Cocaine dependence
304.20 Cocaine Dependence
Refer, in addition, to the text and criteria for Substance Dependence (see p. 192). Cocaine has extremely potent euphoric effects, and individuals exposed to it can develop Dependence after using the drug for very short periods of time. An early sign of Cocaine Dependence is when the individual finds it increasingly difficult to resist using cocaine whenever it is available. Because of its short half-life of about 30-50 minutes, there is a need for frequent dosing to maintain a "high." Persons with Cocaine Dependence can spend extremely large amounts of money on the drug within a very short period of time. As a result, the person using the substance may become involved in theft, prostitution, or drug dealing or may request salary advances to obtain funds to purchase the drug. Individuals with Cocaine Dependence often find it necessary to discontinue use for several days to rest or to obtain additional funds. Important responsibilities such as work or child care may be grossly neglected to obtain or use cocaine. Mental or physical complications of chronic use such as paranoid ideation, aggressive behavior, anxiety, depression, and weight loss are common. Regardless of the route of administration, tolerance occurs with repeated use. Withdrawal symptoms, particularly hypersomnia, increased appetite, and dysphoric mood, can be seen and are likely to enhance craving and the likelihood of relapse. The overwhelming majority of individuals with Cocaine Dependence have had signs of physiological dependence on cocaine (tolerance or withdrawal) at some time during the course of their substance use. The designation of "With Physiological Dependence" is associated with an earlier onset of Dependence and more cocaine-related problems.
Specifiers
The following specifiers may be applied to a diagnosis of Cocaine Dependence (see p. 195 for more details):
- With Physiological Dependence
- Without Physiological Dependence
- Early Full Remission
- Early Partial Remission
- Sustained Full Remission
- Sustained Partial Remission
- In a Controlled Environment