Withdrawal

A withdrawal syndrome, often referred to as the "crash," consists of strong craving, electroencephalograph abnormalities, depression, alterations in sleep patterns, hypersomnolence, and hyperphagia (Jones, 1984). However, because abrupt discontinuation of cocaine does not cause any major physiological sequelae, cocaine is stopped and not tapered or substituted by a cross-tolerant drug during medically supervised withdrawal. Following the resolution of intoxication and acute withdrawal symptoms, there is a 1- to 10-week period of chronic dysphoria, anergia, and anhedonia. Relapses frequently occur, because the memory of cocaine euphoria is quite compelling in contrast to a bleak background of intense boredom. If patients can remain abstinent from illicit mood-altering drugs during this period, the dysphoria gradually improves. Thereafter, intense cocaine craving is replaced by episodic craving that is frequently trig gered by environmentally conditioned cues during an indefinite extinction phase.

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