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Cocaine Withdrawal-Reply

Herbert G. Kleber, MD; Frank H. Gawin, MD
Arch Gen Psychiatry. 1987;44(3):298. doi:10.1001/archpsyc.1987.01800150122017.
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Brower and Paredes suggest that our three-phase conceptualization of cocaine abstinence phenomena may require revision because (1) naturalistic methods limit the reliability and validity of our findings, (2) physical signs and symptoms are not described, and (3) we disregard previous convention regarding the term withdrawal, since we apply it to protracted psychologic abstinence phenomenon (phase 2: withdrawal), such as anhedonia, rather than to immediate postbinge symptoms (phase 1: crash) that are accompanied by physical distress. They suggest that our reconceptualization should be merged with the existing conceptualization and that both phase 1 and phase 2 should be termed withdrawal. They bring up three disparate issues.

First, naturalistic methods do limit the reliability, validity, and generalizability of our findings. The second paragraph of our "Comment" section already states this. Once naturalistic observation defines a framework, highly structured investigations can proceed. If our report has value, it is in its contribution


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