Cocaine-related disorders
Cocaine-Related Disorders
Cocaine, a naturally occurring substance produced by the coca plant, is consumed in several preparations (e.g., coca leaves, coca paste, cocaine hydrochloride, and cocaine alkaloids such as freebase and crack) that differ in potency due to varying levels of purity and speed of onset. However, in all forms, cocaine is the active ingredient. Chewing coca leaves is a practice generally limited to native populations in Central and South America, where cocaine is grown. The use of coca paste, a crude extract of the coca plant, occurs almost exclusively in cocaine-producing countries in Central and South America, where its nickname is "basulca." Solvents used in the preparation of coca paste often contaminate the paste and may cause toxic effects in the central nervous system and other organ systems when the paste is smoked. Cocaine hydrochloride powder is usually "snorted" through the nostrils ("snorting") or dissolved in water and injected intravenously. It is sometimes mixed with heroin, yielding a drug combination known as a "speedball."
A commonly used form of cocaine in the United States is "crack," a cocaine alkaloid that is extracted from its powdered hydrochloride salt by mixing it with sodium bicarbonate and allowing it to dry into small "rocks." Crack differs from other forms of cocaine primarily because it is easily vaporized and inhaled and thus its effects have an extremely rapid onset. The clinical syndrome and adverse effects that are associated with crack use are identical to those produced by comparable doses of other cocaine preparations. Before the advent of crack, cocaine was separated from its hydrochloride base by heating it with ether, ammonia, or some other volatile solvent. The resulting "free base" cocaine was then smoked. This process was dangerous because of the risk that the solvents could ignite and harm the user.
This section contains discussions specific to the Cocaine-Related Disorders. Texts and criteria sets have already been provided to define the generic aspects of Substance Dependence (p. 192) and Substance Abuse (p. 198) that apply across all substances. The application of these general criteria to Cocaine Dependence and Abuse is provided below. However, there are no unique criteria sets for Cocaine Dependence or Cocaine Abuse. Specific texts and criteria sets for Cocaine Intoxication and Cocaine Withdrawal are also provided below. The Cocaine-Induced Disorders (other than Cocaine Intoxication and Withdrawal) are described in the sections of the manual with disorders with which they share phenomenology (e.g., Cocaine-Induced Mood Disorder is included in the "Mood Disorders" section). Listed below are the Cocaine Use Disorders and the Cocaine-Induced Disorders.
Cocaine Use Disorders
- 304.20 Cocaine Dependence (see p. 242)
- 305.60 Cocaine Abuse (see p. 243)
Cocaine-Induced Disorders
- 292.89 Cocaine Intoxication (see p. 244) Specify if: With Perceptual Disturbances
- 292.0 Cocaine Withdrawal (see p. 245)
- 292.81 Cocaine Intoxication Delirium (see p. 143)
- 292.11 Cocaine-Induced Psychotic Disorder, With Delusions (see p. 338)
Specify if: With Onset During Intoxication - 292.12 Cocaine-Induced Psychotic Disorder, With Hallucinations (see p. 338) Specify if: With Onset During Intoxication
- 292.84 Cocaine-Induced Mood Disorder (see p. 405) Specify if: With Onset During Intoxication/With Onset During Withdrawal
- 292.89 Cocaine-Induced Anxiety Disorder (see p. 479) Specify if: With Onset During Intoxication/With Onset During Withdrawal
- 292.89 Cocaine-Induced Sexual Dysfunction (see p. 562)
Specify if: With Onset During Intoxication - 292.85 Cocaine-Induced Sleep Disorder (see p. 655) Specify if: With Onset During Intoxication/With Onset During Withdrawal
- 292.9 Cocaine-Related Disorder Not Otherwise Specified (see p. 250)