The Effectiveness of Treatments for Cocaine Dependence in Schizophrenic Patients: A Systematic Review

Abstract

Objectives:To evaluate and compare the effectiveness of available treatments for cocaine dependence in schizophrenic patients. Method: We searched articles published between May 2002 and June 2012 in the following databases: Scopus, Pubmed and Web of Knowledge. The key words utilised were “schizophrenia”, "dementia praecox", "schizophrenic disorder", "cocaine related disorder", "cocaine abuse", "cocaine addiction", "cocaine dependence", “treatment”, “therapeutic”, and "drug therapy”. Selection of studies and data extraction: Original articles in English, Portuguese and Spanish were selected. Controlled, double-blind and open-label studies involving only human subjects were included in this review.Data Synthesis:We found studies on typical and atypical antipsychotics and one monoamine transporter antagonist. There were few indications of the effectiveness of atypical antipsychotic medications for the treatment of cocaine dependence in patients with schizophrenia.Conclusions:We suggest that further studies be conducted with atypical antipsychotic medicationsand greater methodological strictness, including using a placebo group in the studies, so that health professionals can determine the real effectiveness of this class of medication for the treatment of cocaine dependence in schizophrenic patients.

Psychostimulants

“…Other atypical antipsychotics, like risperidone, olanzapine, or reserpine, were no more effective in reducing psychostimulant consumption than placebo when considered in a meta-analysis Kishi, Matsuda, Iwata, & Correll, 2013). Similar conclusions were reached when antipsychotics were considered as a treatment of cocaine addiction in schizophrenic patients (Sabioni, Ramos, & Galduroz, 2013).…”

Once-Monthly Long-Acting Injectable Aripiprazole for the Treatment of Patients with Schizophrenia and Co-occurring Substance Use Disorders: A Multicentre, Observational Study

“…In addition, a systematic review of 14 placebo-controlled studies investigating the use of antipsychotics for cocaine dependence from the Cochrane Collaboration did not find significant differences in any of the outcome variables analyzed, including the number of patients using cocaine during treatment, continuous abstinence and craving [41], supporting the results of a previous meta-analysis on the use of antipsychotics for cocaine or psychostimulant use disorder [42]. Focusing on patients with a dual disorder diagnosis, another systematic review concluded that the efficacy of antipsychotics for cocaine dependence in patients with schizophrenia has not been robustly demonstrated [43]. Although the sample size precludes any conclusion, it is worthy to mention that the three patients with heroin use disorder at baseline achieved abstinence at the end of the follow-up.…”

Psychostimulant addiction treatment

“…Aripiprazole, a second-generation antipsychotic drug also used in the treatment of depression, has shown no efficacy in clinical trials of cocaine-use disorder (Sabioni, Ramos, & Galduroz, 2013) or methamphetamine-use disorder (Coffin et al, 2013; Sulaiman et al, 2013). …”

“… The following reviews were included in the manuscript but not in this table: Garbutt, 2010; Herin et al, 2010; Mereu et al, 2013; Sofuoglu et al, 2013; Soares et al, 2003; Lima et al, 2003; Pani et al, 2011; Sabioni et al, 2013; Minozzi et al, 2008; Lima et al, 2002; Gardner & Kosten, 2007; Kosten & Domingo, 2013; Ishizaka & Hawkins, 2007. CBT – Cognitive Behavioral Therapy; BE – benzoylecgonine; SR – sustained release; IR – immediate release; IV – intravenous; …”