SHOULD PROTRACTED WITHDRAWAL FROM DRUGS BE INCLUDED IN DSM-IV

Objective: The authors reviewed both clinical data and selected labora tory research related to withdrawal from alcohol, opiates, and stimula nts in order to draw a conclusion about whether the phenomenon of prot racted withdrawal exists and should be included in DSM-IV. Method: Stu dies were located through computerized searches and reference sections of published articles. Results: Symptoms extending beyond the period of acute withdrawal in alcohol and opiate dependence have been fairly consistently described; this is not the case with cocaine. Nevertheles s, protracted alcohol and opiate withdrawal has not been conclusively demonstrated because of the failure of studies to do multiple time poi nt sampling, to use standardized instruments and control groups, and t o readminister the substance in an attempt to suppress withdrawal symp toms. Further, the concept of protracted withdrawal itself is ambiguou sly defined. This confounds interpretation of the literature and precl udes derivation of a unified concept of the term, which would be neces sary for adding the diagnosis to DSM-IV. Conclusions: There is insuffi cient documentation to justify inclusion of protracted withdrawal in D SM-IV because of methodologic limitations of the studies and lack of c onsensus definition of the term itself. An outline for conceptualizing protracted withdrawal is offered in which the symptoms can be seen as 1) a global postuse syndrome, 2) attenuated physiologic rebound, 3) t oxic residuals, 4) expression of preexisting symptoms unmasked by cess ation of use. Future efforts to identify signs and symptoms of protrac ted withdrawal should carefully define the parameters of the syndrome.