Cocaine and amphetamine use in patients with psychiatric illness - A randomized trial of typical antipsychotic continuation or discontinuation

Animal studies indicate that typical antipsychotics (neuroleptics) increase cocaine and amphetamine self-administration. Patients with psychiatric illnesses have high rates of substance abuse and frequently receive chronic typical antipsychotic therapy. This open, pilot study examined the effect of typical antipsychotic discontinuation on cocaine and amphetamine use in patients with psychiatric illnesses. Twenty-four evaluable outpatients were randomized to continue (n = 12) or discontinue (n = 12) chronic typical antipsychotic therapy. The atypical antipsychotic quetiapine was instituted, when necessary, for psychosis in the discontinuation group (n = 8). Participants were assessed weekly over 12 weeks with measures of psychiatric symptoms, drug use, and drug craving. Those discontinuing typical antipsychotics (n = 12) had significant reductions in drug craving compared with those continuing typical antipsychotics. No significant between-group differences in drug use were found. Typical antipsychotic discontinuation combined with a quetiapine switch for those with psychotic symptoms was associated with reduced drug craving. Definitive trials of typical antipsychotic discontinuation in dual-diagnosis patients are warranted.