Definition and Diagnosis
Cocaine use disorder is a problematic pattern of cocaine use leading to clinically significant impairment or distress, often characterized by binge-and-crash patterns of use, strong craving, and psychological rather than prominent physical withdrawal.
Epidemiology
Cocaine use disorder occurs worldwide with regional variation in prevalence; use is often episodic, and a substantial proportion of regular users go on to develop a diagnosable use disorder over time.
Risk Factors
Risk factors include co-occurring substance use (particularly alcohol), impulsive personality traits, family history of substance use disorders, and environments with high availability and social use.
Symptoms and Subtypes
Features include intense craving, binge use followed by a crash phase of fatigue and dysphoria, tolerance, and complications such as agitation, paranoia, cardiovascular strain, and, with heavy use, psychotic symptoms.
Diagnosis
DSM-5-TR criteria for stimulant use disorder are applied, assessing impaired control, social impairment, risky use, and physiological criteria, with severity based on the number of criteria met within twelve months.
Treatment
No medication is currently approved specifically for cocaine use disorder; treatment relies primarily on psychosocial approaches such as CBT and contingency management, alongside management of co-occurring psychiatric conditions and cardiovascular monitoring.
Prognosis
Course is often chronic and relapsing, with cardiovascular complications a significant medical risk of continued use; structured psychosocial treatment improves abstinence rates.
Reference
Sadock, B. J., Sadock, V. A., & Ruiz, P. Kaplan & Sadock's Synopsis of Psychiatry (11th ed.).