Cocaine use disorder

Cocaine use disorder is a pattern of cocaine use leading to clinically significant impairment or distress. The majority of people who use cocaine do not have a use disorder. There is an increased risk of developing cocaine use disorder with heavier use and when cocaine is smoked or injected, or when there is a genetic or epigenetic propensity.

Diagnosis is based on clinical assessment. Further investigations such as urine toxicology, cardiovascular exam, and neurologic exam may be required. Comorbid medical and psychiatric illnesses, as well as other substance use disorders, should be assessed.

Patients with signs of cocaine intoxication (e.g., loss of consciousness, chest pain, or focal neurologic complaints) will require emergency investigation and treatment.

Treatment options include drug counseling, contingency management, cognitive behavioral therapy, and motivational interviewing.

Evidence suggests that pharmacotherapy has limited efficacy in treating cocaine use disorder, but it may be considered in certain circumstances.

Cocaine is a controlled illicit, highly addictive stimulant drug that is usually either insufflated (snorted), injected, or smoked in its freebase form (crack). Cocaine use is normally occasional, with the majority of individuals who use cocaine not meeting the criteria for cocaine use disorder.

Cocaine use disorder is a pattern of cocaine use leading to clinically significant impairment or distress, defined by presence of at least 2 of 11 symptoms during a 12-month period.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.

The Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR) classifies cocaine use disorder as mild, moderate, or severe defined by the number of symptoms within a 12-month period.[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR). Washington, DC: American Psychiatric Publishing; 2022.

See also Cocaine toxicity.