Assessment and extinction of conditioned withdrawal-like responses in an integrated treatment for opiate dependence

Recent data have generally been consistent with our pilot findings: a significant proportion--33 to 40%--of opiate-dependent patients show a time-linked decrease in skin-temperature in response to standard drug-related stimuli, suggestive of conditioned withdrawal. Patients' physiological changes are often accompanied by subjective craving and withdrawal, but the correlation among these measures is modest. Though craving seems to diminish with repeated exposure to drug-related stimuli, withdrawal-like symptoms are often persistent and slow to extinguish. Our current design initially assumed that most patients would show conditioned craving and withdrawal to our standard stimuli and that our current procedure would be adequate to produce complete extinction for these "responders.' As it turned out, not all patients respond to our standard stimuli, and our extinction procedure is not completely effective for those who do. Given these two findings, our current design does not permit the best test of the potential clinical benefits of extinction. Our rich experience during the first phase of this project has stimulated several procedural changes which should increase our accuracy in determining the incidence of these conditioned phenomena, our effectiveness in extinguishing them, and permit a better assessment of their potential clinical benefit. These are as follows: Individualize eliciting (drug-related) stimuli--We initially chose to use standard (the same for all patients) stimuli for practical and experimental reasons. However, their use may have resulted in an underestimate of the incidence of conditioned craving and withdrawal, and in less relevant extinction for many patients.(ABSTRACT TRUNCATED AT 250 WORDS)