Am J Psychiatry 1991; 148:1712-1716
Copyright © 1991 by American Psychiatric Association
Clinical phenomenology and neurobiology of cocaine abstinence: a prospective inpatient study
SL Satel, LH Price, JM Palumbo, CJ McDougle, JH Krystal, F Gawin, DS Charney, GR Heninger and HD Kleber
Clinical Neuroscience Research Unit, Abraham Ribicoff Research Facilities, Connecticut Mental Health Center, West Haven.
OBJECTIVE: This study was undertaken to document symptoms and changes in
dopaminergic function emerging after abrupt cessation of cocaine use.
METHOD: After admission, 22 patients with DSM-III-R cocaine dependence were
observed drug free for 3 weeks. The patient-rated Ribicoff Abstinence
Rating Scale, Symptom Rating Scale, Physical Symptom Scale, Patient Rated
Anxiety Scale, Beck Depression Inventory, and visual analogue scales for 16
subjective states were completed daily, and nurses rated 13 patients with
the global anxiety and depression items of the Short Clinical Rating Scale.
Serial blood samples were obtained three times weekly, and the patients'
levels of prolactin, growth hormone (GH), and homovanillic acid (HVA) were
measured. Their prolactin and GH values were compared with those of matched
normal subjects. RESULTS: A total of 62 subjective symptom variables were
evaluated. At baseline, the symptom ratings were mildly elevated. At 3
weeks there were significant decreases from baseline in 28 variables and
nearly significant decreases in six additional variables. Nurse-rated
anxiety and depression also changed, but in a more variable pattern. There
was a small but significant increase from baseline over time in plasma
prolactin, but there were no significant changes in GH or HVA. The
patients' prolactin and GH values did not differ from those of the normal
subjects. CONCLUSIONS: These findings suggest that symptoms after inpatient
cessation of uncomplicated cocaine addiction are relatively mild and
decrease linearly over the first month. Evidence of dysregulated central
dopamine function was limited. The findings do not support routine use of
pharmacological agents in the inpatient management of such patients.
