Psychological Disorders: Cocaine Dependence

American Description
A. Cocaine abuse: A destructive pattern of cocaine use, leading to significant social, occupational, or medical impairment.

B. Must have three (or more) of the following, occurring when the cocaine use was at its worst:

1. Cocaine tolerance:
Either need for markedly increased amounts of cocaine to achieve intoxication, or markedly diminished effect with continued use of the same amount of cocaine.

2. Cocaine withdrawal symptoms:
Either (a) or (b).
(a) Two (or more) of the following, developing within several hours to a few days of reduction in heavy or prolonged cocaine use:
sweating or rapid pulse
increased hand tremor
insomnia
nausea or vomiting
physical agitation
anxiety
transient visual, tactile, or auditory hallucinations or illusions
grand mal seizures
(b) Cocaine is taken to relieve or avoid withdrawal symptoms.

3. Greater use of cocaine than intended:
Cocaine was often taken in larger amounts or over a longer period than was intended

4. Unsuccessful efforts to cut down or control cocaine use:
Persistent desire or unsuccessful efforts to cut down or control cocaine use

5. Great deal of time spent in using cocaine, or recovering from hangovers

6. Cocaine caused reduction in social, occupational or recreational activities:
Important social, occupational, or recreational activities given up or reduced because of cocaine use.

7. Continued using cocaine despite knowing it caused significant problems:
Cocaine use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been worsened by cocaine (e.g., current cocaine use despite recognition of cocaine-induced depression)

European Description
A cluster of physiological, behavioural, and cognitive phenomena in which the use of cocaine takes on a much higher priority for a given individual than other behaviours that once had greater value. A central descriptive characteristic of the dependence syndrome is the desire (often strong, sometimes overpowering) to take cocaine (which may or may not have been medically prescribed). There may be evidence that return to substance use after a period of abstinence leads to a more rapid reappearance of other features of the syndrome than occurs with nondependent individuals.

Diagnostic Guidelines
A definite diagnosis of dependence should usually be made only if three or more of the following have been experienced or exhibited at some time during the previous year:

(a) a strong desire or sense of compulsion to take cocaine;

(b) difficulties in controlling cocaine-taking behaviour in terms of its onset, termination, or levels of use;

(c) a physiological withdrawal state when cocaine use has ceased or been reduced, as evidenced by: the characteristic withdrawal syndrome for cocaine; or use of the same (or a closely related) substance with the intention of relieving or avoiding withdrawal symptoms;

(d) evidence of tolerance, such that increased doses of cocaine are required in order to achieve effects originally produced by lower doses (clear examples of this are found in cocaine-dependent individuals who may take daily doses sufficient to incapacitate or kill nontolerant users);

(e) progressive neglect of alternative pleasures or interests because of cocaine use, increased amount of time necessary to obtain or take the substance or to recover from its effects;

(f) persisting with cocaine use despite clear evidence of overtly harmful consequences, such as depressive mood states consequent to periods of heavy substance use, or drug-related impairment of cognitive functioning; efforts should be made to determine that the user was actually, or could be expected to be, aware of the nature and extent of the harm.

Narrowing of the personal repertoire of patterns of cocaine use has also been described as a characteristic feature.

It is an essential characteristic of the dependence syndrome that either cocaine taking or a desire to take cocaine should be present; the subjective awareness of compulsion to use drugs is most commonly seen during attempts to stop or control substance use.