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Patients admitted to a long-term residential substance abuse treatment facility (N = 246) were administered a battery of neuropsychological tests and the Millon Clinical Multiaxial Inventory (MCMI–II). Those who displayed general cognitive impairment scored higher on the Avoidant, Antisocial, Paranoid, and Thought Disorder scales than those who did not have such impairment. Further analyses showed that cognitive status and personality functioning, particularly an antisocial personality style, were independently and interactively related to program participation. Patients with elevations on the MCMI–II scale measuring antisocial personality style and who had cognitive impairment stayed in the program a shorter amount of time, were rated as less positively participatory by clinical staff, and were removed more frequently from treatment for rule violations than other residents. Clinical implications of these findings are discussed.