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Drugs for Cocaine Dependence: Not Easy-Reply

Arthur Margolin, PhD; Thomas R. Kosten, MD; S. Kelly Avants, PhD
Arch Gen Psychiatry. 1992;49(11):905-906. doi:10.1001/archpsyc.1992.01820110069012.
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In Reply.—  Not easy, but consider the context. Hollister et al raise an important issue regarding the assessment of pharmacotherapeutic agents for cocaine dependence—whether cocaine craving is an appropriate surrogate outcome measure of cocaine use in inpatient studies. In our experience, and that of other researchers,1 craving for cocaine declines fairly rapidly when cocaine-addicted individuals are sequestered as inpatients. Yet, on return to their former drug-using environments, a large percentage of these same patients may experience intense cravings and relapse.2 These observations are consistent with a conditioning model of relapse: cues associated with previous cocaine use elicit cocaine-associated appetitive motivational states which, in turn, give rise to drug-seeking behavior.3 The ability of a given pharmacologic agent to deflect these context-sensitive motivational states, both acutely and over the course of treatment, may be an important determinant of its effectiveness in the treatment of cocaine addiction.4,5 This will be

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