It Doesn’t Work, But Psychiatry Will Keep Doing It

    Do not think about, write about or deal with  human behavior without determining the effects of incentives.

   Usage of anti-psychotics to fix drug addiction makes me hark back to my days working in corrections. When I asked a psychiatrist about the use of drugs for drug addiction, she archly informed me, with the hubris peculiar to those who get their status unearned, that what she was doing was dispensing medicine, not drugs. That didn’t make the “treatment” successful, just embedded it in the web of myths of psychiatry. “We can’t do much that is useful, but, by God, we can pretend with the best of ‘em.”

   Thanks to for the reference.


Send to:
J Clin Psychiatry. 2013 Dec;74(12):e1169-80. doi: 10.4088/JCP.13r08525.
Antipsychotics for cocaine or psychostimulant dependence: systematic review and meta-analysis of randomized, placebo-controlled trials.
Kishi T, Matsuda Y, Iwata N, Correll CU.
Author information

    Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan; Division of Psychiatry Research, The Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks.

Since cocaine and psychostimulant dependence are related to increased dopamine release, antipsychotics have been tried to reduce their reinforcing properties. A meta-analysis was undertaken to assess the efficacy and tolerability of antipsychotics in cocaine- or stimulant-dependent patients.


We searched PubMed, Cochrane Library databases, and PsycINFO from database inception until June 24, 2013, using the following keywords: (randomized OR random OR randomly) AND (placebo) AND (methylphenidate OR cocaine OR methamphetamine OR amphetamine OR 3,4-methylenedioxymethamphetamine) AND (dependence OR abuse) AND (antipsychotic OR neuroleptic OR 34 specific antipsychotic names).

Included were randomized, placebo-controlled trials of antipsychotics lasting at least 2 weeks in patients with primary cocaine or psychostimulant dependence. Of 363 hits, we removed 316 duplicates, 20 references based on abstract/title, and 13 ineligible full-text articles, retaining 14 trials for this meta-analysis.
Two authors independently extracted the data. Coprimary outcomes included degree of substance use and lack of abstinence. Risk ratio (RR), 95% CI, and standardized mean difference were calculated.

Ten studies in patients with primary cocaine dependence (risperidone = 5, olanzapine = 3, reserpine = 2; n = 562) and 4 in those with amphetamine/methamphetamine dependence (aripiprazole = 4; n = 179) were meta-analyzed (14 studies, total n = 741). When study results were pooled together, antipsychotics did not differ from placebo in regard to cocaine use days and lack of cocaine or amphetamine/methamphetamine abstinence, severity of addiction, cocaine or amphetamine/methamphetamine craving, Clinical Global Impressions-Severity of Illness (CGI-S) scores, depression, anxiety, compliance, all-cause discontinuation, and several side effects. However, antipsychotics caused more intolerability-related discontinuation than placebo (P = .0009). Individually, aripiprazole was superior to placebo in regard to CGI-S (P = .001), while olanzapine was inferior to placebo in regard to cocaine craving (P = .03) and risperidone was inferior to placebo in regard to depression (P = .002).

Antipsychotics had no advantages over placebo in regard to cocaine use and cocaine or psychostimulant abstinence or craving, while causing more intolerability-related discontinuations.


    Several years ago, a world-wide sample testing respirdal’s value in decreasing aggression in special needs populations  found the drug “placebo” had a better effect. Respirdal is still given for aggression because psychiatry doesn’t depend on facts.

    Anyhow, the lack of effectiveness will not change prescribing habits. It’s the money and status that comes from appearing to do something useful, doncha know? Exactly the same as government. All part of The Great Pretend.

To order my novel, “Days of Songs and Mirrors: A Jacobite in the ‘45”, click here

Cheerio and ttfn,
Grant Coulson
Cui Bono–Cherchez les Contingencies


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