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Little has been written about the differences between male and female cocaine abusers. We therefore compared sociodemographic characteristics, reasons for cocaine use, drug effects, depressive symptoms, and psychiatric diagnoses in 95 men and 34 women hospitalized for cocaine abuse. Men were more likely to be employed, to hold higher status jobs, and to be self-supporting. Women were more likely to cite specific reasons for drug use, while men tended to use cocaine as part of a larger pattern of antisocial behavior. Women were diagnosed more often as having major depression, and their depressive symptoms improved much more slowly than men's when drug free. These findings suggest that women cocaine abusers may initially experience more residual problems, eg, depression and job dissatisfaction, than men after becoming drug free. Drug treatment centers should be alert to possible differences based on gender.
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PMID:A comparison of male and female cocaine abusers. 281 43

Death as a consequence of cocaine abuse is continuing to increase in all parts of the United States. Cocaine use may cause the development of psychosis, with subsequent expression of suicidal ideations, and potentially even successful suicide. Cocaine dependence may also cause depression in the individual who is unable to control his or her craving for the drug, and suicide may be perceived as the only solution to a desperate problem. Despite the dramatic escalation of cocaine abuse and the potential toxicity of this drug, there have been no reports within the United States of cocaine being used as the agent to accomplish a suicide. Herewith are reported three cases in which depression and desperation over cocaine dependence were the motivations for successful suicide, which was accomplished through the intravenous injection of cocaine to the point of death. True cocaine suicide is probably only identified through the presence of objective scene information that unequivocally proves suicidal intent, such as notes or letters which contain information to this effect. A careful search of the scene of death in cocaine fatalities is mandatory, and diligent application of routine scene investigation principles may reveal that suicide through the use of cocaine is more widespread than first appearances would suggest.
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PMID:Suicide by intravenous injection of cocaine. A report of three cases. 291 83

This report reviewed 996 emergency room visits and 279 hospital admissions of patients with complications of cocaine abuse seen at the San Francisco General Hospital between 1979 and 1986. In 143 cases, acute neurologic or psychiatric symptoms were the primary complaint, and case-notes provided sufficient detail for analysis. The major neurologic complications included one or more seizures (n = 29), focal neurologic symptoms or signs (12), headache (10), and transient loss of consciousness (six). Psychiatric disturbances included agitation, anxiety, or depression (33), psychosis and paranoia (24), and suicidal ideation (18). The most serious consequences were found in patients with prolonged seizures or strokes, those who jumped out of buildings, and those who attempted suicide by overdosing with other drugs. There was no correlation between the appearance of complications and the reported route of administration, the amount of cocaine used, or prior experience with cocaine. The number of patients who are seeking hospital attention for these or related complaints appears to be rising substantially. Cocaine abuse, regardless of the use pattern, is associated with a variety of potentially severe neurologic and psychiatric complications.
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PMID:Acute neurologic and psychiatric complications associated with cocaine abuse. 367 91

We have characterized five subtypes of cocaine abusers on the basis of clinical presentation, family history data, and response to specific treatment interventions. These include depressed patients who value the euphorigenic effects of the drug, patients with bipolar or cyclothymic disorder who use cocaine to augment manic or hypomanic symptoms or to alleviate depression, adults with ADD, residual type, who find that cocaine has a paradoxical effect of increasing attention span and decreasing motor restlessness, patients with narcissistic and borderline personality disorders who use cocaine for its social prestige and because it bolsters self-esteem, and patients with antisocial personality disorder who use cocaine as part of an overall pattern of antisocial behavior. Although not all cocaine abusers fit neatly into these categories, careful psychiatric evaluation and subtyping is essential in designing a specific treatment program for these patients. As the prevalence rate of cocaine abuse increases, studies that examine the efficacy of various treatment approaches for specific subtypes of cocaine abusers will be essential. It is hoped that our work will be a step in that direction.
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PMID:Subtypes of cocaine abusers. 377 2

During a 2.5-year follow-up study of opioid addicts, we found that cocaine abuse had become an increasing and major problem through 1983. Cocaine abuse had only minimally declined during the follow-up period despite treatment, and the number of opioid addicts with at least weekly cocaine abuse had doubled. The clear effect of methadone maintenance treatment in reducing opioid abuse was not evident for cocaine abuse. During the follow-up period, more cocaine use was reported by the methadone-treated subjects than by those undergoing detoxification only. Prognostically, cocaine users were more likely to be nonwhites and men. Subjects who increased their cocaine use during the follow-up period were more likely to have depressive disorders and more likely to be found among methadone- and "drug-free"-treated subjects than among detoxification subjects. Thus, among methadone- and drug-free-treated subjects, depression appeared to be a risk factor for escalating cocaine abuse; this risk factor may benefit from specific interventions.
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PMID:A 2.5-year follow-up of cocaine use among treated opioid addicts. Have our treatments helped? 382 21

Specific consequences of cocaine abuse on health and psycho-social functioning were assessed in 55 cocaine-abusing subjects who called a telephone "helpline." REsults showed a high incidence and wide range of adverse consequences including: impairment of job functioning, interpersonal relationships, and financial status; disturbances of mood and cognitive functioning; psychiatric symptoms of depression, paranoia, and increased suicidal/violent tendencies; and physical symptoms of exhaustion, weight loss, sleep problems, and seizures. Cocaine-related automobile accidents, suicide attempts, and violent acts, including a cocaine-related homicide, were also reported. Intranasal users reported no fewer and no less severe adverse consequences than free-base smokers or intravenous users. Our findings challenge popular notions that cocaine is a benign "recreational" drug and that the intranasal route of administration guarantees protection against addictive patterns of use and adverse effects.
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PMID:Adverse effects of cocaine abuse. 643 68

Cocaine is a powerful euphoriant and it relieves, though only transiently, depression, dread and dysphoria. New patterns of cocaine abuse, such as the inhalation of vaporized cocaine base, the intravenous injection of cocaine hydrochloride and the smoking of coca paste, produce a brief elation that quickly gives way either to a return to the baseline mood or to displeasure, resulting in a strong desire to return to the momentary ecstatic experience, a cycle that leads to compulsive use. The enormous profits made from illicit traffic in cocaine lead to corruption, violence and political destabilization. The individual costs of cocaine abuse include loss of personal fortunes, jobs and families. The safety of cocaine use is a myth. There are a number of ways in which cocaine can be lethal. The high doses of cocaine abused today induce physical dependence, but this is less a contributory factor than the intense psychological craving to perpetuate cocaine use. There is no specific way to treat dysfunctional cocaine use; instead the treatment plan must deal with the individual's specific situation. Except for a reduction of cocaine supply at the source, preventive measures are only feasible in the context of abstinence from all abusable drugs.
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PMID:Recent developments in the abuse of cocaine. 644 Jun 13

Increasing numbers of individuals with a diagnosis of cocaine abuse (DSM-III, 305.6) are seeking medical and psychiatric care. The majority of users inhale the drug in powdered form, as cocaine is rapidly absorbed by mucous membranes. The patterns of use resemble those for the use of alcohol and marijuana: recreational, intensified, circumstantial, and compulsive. When cocaine is taken intravenously or by freebasing, individuals are much more vulnerable to developing a compulsive pattern of use that could lead to an organic delusional syndrome. Cocaine causes systemic effects that are similar to those of amphetamine, but they have a much shorter duration of action. Blood pressure, heart rate, feelings of "pleasantness" and "stimulation" are increased, and hunger is decreased. Acute tolerance may develop over hours of continuous use, but it disappears after a short period of abstinence (overnight). In psychomotor testing, performance that is impaired by fatigue is restored to baseline levels. Users like cocaine because they feel more alert, energetic, sociable, and sensual. However, these positive feelings are commonly followed by anxiety, depression, irritability, fatigue, and craving more cocaine. Chronic intoxication is always associated with adverse psychosocial sequelae. Treatment initially must be directed toward the patient's stopping all use of cocaine, employing strategies such as contingency contracts, urinalysis, family intervention, the assignment of financial control to others, or hospitalization. Several psychopharmacologic agents are helpful as an adjunct to a comprehensive treatment plan. Overdoses of cocaine are treated by diazepam and propranolol. Antidepressant medications, both TCAs and MAOIs, often help relieve the symptoms of depression that emerge when chronic use of cocaine is discontinued. Classical and operant conditioning contribute to craving for the drug and opportunities to extinguish these factors are valuable in preventing relapse. Compulsive users often have an Axis II diagnosis of borderline or narcissistic personality disorder, which require long-term psychodynamic psychotherapy.
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PMID:Cocaine abuse and its treatment. 652 10

Alexithymia is increased in addictive disorders such as alcoholism, cocaine abuse, and binge eating. Pathological gambling is a form of addictive disorder and may be influenced by alexithymia. We examined the association of alexithymia (Toronto Alexithymia Scale) and pathological gambling (South Oaks Gambling Screen) in 1,147 young adults; 3.1% were classified as pathological gamblers. Alexithymia was found in 31.4% of pathological gamblers, compared to 11.1% of controls; both affective and cognitive aspects of alexithymia were associated with gambling problems. The relationship was independent of depression and physical illness, and was found for both sexes, but only for Caucasians. Alexithymia may be a risk factor for pathological gambling in some populations.
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PMID:Alexithymia and pathological gambling. 762 67

Anxiety is a key symptom of the cocaine withdrawal syndrome in human addicts, and it is considered to be one of the major factors in precipitating relapse to chronic cocaine abuse. Corticotropin-releasing factor (CRF) plays an important role in the pathophysiology of anxiety and depression, and it may also be involved in the acute behavioral and neuroendocrine actions of cocaine. The role of endogenous CRF in cocaine withdrawal-induced anxiety was investigated in the present study. Animals were subjected to chronic cocaine (20 mg/kg, intraperitoneally, once a day for 14 days) administration. Rats tested 30 min after the last cocaine injection did not show withdrawal anxiety on the elevated plus maze or any alterations in brain CRF levels. Withdrawal (48 h) from chronic cocaine administration produced an intense anxiety-like behavior characterized by decreased open arm exploration. Immunoreactive CRF (CRF-LI) levels were selectively altered in the hypothalamus, in the amygdala and in the basal forebrain structures at the time of the behavioral anxiety, reflecting an increased activity of brain CRF systems. Daily intracerebroventricular (i.c.v.) pretreatment with an immunoserum raised against CRF completely prevented the development of anxiety induced by cocaine withdrawal. These data suggest that extrahypothalamic-limbic CRF hypersecretion may be involved in the development of anxiety related to cocaine withdrawal and that the CRF system may be a useful target for new pharmacotherapies for cocaine withdrawal and relapse.
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PMID:Brain corticotropin-releasing factor mediates 'anxiety-like' behavior induced by cocaine withdrawal in rats. 779 57


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