Diagnosis of Cocaine Use Disorders
The initial evaluation period should include the collection of a complete history of all substance abuse, which is essential to ac-curate diagnosis and appropriate treatment. The history includes the circumstances under which each drug was used, the psycho-active effects sought and obtained, the route of administration, and the frequency and amount of each drug used. Cocaine abus-ers frequently abuse other drugs and alcohol to enhance euphoria or to alleviate dysphoric effects associated with cocaine abuse (agitation, paranoia). A thorough history with diagnosis of other substance use disorders is important to treatment planning. Pa-tients may need detoxification from other substances prior to ini-tiation of cocaine abuse treatment. It is also important to monitor clinically for relapses to any substance abuse during treatment for cocaine use disorders because the use of other drugs and alcohol often leads to resumption of cocaine abuse. In addition, a thor-ough history of current and previous substance abuse is important so that treatment can be individualized and patients can be helped to develop coping skills that will assist them in specific situations that they identify as placing them at high risk for relapse.
A complete physical examination is necessary to determine whether medical complications of substance abuse are present. Common medical problems seen in those with cocaine use disor-ders include poor nutrition, vitamin deficiencies, anemia, human immunodeficiency virus (HIV) infection and sexually-transmit-ted diseases. In those who self-administer the drug by injection or who abuse other drugs in addition to cocaine by the intrave-nous route, endocarditis, abscesses, cellulitis, and Hepatitis B and C occur with regularity. The clinical evaluation should in-clude blood studies to determine the presence of abnormalities and urine toxicology screen to determine recent drug use.