We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

The Physiology of Cocaine Craving and 'Crashing'-Reply

Herbert D. Kleber, MD; Frank H. Gawin, MD
Arch Gen Psychiatry. 1987;44(3):299-300. doi:10.1001/archpsyc.1987.01800150123019.
Text Size: A A A
Published online


In Reply.—  Dackis1 and we2,3 have previously noted clinical impressions like those that we systematically observed in our sample of 30 cocaine abusers. The same impressions were first described by Lewin 99 years ago and elaborated by Maier over 50 years ago.4 Connell and Ellinwood have described similar impressions in chronic amphetamine abuse. However, no previous reports of cocaine or amphetamine abuse reports fully elaborated the nature or importance of phase 2 symptoms.Our article's4 clinical focus did not warrant detailed discussion of neurophysiology, so the comments of Dackis et al provide a welcome opportunity to clarify current issues and hypotheses. The importance of dopamine in stimulant euphoria and addiction was first established for amphetamine in the early 1970s in a series of studies by Wise and coworkers, as well as several other groups.5 This was also substantiated for cocaine by DeWit and Wise in


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.