success,8 potential treatments for cocaine addiction are most cogently tested in outpatients, employing urine screens for benzoylecgonine as the pri¬ some
mary outcome measure. Hence, we doubt that definitive conclusions con¬ cerning pharmacotherapies for cocaine addiction can be drawn from inpa¬ tient studies. Arthur Margolin, PhD Substance Abuse Treatment Unit Department of Psychiatry Yale University School of Medicine 9141/2 Howard Ave New Haven, CT 06519 Thomas R. Kosten, MD S. Kelly Avants, PhD New Haven, CT
1. Weddington WW, Brown BS, Haertzen CA, Cone EJ, Dax EM, Herning RI, Michaelson BS. Changes in mood, craving, and sleep during short-term abstinence reported by male cocaine addicts: a controlled, residential study. Arch Gen Psychiatry. 1990; 47:861-868. 2. O'Brien CP, Jaffe J, eds. Advances in Understanding the Addictive States. New York, NY: Raven Press; 1991. 3. Stewart J, deWit H, Eikelboom R. The role of unconditioned and conditioned drug effects in the self-administration of opiates and stimulants. Psychol Rev. 1984;91:251-268. 4. Kosten TR. Can cocaine craving be a medication development outcome: drug craving and relapse in opioid and cocaine dependence. Am J Addictions. In press. 5. Wise RA. The neurobiology of craving. J
Abnorm
Psychol. 1988;97:118-132.
6. Margolin A, Kosten TR, Petrakis I, Avants SK, Kosten TK. Bupropion reduces cocaine abuse in methadone-maintained patients. Arch Gen
Psychiatry. 1991;48:87.
7. Vuchinich RE, Tucker JA. Contributions from behavioral theories of choice to an analysis of alcohol abuse. J Abnorm Psychol. 1988;97: 181-195. 8. Dackis
treatment
CA, Gold MS. Bromocriptine as of cocaine abuse. Lancet. 1985;1:
1151-1152.
Geographic Variations
in the Prevalence of Schizophrenia
To the Editor.\p=m-\Youssefet al1 claim to have demonstrated significant geographic variation in the prevalence of schizophrenia in a small rural county in Ireland. If this were indeed the case, extensive studies attempting to rigorously define the cause of the geographic variation would be imperative. We believe there is a serious weakness in their study, namely, the probable instability of the rates due to limited population sizes of the electoral divisions under study and the
rate of occurrence of We think the authors have overstated their findings and we cannot agree that the study has demonstrated geographic variation in rates
relatively rare schizophrenia. of
schizophrenia, as claimed. Although the fit of the Poisson model of constant rates (\m=x\2=56.88, df=35, and P
mary outcome measure. Hence, we doubt that definitive conclusions con¬ cerning pharmacotherapies for cocaine addiction can be drawn from inpa¬ tient studies. Arthur Margolin, PhD Substance Abuse Treatment Unit Department of Psychiatry Yale University School of Medicine 9141/2 Howard Ave New Haven, CT 06519 Thomas R. Kosten, MD S. Kelly Avants, PhD New Haven, CT
1. Weddington WW, Brown BS, Haertzen CA, Cone EJ, Dax EM, Herning RI, Michaelson BS. Changes in mood, craving, and sleep during short-term abstinence reported by male cocaine addicts: a controlled, residential study. Arch Gen Psychiatry. 1990; 47:861-868. 2. O'Brien CP, Jaffe J, eds. Advances in Understanding the Addictive States. New York, NY: Raven Press; 1991. 3. Stewart J, deWit H, Eikelboom R. The role of unconditioned and conditioned drug effects in the self-administration of opiates and stimulants. Psychol Rev. 1984;91:251-268. 4. Kosten TR. Can cocaine craving be a medication development outcome: drug craving and relapse in opioid and cocaine dependence. Am J Addictions. In press. 5. Wise RA. The neurobiology of craving. J
Abnorm
Psychol. 1988;97:118-132.
6. Margolin A, Kosten TR, Petrakis I, Avants SK, Kosten TK. Bupropion reduces cocaine abuse in methadone-maintained patients. Arch Gen
Psychiatry. 1991;48:87.
7. Vuchinich RE, Tucker JA. Contributions from behavioral theories of choice to an analysis of alcohol abuse. J Abnorm Psychol. 1988;97: 181-195. 8. Dackis
treatment
CA, Gold MS. Bromocriptine as of cocaine abuse. Lancet. 1985;1:
1151-1152.
Geographic Variations
in the Prevalence of Schizophrenia
To the Editor.\p=m-\Youssefet al1 claim to have demonstrated significant geographic variation in the prevalence of schizophrenia in a small rural county in Ireland. If this were indeed the case, extensive studies attempting to rigorously define the cause of the geographic variation would be imperative. We believe there is a serious weakness in their study, namely, the probable instability of the rates due to limited population sizes of the electoral divisions under study and the
rate of occurrence of We think the authors have overstated their findings and we cannot agree that the study has demonstrated geographic variation in rates
relatively rare schizophrenia. of
schizophrenia, as claimed. Although the fit of the Poisson model of constant rates (\m=x\2=56.88, df=35, and P
