New Study Examines Effects of Stopping Psychiatric Medication UCLA Luskin School professor co-authors report showing that more than half succeed in discontinuing usage of drugs

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Despite numerous obstacles and severe withdrawal effects, long-term users of psychiatric drugs can stop taking them if they choose, and mental health care professionals could be more helpful to such individuals, according to a new study.

A new study shows that while long-term users of psychiatric drugs can stop taking them if they choose, mental health care professionals could be more helpful to such individuals dealing with problems like severe withdrawal effects.

While 1 in 6 Americans take a psychiatric medication for serious mental illness, there is little research on people’s experiences coming off the drugs. In the first large-scale study in the United States on this subject, Live & Learn, Inc., in partnership with researchers at the UCLA Luskin School of Public Affairs, UC San Francisco and New York University, began to fill this knowledge gap. Study findings are now available online in Psychiatric Services, a journal published by the American Psychiatric Association.

Surveying 250 long-term users of psychiatric medications who had a diagnosis of serious mental illness and chose to discontinue use, the study found that more than half succeeded in discontinuing usage, despite having little professional support while experiencing severe withdrawal symptoms including insomnia, crying and diarrhea. The majority of survey respondents cited the main reason they attempted to quit centered on health risks of long-term use and side effects.

Of the study’s respondents, 54 percent managed to stay off psychiatric medication for at least one year, with few reporting relapse or re-hospitalization. Eighty-two percent of those who discontinued use reported being “satisfied” with their choice.

“People stop taking their psychiatric medications whether or not they find the drugs helpful, and they do so at all stages of the medication experience — days, weeks, months, or years after taking them,” said David Cohen, professor in Social Welfare at UCLA Luskin and a co-author of the study.  “This study is novel because it asks questions about stopping to take medications from the consumer’s point of view.”

Many industry-funded studies have asked patients why they stop taking their medications, but typically with a view to increase compliance, according to Cohen. By contrast, this study asks consumers what they experienced while coming off drugs, who helped them make and carry out their decision, and whether they were satisfied with their attempted or completed discontinuation.

“Over 70 percent of our study sample had taken medication for more than a decade; however, these individuals reported having little to rely on when discontinuing except the internet and social support in order to endure withdrawal. Limiting access to care through cuts to health and psychosocial services can only make that situation worse,” says principal investigator Laysha Ostrow, founder and CEO of Live & Learn, a California-based social enterprise that provides research, technical assistance and knowledge translation services to behavioral health systems. “Most were working with a provider at the time but did not find them helpful in the process. However, even though it was often complicated and difficult, the majority who were able to come off medication completely were satisfied with their decision to do so.”

Cohen said that there are still plenty of challenges for researchers who are examining this topic.

“There’s a lot of work to do to understand how people come off medications and how to help them do so safely, especially when they’re taking several psychiatric medications simultaneously,” he said. “This study didn’t use a probability sample. Though it very carefully selected the 250 respondents, most with over 10 years’ history of taking medications, it should be a priority to confirm or modify these findings with a probability sample.”

The study was funded through a grant by the Foundation for Excellence in Mental Health Care.

David Cohen

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David Cohen’s research looks at psychoactive drugs – prescribed, licit, and illicit – and considers some of their wanted and unwanted effects as socio-cultural phenomena “constructed” through language, attitudes, and policies, and therefore sensitive to social conditions and social change. He questions the assumption that psychiatric drugs are prescribed because they mostly act on neurochemical substrates of disorders or symptoms, and he helped conceive the “drug centered” model of psychiatric drug action as an alternative. Public and private institutions in the U.S., Canada, and France have funded him to conduct clinical-neuropsychological, qualitative, and epidemiological studies of patients, professionals, and the general population to examine uses to which psychoactive drugs are put and the effects people perceive from these uses.

His work also documents harms induced by mental health treatments (iatrogenesis) and examines social factors contributing to these harms. He studies the deliberate spread of ignorance (agnotology) through the capture of scientific organizations and research by corporations or professions in the mental health system. He charts the rise and fall of schools of thought in this system and how practitioners and historians justify their adoption and repudiation. He pursues national and international comparative research on involuntary psychiatric detentions and treatments of people who experience extreme states.

In his counseling work, Cohen developed person-centered methods to assess how psychiatric drugs affect people, to safely discontinue from them, and to provide non-medical helpers entry into the contested psychopharmacology scene. He has given workshops on this topic around the world. He designed and launched the online CriticalThinkRx Critical Curriculum on Psychotropic Medication for child welfare professionals in 2009, since taken by thousands of practitioners and updated in 2018. Tested in a 16-month longitudinal controlled study, CriticalThinkRx was shown to reduce psychiatric prescribing to children in foster care. He has consulted with governments, agencies, courts, professional groups, community groups, care providers and legal professionals in several countries seeking to reduce harms of prescribed psychotropic drugs to children, adults, and older people in different settings.

Cohen has authored or co-authored over 120 articles and chapters. His edited books include Challenging the Therapeutic State (1990), Médicalisation et contrôle social (1996), and Critical New Perspectives on ADHD (2006). His co-authored books include Guide critique des médicaments de l’âme (1995), Your Drug May Be Your Problem (1999/2007), and Mad Science: Psychiatric Coercion, Diagnosis, and Drugs (2015). He has received awards for his publications, research, teaching, mentoring, and advocacy. His views have been published in leading newspapers and other popular media.

Cohen previously taught at University of Montreal and Florida International University. In Montreal, he directed the Health and Prevention Social Research Group, and at FIU, he was PhD Program Director and Interim Director of the School of Social Work. He held the Fulbright-Tocqueville Chair to France in 2012, and the Marjorie Crump Chair in Social Welfare at UCLA from 2013-2018. At the Luskin School, Cohen served as Associate Dean of Research and Faculty Development between 2018-2023 and is currently Associate Dean.

Selected recent publications

Discontinuing Psychiatric Medications from Participants in Randomized Controlled Trials: A systematic Review (2019)

Incidences of Involuntary Psychiatric Detentions in 25 U.S. States (2020)

Withdrawal Effects Confounding: Another Sign of Needed Paradigm Shift in Psychopharmacology Research (2020)

David Cohen Offers Policy Suggestions for Protecting Foster Youth Social Welfare professor explains how to stem the tide of psychotropic drug prescriptions to children in foster care.

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In November, UCLA Luskin Professor David Cohen was quoted in an ongoing investigative series by the San Jose Mercury News and Bay Area News Group on psychiatric drugs and foster youth.

In the third reported piece in the investigation titled “The Rx Alliance That Drugs Our Kids,” the San Jose Mercury News reveals that nearly 1 of every 4 adolescents in California’s foster care system are prescribed psychiatric drugs to control their behavior. That is more than three times the rate for adolescents nationwide. Often, the drugs that are prescribed are untested or not approved for children.

The investigation also showcased the relationship between the foster care prescribers and pharmaceutical companies. Pharmaceutical companies are spending millions of dollars to influence physicians who prescribe psychiatric medications to California children in foster care. The article explains that foster care prescribers earn nearly twice as much than the typical California doctor, with the highest paid doctors ranging from child psychiatrists to researchers at universities. The bulk of the payments fund drug company-sponsored research.

Professor Cohen noted that this incentive from pharmaceutical companies may be a motivating factor for some doctors.

“These figures suggest these doctors are not looking out primarily for the kids’ interests…but are looking out for their financial interests, and we should all be wary,” he said.

“The experimentation, the drug cocktails, the first-line drugging typically starts with the group that’s the least protected — and foster kids are at the bottom of the ladder in our society and so it’s easier to do this to them.”

Last week, as a follow-up to this article, Cohen offered some policy suggestions in California Healthline, for how to deal with the situation.

His policy proposals are:

1. The Department of Social Services should publish every quarter the percentage of children in foster care and other residential settings under state care who receive one or more prescriptions for psychotropic drugs. This publicly funded aggregated data has obvious public health relevance and no confidentiality concerns exist.

2. Any payment to a physician from a drug company is a payment for good services rendered (i.e., increasing a company’s revenues by enticing physicians to write prescriptions to foster children publicly reimbursed through Medicaid). Consumer bureaus should develop lists of physicians who do not accept funding of any kind from pharmaceutical companies. The medical licensing board should require physicians to display prominent signs in their waiting rooms informing patients about their drug industry funding.

 3. Alaska attorney Jim Gottstein has argued that cocktails of antipsychotics for behavior problems of children are prescriptions for non-medically indicated reasons and thus constitute false claims for Medicaid reimbursement according its own rules. If so, California Medi-Cal might just wish to obey federal law: screen those prescriptions properly and refuse to reimburse them (and kindly notify prescribers that they are breaking the law).

4. The executives of pharmaceutical companies found to have engaged in illegal marketing of their products should be held criminally responsible rather than their companies just paying fines as the cost of doing business (like $10.4 billion in 74 court judgments and settlements between 2010 and 2012).

5. Child welfare workers and juvenile court judges have an ethical duty to inform themselves responsibly about the drugs they encourage and sometimes compel non-consenting children to take. The drug industry floods the market with studies purporting to show short-term improvement in symptoms while it studiously under-documents harms and long-term consequences. Perhaps these officials should be held responsible when things go wrong, not just given a free pass because they don’t prescribe.

6. A stable foster placement matters for a child’s well-being, thus child welfare workers may understandably refer a child for a medication evaluation in order to avoid interrupting the placement. But psychological and behavioral instabilities shown by maltreated or neglected children are normal reactions to adversity, not mental illnesses to medicalize. A severe or delayed reaction to maltreatment does not automatically justify a prescription; it requires even more personal, individual attention given to a child.

 

Two Faculty Books receive Honorable Mention for “Outstanding Social Work Book”

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Two separate books by Social Welfare faculty members have been honored in the competition for the Society for Social Work and Research’s inaugural “Outstanding Social Work Book Award.”

Dr. Stuart A. Kirk, distinguished professor emeritus of Social Welfare, Dr. David Cohen, Professor of Social Welfare, Marjorie Crump and Dr. Tomi Gomory, Florida State University, received Honorable Mention for their book Mad Science: Psychiatric Coercion, Diagnosis, and Drugs.

Mad Science argues that much of modern American psychiatry’s claims are not based on convincing research, and provides a scientific and social critique of current mental health practices.

Dr. Laura S. Abrams, associate professor of Social Welfare and chair of the doctoral program, was recognized for her book Compassionate Confinement: A Year in the Life of Unit C, co-authored with Dr. Ben Anderson-Nathe of Portland State University,

Their book focuses on juvenile corrections, using narratives, observations and case examples from a year of fieldwork at a boy’s residential facility to highlight the system’s tensions and show unexpected pathways to behavior change.

Both works provide critical examinations of the history, institutions, and discourses involved in shaping institutional responses to some of the most pressing social problems.

SSWR is the leading academic and research organization in the field of social welfare. In conferring the award, the organization recognizes the “outstanding scholarly contributions that advance social work knowledge,” SSWR President Eddie Uehara said.

The awards will be formally presented at the SSWR annual meeting in New Orleans this January.