Clinical Considerations for Long-acting Injectable Risperidone's Use on Cocaine Dependence and Dual Diagnosis

Abstract

Introduction The aim of this study was to evaluate the prognosis of patients with cocaine dependence and dual diagnosis when long-acting injectable risperidone (LAIR) is used in their treatment. Method Open, one-arm, and naturalistic study of a 12-week follow-up was carried out. Fifty-seven patients were recruited during 1 year, when they consecutively started to receive treatment for cocaine dependence at 4 addictive behavior units and a prison in Spain. The questionnaires used were International Personality Disorder Examination, Impulses Control Scale of Ramón y Cajal, Symptom Check List-90-R, and Visual Analog Scale for Craving. Results 91.2% were men, with an average age of 33.7 years; 66.8% were single, 36.8% were unemployed, and 36.8% were with primary education. Personality disorder was shown by 39.3% (25% borderline and 12.5% antisocial). All received a conventional treatment and LAIR, with an average dose of 34.2 mg. Of the sample, 66.6% completed the study, showing a statistically significant improvement in impulsiveness, psychopathology, craving, and health emergencies. However, only 18.9% of the sample remained totally abstinent, whereas 21.6% showed one consumption during the following period. Abstinence from cocaine was not related to social-demographic variables or to the LAIR dose, nonetheless the diagnosis of borderline personality disorder had the worst prognosis. Conclusions Although cocaine dependence has no specific pharmacological treatment, approaches to treating inpatients and outpatients could include LAIR because of its efficacy on other frequently related mental illnesses (dual diagnosis). However, borderline personality disorder and cocaine dependence could be an exception, maybe because mood instability prevails over impulsivity and other antipsychotic responding symptoms.