important predic­ used the Point Subtraction Aggression felonies exhibited more aggressive tor. Furthermore, no significant relation- Paradigm and other laboratory mea­ ship existed between the amount of responses in the Point Subtraction sures of aggression to assess the effects Aggression Paradigm than did cocaine withdrawal symptoms and the of alcohol consumption on aggression. level of aggressive behavior exhibited by parolees convicted of nonviolent Among those studies, several investiga­ felonies (Cherek et al. 1996, 1997). the study participants. These findings tions using a variety of laboratory mea­ support the belief that a life-long his- sures of aggression demonstrated that tory of aggressive behavior (which is • Female parolees with self-reported the consumption of alcohol-containing histories of violent behavior demon­ one of the criteria for ASPD) plays a beverages resulted in greater aggressive critical role in predicting current strated significantly more aggressive behavior among the participants than aggressive behavior. responses than did female parolees did the consumption of non-alcohol- with nonviolent histories (Cherek et containing beverages. Based on those The importance of various individ­ al. 2000). studies, the authors concluded that ual differences, including personality alcohol does in fact increase aggression characteristics, in determining the sus­ • Although the relationship between a in humans. ceptibility to aggressive behavior also person’s testosterone hormone level However, high variability exists in has been demonstrated in other non- and level of aggression is complex, the extent to which alcohol is related alcohol-related laboratory aggression many studies have found an associa­ with aggression as measured in such studies, as follows: tion between increased testosterone laboratory studies. Furthermore, as in levels and high aggression (Archer “real-life” alcohol consumption, not • Women who reported moderate to 1991). Human laboratory studies have all study participants show increased severe menstrual symptoms were more confirmed that higher levels of aggression after drinking alcohol. This aggressive across their cycles than testosterone, whether resulting from variability likely results from individual women who reported minimal testosterone administration (Kouri personality traits that influence a per- symptoms (Dougherty et al. 1998). et al. 1995) or from a person’s own son’s predisposition to aggressive behav­ (i.e., endogenous) testosterone levels ior (e.g., the presence of ASPD) both (Dougherty et al. 1997), were related in the presence and absence of alcohol. 1Although these prisoners were not diagnosed with ASPD according to the current criteria, some criteria of ASPD, to higher rates of aggression in both For example, as mentioned earlier in such as impulsive and aggressive behavior, are highly likely men and women. this section, laboratory studies in which to be present in persons incarcerated for violent crimes.

Vol. 25, No. 1, 2001 7 • Men with high levels of trait hostility ular interest, the proportion of men and ria, the participants with ASPD had as measured by hostility-assessing women in the low- and high-aggression committed significantly more aggres­ questionnaires showed enhanced sus­ groups was nearly equal (see figure 1). sive acts over their lifetimes than had ceptibility to increases in aggression The observations described in the the non-ASPD participants. after receiving a treatment that lowers previous paragraph suggest that people During the study, the participants the levels of the brain chemical sero- with ASPD, many of whom have par­ each received four drinks (one drink per tonin2 (Dougherty et al. 2000). ticularly strong aggressive tendencies, day) containing varying amounts of should be especially prone to alcohol- alcohol before their level of aggression • Women with borderline personality related aggression. To explore this notion was assessed using the Point Subtraction disorder3 demonstrated more aggressive in more detail, Moeller and colleagues Aggression Paradigm. The study found responses than did women without (1998) compared alcohol’s effect on a significant difference in alcohol’s effect the disorder (Dougherty et al. 1999a). aggression in 8 people who met the cri­ on aggressive responding between par­ teria for ASPD with 10 people who did ticipants with and without ASPD. Several laboratory studies have sup- not meet those criteria. As was to be Thus, participants with ASPD exhibited ported the idea that the level of alcohol- expected based on the diagnostic crite­ a greater increase in aggressive respond- related aggression is related to whether a person has a history of past aggressive behavior. For example, Giancola and Zeichner (1995) demonstrated in a study 350 using laboratory measures of aggression Aggressive group that aggressive personality characteristics are associated with alcohol-related aggres­ 300 Non-aggressive group sion. Bailey and Taylor (1991) also demonstrated the interactions between personality traits, alcohol consumption, 250 and aggression. In that study, college students with higher self-reported trait hostility demonstrated more rapid increases 200 in aggression in response to provocation after alcohol consumption than did stu­ dents with lower trait hostility. In a study comparing the effects of 150 alcohol on aggression in both men and women, Dougherty and colleagues (1999b) also found evidence for the 100 influence of individual differences in Number of Aggressive Responses personality characteristics. In that study, both the men and women exhibited 50 similar increases in aggression after con­ suming alcohol. Further analysis indi­ cated, however, that these increases in 0 aggression were particularly high in the 1 2 3 4 5 6 participants who demonstrated elevated PSAP Sessions levels of “aggressive responding” even when they did not receive alcohol (i.e., under placebo conditions). In other Figure 1 Effects of alcohol consumption on mean number of aggressive responses as determined using the Point Subtraction Aggression Paradigm (PSAP) words, participants with the strongest (Cherek 1992). The participants completed six sessions on each of two tendencies for aggression while sober test days (i.e., a placebo day and an alcohol dose day). On both days, exhibited the greatest increases in aggres­ the participants consumed a beverage 15 minutes before sessions 2, 3, sion after consuming alcohol. Of partic­ and 4. On the alcohol dose day, each beverage contained alcohol corre­ sponding to approximately 1.5 standard drinks*. The participants were 2Low levels of serotonin have been associated with divided into two groups based on high and low aggressive performance certain personality characteristics, such as aggression and on the placebo day. Alcohol ingestion increased aggressive responding depression. in the aggressive group (i.e., participants who had been more aggressive 3Borderline personality disorder, which occurs primarily in on the placebo day) but not in the nonaggressive group. women, is characterized by a pattern of intense and self- destructive relationships along with impulsive behaviors *A standard drink is defined as one 12-ounce beer, one 5-ounce glass of wine, or 1.5 ounces of distilled spirits. (APA 1994).

8 Alcohol Research & Health Antisocial Personality Disorder, Alcohol, and Aggression

ing after consuming alcohol than did • People who are more likely to be associated with alcohol consumption the non-ASPD participants (see figure 2). aggressive when sober, regardless of are that alcohol will make the drinker As with previous research using other the underlying reasons, are more less inhibited and more outgoing. Such samples, the alcohol-related increase in likely to exhibit increased aggressive expectancies can influence a drinker’s aggressive behavior was positively corre­ behavior when under the influence behavior, because people are more likely lated with the number of past aggressive of alcohol. to behave under the influence of alco­ acts the participants had committed. hol in the manner in which they expect When analyzed together, the find­ to behave. ings of these human laboratory studies Evidence for the effect of expectancies on the association between aggression, Potential Mechanisms derives from studies in which participants personality characteristics, and alcohol Contributing to Alcohol- were first asked to describe the way they consumption allow three main conclu­ Related Aggression believed alcohol influenced behavior. sions, as follows: Subsequently, the participants received Several theories exist regarding the causes a drink that they were told contained • As a group, people with ASPD appear underlying alcohol-related aggression. alcohol, but which in fact did not con­ to be more aggressive than people Some of these theories focus on the roles tain significant amounts of alcohol. The without ASPD, although not all of expectancies, changes in brain func­ study found that the participants showed people with ASPD show increased tion, and changes in brain chemistry. increases in those behaviors that they aggressive behavior. believed would be increased by alcohol, Expectancies even though they had not received any • The most important predictor of alcohol (Leigh 1989). Thus, the observa­ current aggressive behavior appears The term “expectancies” refers to the tion that people with a history of aggres­ to be the amount of aggressive notion that a person has certain assump­ sive behavior show increased aggression behavior a person has demonstrated tions about alcohol’s effects on behav­ under the influence of alcohol may result in the past. ior. For example, common expectancies from the fact that these people expect alcohol to make them more aggressive. Expectancies probably are not the sole explanation for alcohol-related 300 aggression, however. In fact, to reduce the influence of expectancies, researchers 250 conducting studies using laboratory measures of aggression generally take Non-ASPD participants 200 ASPD participants great care not to mention the study’s purpose to the participants. For example, 150 in the study by Moeller and colleagues (1998) on the association between ASPD 100 and alcohol-related aggression, the partici­ pants were told that the study’s purpose 50 was to measure alcohol’s effects on mood and reaction time. Furthermore, in 0 another study demonstrating that alcohol After Alcohol Consumption increased aggression significantly more 4 Changes in Aggressive Responses -50 than an active placebo, Chermack and Taylor (1995) detected no significant -100 effect of expectancies on behavior and no significant interaction between expectancies and the alcohol dose used. Figure 2 Alcohol’s effect on aggressive responding in both people with and people without antisocial personality disorder (ASPD). Researchers compared the levels of aggressive responding in study participants after they consumed Changes in Brain Function a nonalcoholic beverage (i.e., placebo) with responses after they consumed Another theory regarding the mecha­ 1 gram of alcohol per kilogram body weight (corresponding to approximately four standard drinks*). In people without ASPD, alcohol consumption nisms through which alcohol increases slightly decreased aggressive responding, whereas in people with ASPD, aggression centers around the way that alcohol consumption substantially increased aggressive responding.

4 *A standard drink is defined as one 12-ounce beer, one 5-ounce glass of wine, or 1.5 ounces of distilled spirits. An active placebo in this case is a drink that contains enough alcohol to have an alcoholic aroma but not enough alcohol to result in detectable blood alcohol levels.

Vol. 25, No. 1, 2001 9 alcohol “disinhibits,” or brings out, aggression, at least in part, by directly questions remain, however, regarding behaviors that are normally repressed. affecting GABA activity. the role of ASPD in this relationship. This theory is based on the concept Alcohol also affects serotonin levels For example, it is still unclear whether that alcohol impairs higher reasoning, in the brain. Serotonin is a neurotrans­ the association of alcohol-related aggres­ or “executive,” brain functions, allow­ mitter that is widely distributed in the sion with ASPD results from some key ing more basic or impulsive brain func­ brain. It is involved in the coordination feature of ASPD itself or from the diffi­ tions to take over. Support for this the­ of complex motor and sensory patterns culties that many people with ASPD ory derives from study findings indicat­ of behavior, such as sleep, appetite, and have in controlling aggressive or impul­ ing that alcohol intoxication impairs mood (Cooper et al. 1991). Most stud­ sive behaviors. Similarly, researchers several aspects of higher brain function­ ies have found that alcohol increases have not yet determined the neurologi­ ing, including planning, verbal fluency, brain serotonin levels, although other cal and biochemical factors underlying attention, and memory (Peterson et al. studies have noted that alcohol decreases alcohol-related aggression. Once scien­ 1990; Dougherty et al. 1999c). Likewise, serotonin levels, at least in some brain tists have further elucidated these issues, some studies have found that people regions (LeMarquand et al. 1994). researchers may be able to develop suc­ with ASPD experience deficits in higher Alcohol’s effects on brain serotonin may cessful treatment approaches aimed at contribute to alcohol-related aggression, reasoning or executive cognitive brain decreasing alcohol-related aggression. because studies of impulsively violent function (Giancola and Moss 1998), Because alcohol-related violence continues people with ASPD have found that thereby suggesting that these people to be a significant public health prob­ may be more susceptible to alcohol’s those people have lower serotonin levels than do nonviolent people (Brown et al. lem, further research on the relationship aggression-inducing effects. between ASPD and alcohol-related 1979). Consequently, alcohol-related reductions in serotonin levels may exac­ aggression clearly is warranted. Changes in Brain Chemistry erbate the susceptibility to aggressive behavior in people with ASPD. (For Alcohol has direct biochemical effects References on the brain itself. Although alcohol’s more information on serotonin’s role in effects on the brain are complex and alcohol-related aggression, see the article American Psychiatric Association. Diagnostic and not fully understood, researchers have in this issue by Higley, pp. 12–19). Statistical Manual of Mental Disorders, Fourth demonstrated that alcohol alters the Edition. Washington, DC: the Association, 1994. activities of several brain chemicals (i.e., Conclusions ARCHER, J. The influence of testosterone on human neurotransmitters), including γ-aminobu­ aggression. British Journal of Psychology 82:1–28, 1991. tyric acid (GABA) and serotonin. Both People with ASPD are more likely to BAILEY, D.S., AND TAYLOR, S.P. Effects of alcohol and of these neurotransmitters have been aggressive disposition on human physical aggression. meet the criteria for alcohol abuse or Journal of Research in Personality 25:334–342, 1991. associated with aggressive behavior. dependence and, as discussed in this GABA is the major inhibitory neu­ article, are more susceptible to alcohol’s BROWN, G.L.; GOODWIN, F.K.; BALLENGER, J.C.; rotransmitter in the brain—that is, it aggression-related effects than people GOYER, P.F.; AND MAJOR, L.F. Aggression in depresses the activity of the nerve cells it humans correlates with cerebrospinal fluid amine without the disorder. Several studies metabolites. Psychiatry Research 1:131–139, 1979. regulates. Like other neurotransmitters, have demonstrated that aggressive per­ GABA modulates the activity of a cell sonality traits are associated with an BUSHMAN, B.J., AND COOPER, H.M. Effects of alco­ by interacting with certain molecules hol on human aggression: An integrative research increase in aggression after drinking review. Psychological Bulletin 107:341–354, 1990. (i.e., receptors) on the cell’s surface, thereby alcohol. Furthermore, in a study of initiating a chain of biochemical reactions CHEREK, D.R. A Manual for the Point Subtraction people with ASPD, those participants © that result in altered nerve cell activity. who had exhibited the most aggression Aggression Paradigm . Houston: University of Texas Houston, 1992. Two main types of GABA receptors exist, in the past were most likely to become GABAA and GABAB. Alcohol, like cer­ aggressive under the influence of alco­ CHEREK, D.R.; SCHNAPP, W.; MOELLER, F.G.; AND tain sedating agents (e.g., benzodi­ hol. Researchers have developed several DOUGHERTY, D.M. Laboratory measures of aggressive azepines, such as Valium®, and barbitu­ responding in male parolees with violent and nonvio­ theories to explain the cause of alcohol- lent histories. Aggressive Behavior 22:27–36, 1996. rates), enhances GABA’s effect on the related aggression that focus on expectan­ GABAA receptor. Thus, at least some cies, brain function, and brain chem­ CHEREK, D.R.; MOELLER, F.G.; SCHNAPP, W.; AND of alcohol’s effects probably are medi­ istry. However, it is unlikely that any DOUGHERTY, D.M. Studies of violent and nonvio­ ated through this neurotransmitter in lent male parolees: I. Laboratory and psychometric one factor can sufficiently explain the measurements of aggression. Biological Psychiatry select brain regions (Cooper et al. 1991). association between alcohol consump­ 41:514–522, 1997. Furthermore, animal studies have found tion and increased aggression. that treating animals with medications Human laboratory studies have led CHEREK, D.R.; LANE, S.D.; DOUGHERTY, D.M.; MOELLER, F.G.; AND WHITE, S. Laboratory and which block GABA activity can dimin­ to significant advances in understanding questionnaire measures of aggression among female ish alcohol-related aggression (Miczek the relationship between personality parolees with violent or nonviolent histories. et al. 1993). Thus, alcohol may increase and alcohol-related aggression. Several Aggressive Behavior 26:291-–307, 2000.

10 Alcohol Research & Health Antisocial Personality Disorder, Alcohol, and Aggression

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