Psychopathy is a personality syndrome characterized by egocentricity, grandiosity, remorselessness, callousness, impulsivity, and manipulativeness. It is also a disorder highly comorbid with substance use disorders ( Derefinko and Lynam, 2007 ; Smith and Newman, 1990 ; Tourian et al., 1997 ). However, unlike their other criminal counterparts, psychopaths' substance use related problems appear remarkably resilient despite treatment ( Smith and Newman, 1990 ) leading many to conclude the dually diagnosed psychopathic substance misuser is "untreatable." However, this pessimistic stance is predicated upon the notion that psychopathy is a homogeneous, categorical construct. Such a conclusion leaves little hope for treating substance use problems in this population, and has certainly attenuated efforts at developing effective clinical interventions ( Seto and Quinsey, 2006 ). In this review, we argue that conceptualizing psychopathy as a heterogeneous and dimensional construct reveals a common thread of negative emotionality (NEM) that may clarify the relations between psychopathy and substance use disorders as well as pave the way for more practical and viable treatment options.