Cocaine Abuse and Cocaine Intoxication

Cocaine Abuse

Substance abuse is described by DSM-IV-TR as a maladaptive pattern of substance use demonstrated by recurrent and signifi-cant adverse consequences related to repeated use. For example, there may be neglect of obligations to family or employer, repeated use in hazardous situations, legal problems and recurrent social or interpersonal problems. These problems must recur within the same 12-month period. The intensity and frequency of use are less in cocaine abuse than in cocaine de-pendence. Episodes of abuse may occur around paydays or spe-cial occasions and may be characterized by brief periods (hours to days) of high-dose binge use followed by longer periods of abstinence or nonproblem use.

Cocaine Intoxication

The clinical effects of cocaine intoxication are characterized initially by euphoria (referred to as “high”) and also include agi-tation, anxiety, irritability or affective lability, grandiosity, im-paired judgment, increased psychomotor activity, hypervigilance or paranoia, and sometimes hallucinations (visual, auditory, or tactile) may occur. Physical symptoms that can accompany co-caine intoxication include hypertension, tachycardia, hyperther-mia, pupillary dilatation, nausea, vomiting, tremor, diaphoresis, chest pain, arrhythmia, confusion, seizures, dyskinetic move-ments, dystonia and, in severe cases, coma. These effects are more frequently seen in high-dose binge users of cocaine. Car-diovascular effects are probably a result of sympathomimetic properties of cocaine (i.e., release of norepinephrine and block-ade of norepinephrine reuptake). The DSM-IV criteria of cocaine intoxication are based on the general criteria for substance intoxi-cation.