Conditioned craving and arousal in cocaine addiction: a preliminary report.

Though data collection is still in progress, several significant findings are already apparent from our study of cocaine 'reminders': 1) In the laboratory, detoxified cocaine abusers show a differential responsivity to drug-related cocaine 'reminders', responding with strong signs of physiological arousal (peripheral skin temperature reductions and decreases in skin resistance) and subjective cocaine craving. 2) In extinction sessions, repeated, non-reinforced exposure to cocaine 'reminders' led to a complete reduction in craving to these stimuli by the fifteenth hour-long session. High and 'crash' responses were virtually eliminated by the sixth hour of extinction. 3) Physiological arousal to cocaine 'reminders' was often still in evidence even after fifteen hours of extinction. 4) Even after completing the current extinction protocol cocaine abusers may crave--and use--cocaine when experiencing drug 'reminders' in the natural environment. Clearly, detoxified cocaine abusers can experience conditioned craving and arousal to cocaine 'reminder' stimuli. These responses can be both intense and persistent, meaning that the abstinent cocaine abuser may be vulnerable long after detoxification is complete. Though the program of extinction described here is effective in reducing craving to cocaine-related stimuli presented in the context of the laboratory or clinic, this effect may not generalize well to the natural environment. We are currently considering two approaches to this problem: 1) One approach would attempt to increase the generalization of extinction by the use of even more realistic stimuli (e.g., the sight of real cocaine) and stimulus contexts (e.g., in vivo repeated exposures).(ABSTRACT TRUNCATED AT 250 WORDS)