Absence of Evidence for Sustained Effects of Daily Cannabidiol Administration on Anandamide Plasma Concentration in Individuals with Cocaine Use Disorder: Exploratory Findings from a Randomized Controlled Trial.

Background: Cannabidiol (CBD) has been proposed to have a therapeutic potential over a wide range of neuropsychiatric disorders, including substance use disorders. Pre-clinical evidence suggests that CBD can increase anandamide (AEA) plasma concentration, possibly mediating some of its therapeutic properties. Whether CBD exerts such an effect on AEA in individuals with cocaine use disorder (CUD) remains unknown. Aims: To explore the sustained effects of daily CBD administration on AEA plasma concentrations compared with placebo in CUD. Methods: We used data from a randomized, double-blind, placebo-controlled trial evaluating CBD's efficacy in CUD. Seventy-eight individuals were randomized to receive a daily oral dose of 800 mg CBD (n = 40) or a placebo (n = 38). Participants stayed in an inpatient detoxification setting for 10 days, after which they were followed in an outpatient setting for 12 weeks. AEA plasma concentration was measured at baseline and at 23-h post CBD ingestion on day 8 and week 4. A generalized estimating equation model was used to assess CBD's effects on AEA, and sensitivity analyses were computed using Bayesian linear regressions. Results: Sixty-four participants were included in the analysis. Similar mean AEA plasma concentrations in both treatment groups (p = 0.357) were observed. At day 8, mean AEA plasma concentrations (± standard deviation) were 0.26 (± 0.07) ng/mL in the CBD group and 0.29 (± 0.08) ng/mL in the placebo group (p = 0.832; Bayes factor [BF] = 0.190). At week 4, they were 0.27 (± 0.09) ng/mL in the CBD group and 0.30 (± 0.09) ng/mL in the placebo group (p = 0.181; BF = 0.194). Conclusion: While not excluding any potential acute and short-term effect, daily CBD administration did not exert a sustained impact on AEA plasma concentrations in individuals with CUD compared with placebo. Registration: clinicaltrials.gov (NCT02559167).

Association Between Markers of Vulnerability for Cannabis-Related Harms and Source of Supply: Secondary Analysis of a Representative Population Survey.

OBJECTIVE: In 2018, the sale of non-medical cannabis was authorized in the province of Quebec in Canada, within a public monopoly under the Société Québécoise du Cannabis (SQDC). The objective of this study was to offer a description of the cannabis-using population regarding the sources of cannabis supply and to explore whether at-risk individuals are purchasing cannabis at SQDC. METHOD: We used data from a cross-sectional, representative population survey (age >18 years, n = 1799), the Enquête Québécoise sur le Cannabis, which was completed between February and June 2019. Analyses involved adjusted binary logistic regressions, incorporating population weights, to assess 7 potential indicators of harm. RESULTS: The vulnerability profiles of SQDC consumers (47.8%) and those acquiring their cannabis elsewhere (52.2%) were similar in terms of frequency of cannabis use (adjusted odds ratio [aOR] = 0.46; 95% confidence interval [CI] = 0.12-1.67), motivation to use (aOR = 0.62; 95% CI = 0.16-2.46), concomitant consumption of other substances (aOR = 0.80; 95% CI = 0.14-4.75), cannabis-impaired driving behaviours (aOR = 0.93; 95% CI = 0.26-3.36), psychological distress (aOR = 0.99; 95% CI = 0.26-3.79), and problematic cannabis use (aOR = 0.46; 95% CI = 0.13-1.64). However, SQDC consumers were more likely to be aware of the cannabinoid content of the product purchased compared to those who acquired their cannabis from other sources (aOR = 4.12; 95% CI = 1.10-15.40). CONCLUSIONS: No association was detected between the source of cannabis supply and potential vulnerability indicators of cannabis-related harms, but SQDC consumers were more aware of the cannabinoid content of the products purchased. These results suggest that the regulated government supply in Quebec is reaching a substantial portion of those with potential high vulnerability to harm. Whether this knowledge translates into a reduction in the negative consequences related to consumption is still to be determined.

Cannabidiol effects on cognition in individuals with cocaine use disorder: Exploratory results from a randomized controlled trial.

BACKGROUND: Cocaine use disorder (CUD) is associated with various cognitive deficits that impede patients' functionality, prognosis and therapeutic outcomes. New pharmacological treatments for CUD that could improve cognition are needed. OBJECTIVE: To explore whether cannabidiol (CBD) is superior to placebo to improve cognitive functioning in individuals with CUD. METHODS: We conducted an exploratory analysis of a single site, randomized, double-blind, placebo-controlled trial evaluating CBD's efficacy in reducing craving, cocaine use and relapse in individuals with CUD. Seventy-eight individuals diagnosed with CUD were randomized to receive either CBD (800 mg) or placebo for 92 days. We used the Cambridge Neuropsychological Test Automated Battery (CANTAB) to assess inhibition (Stop Signal Task; SST), risky decision making (Cambridge Gambling Task; CGT) and visual memory (Pattern Recognition Memory; PRM). This assessment was made on day 1, day 7 and at week 6. We controlled for sex, severity of dependence and baseline cognitive scores in our generalized estimating equation models. RESULTS: Both groups performed similarly on the PRM (correct answers: p = 0.080), SST (stop signal reaction time: p = 0.644) and CGT (quality of decision making: p = 0.994; deliberation time: p = 0.507; delay aversion: p = 0.968; risk taking: p = 0.914) tests. CONCLUSIONS: We found no evidence for 800 mg of CBD to be more efficacious than placebo for improving cognitive outcomes. Clinical trials evaluating pharmacological treatments for CUD should continue to be a research priority.

Cannabidiol Effect on Anxiety Symptoms and Stress Response in Individuals With Cocaine Use Disorder: Exploratory Results From a Randomized Controlled Trial.

OBJECTIVES: Individuals with a cocaine use disorder (CUD) are more likely to present anxiety, which in turn negatively impacts substance use outcomes. Some evidence suggests that cannabidiol (CBD) presents anxiolytic properties and could be a treatment for substance use disorders. This study explores CBD's effect on stress biomarker (cortisol) and anxiety symptoms in people with CUD. METHODS: Exploratory analyses were conducted using data from a randomized, double-blind, placebo-controlled trial evaluating CBD's efficacy to treat CUD. We randomized 78 individuals with CUD into receiving a daily oral dose up to 800 mg CBD (n = 40) or placebo (n = 38). The trial was divided into 2 phases: an inpatient detoxification lasting 10 days and an outpatient follow-up lasting 12 weeks. Anxiety symptoms and stress response were assessed using a visual analog scale, the Beck Anxiety Inventory, and cortisol levels at multiple time points throughout the study. We also measured anxiety after a stressful and a cocaine-cue scenarios. We used generalized estimating equations models and multiple linear regression to assess CBD's effects on anxiety and cortisol levels. RESULTS: Both treatment groups had similar mean anxiety scores according to the Beck Anxiety Inventory ( P = 0.27) and the visual analog scale ( P = 0.18). CBD did not decrease anxiety after a stressful ( P = 0.14) and a cocaine ( P = 0.885) scenarios compared with placebo. No statistically significant group difference was found in cortisol levels ( P = 0.76). CONCLUSIONS: We found no evidence for 800 mg of CBD to be more efficacious than placebo for modulating anxiety symptoms and cortisol levels in individuals with CUD.

Changes in Alcohol Habits Among Workers During the Confinement of COVID-19: Results of a Canadian Cross-Sectional Survey.

BACKGROUND: The restrictions implemented around the world to contain the spread of the coronavirus disease 2019 (COVID-19) impact workers. Emotional distress and maladaptive behaviors such as alcohol misuse are expected, particularly in vulnerable groups such as front-line health workers. In the present study, we examined if alcohol consumption behaviors in Quebec workers changed during confinement of the COVID-19 pandemic, and whether healthcare workers reported specific patterns of changes. METHODS: Data were obtained from an anonymous online survey conducted among adult workers aged ⩾18 years in the province of Quebec, Canada, between May 25, 2020 and June 26, 2020. Participants provided self-reported data regarding sociodemographic including field of work, as well as mental health disorders, alcohol use, alcohol craving, and type of alcohol consumed. Changes in alcohol behaviors were assessed using Wilcoxon signed rank test for categorial variables and paired-t tests for continuous variables. RESULTS: The survey was completed by 847 participants (77.8% women), with 42.5% healthcare workers. Participants reported increased daily alcohol use (Z = -10.60; P < .001, r = -.372) and alcohol craving (P < .001, d = 0.485) during the confinement. Only the type of alcohol consumed during the confinement differed between health care workers and other workers (OR = 0.45, P = .003). Health care workers used less high alcohol products during the confinement. CONCLUSION: Our results show a significant increase in daily alcohol consumption and in alcohol craving during the confinement in the Quebec working population.

Exploring cannabidiol effects on inflammatory markers in individuals with cocaine use disorder: a randomized controlled trial.

Cocaine use disorder (CUD) is a major public health issue associated with physical, social, and psychological problems. Excessive and repeated cocaine use induces oxidative stress leading to a systemic inflammatory response. Cannabidiol (CBD) has gained substantial interest for its anti-inflammatory properties, safety, and tolerability profile. However, CBD anti-inflammatory properties have yet to be confirmed in humans. This exploratory study is based on a single-site randomized controlled trial that enrolled participants with CUD between 18 and 65 years, randomized (1:1) to daily receive either CBD (800 mg) or placebo for 92 days. The trial was divided into a 10-day detoxification (phase I) followed by a 12-week outpatient follow-up (phase II). Blood samples were collected from 48 participants at baseline, day 8, week 4, and week 12 and were analyzed to determine monocytes and lymphocytes phenotypes, and concentrations of various inflammatory markers such as cytokines. We used generalized estimating equations to detect group differences. Participants treated with CBD had lower levels of interleukin-6 (p = 0.017), vascular endothelial growth factor (p = 0.032), intermediate monocytes CD14+CD16+ (p = 0.024), and natural killer CD56negCD16hi (p = 0.000) compared with participants receiving placebo. CD25+CD4+T cells were higher in the CBD group (p = 0.007). No significant group difference was observed for B lymphocytes. This study suggests that CBD may exert anti-inflammatory effects in individuals with CUD.

Hypnosis for burn wound care pain and anxiety: A systematic review and meta-analysis.

BACKGROUND: Evidence from clinical trials suggests psychological interventions should be considered as an adjunct to medications. OBJECTIVE: The purpose of this systematic review and meta-analysis was to evaluate the effectiveness of clinical hypnosis on pain, anxiety and medication needs during wound care in adults suffering from a burn injury. DATA SOURCES: Medline, PsychINFO, CINAHL, Embase, ISI, SCOPUS, Cochrane, and Proquest databases were searched for randomized controlled trials comparing hypnosis to other interventions during dressing change in adult patients. DATA SYNTHESIS: Two independent reviewers extracted relevant articles and assessed their methodological quality. Only six studies met the inclusion criteria and were described in detail. Available data was pooled with Revman 5.3. RESULTS: For the primary outcome, we found a statistically significant difference in pain intensity ratings favoring hypnosis (MD=-8.90, 95% CI -16.28, -1.52). For the secondary outcomes, there was a statistically significant difference in anxiety ratings favoring hypnosis (MD=-21.78, 95% CI -35.64, -7.93) and no difference in medication usage (MD=-0.07, 95% CI -0.32, 0.17). CONCLUSION: These results suggest that hypnosis reduces pain intensity and anxiety ratings in adults undergoing burn wound care. However, because of the limitations discussed, clinical recommendations are still premature.

Psychopathology in Substance Use Disorder Patients with and without Substance-Induced Psychosis.

Background. Substance-induced psychotic disorder (SIPD) is a diagnosis constructed to distinguish substance-induced psychotic states from primary psychotic disorders. A number of studies have compared SIPD persons with primary psychotic patients, but there is little data on what differentiates substance use disorder (SUD) individuals with and without SIPD. Here, we compared psychopathology, sociodemographic variables, and substance use characteristics between SUD patients with and without SIPD. Methods. A retrospective chart review was conducted on newly admitted patients at a rehabilitation centre between 2007 and 2012. Results. Of the 379 patients included in the study, 5% were diagnosed with SIPD (n = 19) and 95% were diagnosed with SUDs without SIPD (n = 360). More SIPD patients reported using cannabis and psychostimulants, and fewer SIPD patients reported using alcohol than SUDs patients without SIPD. SIPD patients scored higher on the "schizophrenia nuclear symptoms" dimension of the SCL-90R psychoticism scale and exhibited more ClusterB personality traits than SUD patients without SIPD. Discussion. These data are consistent with previous studies suggesting that psychopathology, substance type, and sociodemographic variables play important role in the development of SIPD. More importantly, the results highlight the need for paying greater attention to the types of self-reported psychotic symptoms during the assessment of psychotomimetic effects associated with psychoactive substances.

Cocaine and cognition: a systematic quantitative review.

BACKGROUND: Cocaine use disorder is associated with cognitive deficits. However, the literature remains somewhat ambiguous with respect to which distinct cognitive functions are the most impaired in cocaine use disorder and to how duration of abstinence affects cognitive recovery. Here, we performed a meta-analysis to determine the cognitive domains impaired in cocaine abuse/dependence and the duration of abstinence necessary to achieve cognitive recovery. METHODS: A literature search yielded 46 studies that assessed cognitive dysfunction in subjects with cocaine abuse/dependence. Effect-size estimates were calculated using the Comprehensive Meta-Analysis V2, for the following 11 cognitive domains: attention, executive functions, impulsivity, speed of processing, verbal fluency/language, verbal learning and memory, visual learning and memory, visuospatial abilities, and working memory. Within these 11 domains, effect-size estimates were calculated on the basis of abstinence duration: short- (positive for drugs urine screening), intermediate- (≤12 weeks), and long-term (≥20 weeks) abstinence. RESULTS: Findings revealed moderate impairment across 8 cognitive domains during intermediate abstinence. The most impaired domains were attention, impulsivity, verbal learning/memory, and working memory. For some domains (attention, speed of processing, and verbal learning/memory), impairments were smaller during short-term abstinence than during intermediate abstinence. Finally, small effect-size estimates were found for long-term abstinence. DISCUSSION: These results suggest significant impairment across multiple cognitive domains in cocaine abusers, and that some of these deficits may be partially masked by the residual or acute withdrawal effects of cocaine. Cognitive dysfunctions remain stable during the first months of abstinence and may abate after 5 months of sobriety.

Predictors of community functioning in schizophrenia and substance use disorder patients.

Community functioning is a broad term that encompasses various 'real world' measures of disability among schizophrenia patients. It includes outcomes such as independent living, social competence and behavioural problems-all of which are priorities for treatment among schizophrenia patients, mental health care providers, and family members. An important goal for rehabilitation programs is to identify predictors of community functioning which, in turn, could be used as targets for intervention. The present case-control study examined socio-demographic and substance use disorder (SUD) variables as well as psychiatric, extrapyramidal, and cognitive symptoms as predictors of community functioning in schizophrenia patients with (DD patients; n=31) and without comorbid SUDs (SCZ patients; n=31), and non-psychosis substance abusers (SUD patients; n=39). Psychiatric and extrapyramidal symptoms were evaluated with the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia and the Extrapyramidal Symptoms Rating Scale. Cognition was evaluated using the Cambridge Neuropsychological Test Automated Battery (speed of processing, explicit and working memory). In SCZ patients, community functioning was predicted by explicit memory performance. In DD patients, community functioning was predicted by substance abuse, depression and speed of processing. In SUD patients, community functioning was predicted by substance abuse, positive symptoms and education. Our results suggest that cognition should be among the top treatment priorities in SCZ patients, whereas the key treatment targets in DD patients should be substance abuse and depression. Future studies will need to replicate the current findings, using prospective research designs.

Sensation-seeking, social anhedonia, and impulsivity in substance use disorder patients with and without schizophrenia and in non-abusing schizophrenia patients.

Substance use disorders (SUDs) are common in patients with schizophrenia and this comorbidity is associated with a poorer prognosis, relative to non-abusing patients. One hypothesis that has been advanced in the literature is that dual diagnosis (DD) patients may have a different personality profile than non-abusing schizophrenia patients. The present case-control study aimed to characterize levels of personality traits (sensation-seeking, social anhedonia, and impulsivity) in substance abuse/dependence patients with (DD group; n=31) and without schizophrenia (SUD group; n=39), relative to non-abusing schizophrenia patients (SCZ group; n=23), and healthy controls (n=25). Impulsivity was assessed using the Barratt Impulsivity Scale. Sensation-seeking was assessed using the Zuckerman Sensation Seeking Scale. Social anhedonia was assessed with the Chapman Social Anhedonia Scale. We found that sensation-seeking was significantly higher in DD and SUD, relative to SCZ patients. We found that social anhedonia was significantly elevated in DD and SCZ, relative to healthy controls. We found that impulsivity was significantly higher in DD, SCZ and SUD patients, compared to healthy controls. The results suggest that sensation-seeking is prominent in substance abuse/dependence (irrespective of schizophrenia), social anhedonia is prominent in schizophrenia (irrespective of substance abuse/dependence), and impulsivity is prominent in all three populations.

Questioning the specificity of ASRS-v1.1 to accurately detect ADHD in substance abusing populations.

OBJECTIVE: To assess the specificity of the Adult ADHD Self-Report Scale (ASRS-v1.1) in detecting ADHD among individuals with substance use disorders (SUDs). METHOD: A chart review of 183 SUD patients was conducted. Patients were screened for ADHD with the ASRS-v1.1 and were later assessed by a psychiatrist specialized in ADHD. RESULTS: Among SUD patients scoring positive results on the ASRS-v1.1 for the presence of ADHD, the ADHD diagnosis could only be confirmed in 26% of the sample by an expert psychiatrist. CONCLUSION: The ASRS-v1.1 reports low specificity in detecting ADHD among SUD populations.

Could the use of energy drinks induce manic or depressive relapse among abstinent substance use disorder patients with comorbid bipolar spectrum disorder?

OBJECTIVE: The potential harmful effects of excessive caffeine consumption remain largely unknown among psychiatric populations. Energy drinks have particularly high levels of caffeine content and have previously been shown to induce psychotic relapse. Clinical observations of three bipolar disorder patients with comorbid substance use disorder revealed an excessive consumption of energy drinks prior to manic or depressive relapse. BACKGROUND: Three patients with bipolar spectrum disorder and comorbid substance use disorder were assessed by a psychiatrist upon re-admission to a rehabilitation centre following manic or depressive relapse. The assessment was based on DSM-IV criteria and performed by a psychiatrist who specialized in bipolar spectrum disorder and comorbidities to determine the presence of manic or depressive relapse. Two patients were diagnosed with bipolar disorder type I, and the third with bipolar disorder type II. All three patients were diagnosed with comorbid substance use disorders and all three abused cocaine. RESULTS: In all three cases, relapse occurred following at least one week of excessive binging on energy drinks, with a maximum daily consumption of nine cans. Following cessation of energy drink consumption, two of the patients remained abstinent from drug use and maintained psychiatric stability. One patient relapsed three months post-treatment and resumed consuming cocaine and energy drinks. CONCLUSIONS: These clinical observations support other case reports that suggest the existence of a potential correlation between excessive energy drink consumption and relapse among psychiatric populations.

Evolution of Substance use, Neurological and Psychiatric Symptoms in Schizophrenia and Substance use Disorder Patients: A 12-Week, Pilot, Case-Control Trial with Quetiapine.

Neurological and psychiatric symptoms are consequences of substance abuse in schizophrenia and non-schizophrenia patients. The present case-control study examined changes in substance abuse/dependence, and neurological and psychiatric symptoms in substance abusers with [dual diagnosis (DD) group, n = 26] and without schizophrenia [substance use disorder (SUD) group, n = 24] and in non-abusing schizophrenia patients (SCZ group, n = 23) undergoing 12-week treatment with the atypical antipsychotic, quetiapine. Neurological and psychiatric symptoms were evaluated with the Positive and Negative Syndrome Scale, the Calgary Depression Scale for Schizophrenia, the Extrapyramidal Symptoms Rating Scale, and the Barnes Akathisia Rating Scale. At endpoint, DD and SCZ patients were receiving significantly higher doses of quetiapine (mean = 554 and 478 mg/day, respectively), relative to SUD patients (mean = 150 mg/day). We found that SUD patients showed greater improvement in weekly dollars spent on alcohol and drugs and SUD severity, compared to DD patients. At endpoint, there was no significant difference in dollars spent, but DD patients still had a higher mean SUD severity. Interestingly, DD patients had significantly higher parkinsonism and depression than SCZ patients at baseline and endpoint. On the other hand, we found that SUD patients had significantly more akathisia at baseline, improved more than SCZ patients, and this was related to cannabis abuse/dependence. Finally, SUD patients improved more in Positive and Negative Syndrome Scale positive scores than DD and SCZ patients. Taken together, our results provide evidence for increased vulnerability to the adverse effects of alcohol and drugs in schizophrenia patients. They also suggest that substance abuse/withdrawal may mimic some symptoms of schizophrenia. Future studies will need to determine the role quetiapine played in these improvements.

Is the Mood Disorder Questionnaire an appropriate screening tool in detecting bipolar spectrum disorder among substance use populations?

BACKGROUND: Bipolar spectrum disorder (BSD) has been shown to be difficult to assess in general and is further complicated by the presence of substance use disorder (SUD). OBJECTIVE: To review the specificity of the Mood Disorder Questionnaire (MDQ) in detecting BSD among substance abusers. METHOD: A retrospective chart review was conducted using 183 SUD patients who were screened using the MDQ and later assessed by a psychiatrist specializing in BSD. RESULTS: Among SUD patients scoring positive results on the MDQ for the presence of BSD, the BSD diagnosis could only be confirmed in 23% of the sample by an expert psychiatrist. CONCLUSIONS: The MDQ reports low specificity in detecting BSD among SUD populations. SCIENTIFIC SIGNIFICANCE: Physicians should question individuals on substance use behaviors if BSD is suspected due to high rates of comorbidity and diagnostic challenges.

Clinical evolution of substance use disorder patients during treatment with quetiapine: a 12-week, open-label, naturalistic trial.

OBJECTIVE: Substance use disorders (SUDs) are associated with a variety of psychiatric disorders and mood and behavioral instability. Growing evidence suggests that the atypical antipsychotic quetiapine may be useful in the treatment of SUDs. The primary objective of the current open-label trial was to examine the effects of quetiapine on SUD outcomes in patients entering detoxification. METHODS: Thirty-three nonpsychosis SUD patients participated. Patients received quetiapine for a 12-week beginning in detoxification. Craving, quantities used and psychiatric symptoms were evaluated on baseline and at end point. RESULTS: Out of 33 recruited patients, 26 completed > 9 weeks of treatment. Last observation carried forward (LOCF) analyses revealed that craving, SUD severity and quantities used improved during the study. Psychiatric and depressive symptoms also improved. CONCLUSIONS: Our results cannot be attributed per se to the pharmacological effects of quetiapine owing to the open-label design of the study, the small sample size involved and the fact that patients were involved in an intensive therapy program. Nevertheless, our results indicate that quetiapine may be helpful for the treatment of SUD patients entering detoxification. Controlled studies are warranted to determine whether these results are quetiapine-related.

Extrapyramidal symptoms in substance abusers with and without schizophrenia and in nonabusing patients with schizophrenia.

Extrapyramidal symptoms (EPS) such as parkinsonism, dystonia, dyskinesia, and akathisia are conditions of impaired motor function, which are associated with chronic antipsychotic treatment in schizophrenia. In addition, EPS is often exacerbated by psychoactive substance (PAS) abuse, which is frequently observed in this population. Few studies, however, have investigated the contribution of PAS abuse on EPS in PAS-abusers without comorbid psychosis. This study compared the occurrence of EPS in outpatient schizophrenia patients with (DD group; n= 36) and without PAS abuse (SCZ group; n = 41) as well as in nonschizophrenia PAS abusers undergoing detoxification [substance use disorder (SUD) group; n = 38]. Psychiatric symptoms were measured using the Positive and Negative Syndrome Scale and the Calgary Depression Scale for schizophrenia. Extrapyramidal symptoms were evaluated with the Extrapyramidal Symptoms Rating Scale and the Barnes Akathisia Scale. SUD diagnoses were complemented with urine drug screenings. We found that DD patients exhibited significantly more parkinsonism than SCZ patients. Our subanalyses revealed that cocaine and alcohol abuse/dependence was responsible for the increase in parkinsonism in DD patients. Additionally, we found that SUD individuals exhibited significantly more akathisia than SCZ patients. In these latter individuals, subanalyses revealed that alcohol and cannabis abuse/dependence was responsible for the increase in akathisia. Our results suggest that PAS abuse is a contributor to EPS in individuals with and without schizophrenia.

Antipsychotic agents for the treatment of substance use disorders in patients with and without comorbid psychosis.

Substance dependence has serious negative consequences upon society such as increased health care costs, loss of productivity, and rising crime rates. Although there is some preliminary evidence that atypical antipsychotic agents may be effective in treating substance dependence, results have been mixed, with some studies demonstrating positive and others negative or no effect. The present study was aimed at determining whether this disparity originates from that reviewers separately discussed trials in patients with (DD) and without (SD) comorbid psychosis. Using electronic databases, we screened the relevant literature, leaving only studies that used a randomized, double-blind, placebo-controlled or case-control design that had a duration of 4 weeks or longer. A total of 43 studies were identified; of these, 23 fell into the category of DD and 20 into the category of SD. Studies in the DD category suggest that atypical antipsychotic agents, especially clozapine, may decrease substance use in individuals with alcohol and drug (mostly cannabis) use disorders. Studies in the SD category suggest that atypical antipsychotic agents may be beneficial for the treatment of alcohol dependence, at least in some subpopulations of alcoholics. They also suggest that these agents are not effective at treating stimulant dependence and may aggravate the condition in some cases.