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.