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INTRODUCTION

Cocaine and amphetamines are stimulant drugs that activate the central nervous system (CNS), with resulting strong rewarding effects (e.g., euphoria, "rush" and "high") that contribute to high abuse liability. Most clinical characteristics pertain to all stimulant drugs, with certain exceptions such as the long duration of action of methamphetamine compared to the brief action of cocaine. Given this commonality, unless otherwise noted, all discussion in this chapter pertains to stimulant drugs as a whole. Specific comments will be focused primarily on cocaine, followed by methamphetamine, given that these drugs have received the most research attention. Brief specific mention will be made of other stimulants that are commonly abused, such as methylenedioxmethamphetamine (MDMA, commonly known as "ecstasy").

ESSENTIALS OF DIAGNOSIS

Substance use disorder criteria described in the Diagnostic and Statistical Manual, Fifth Edition (DSM 5) (American Psychiatric Association [APA], 2013) are applicable to cocaine and other stimulants. The stimulant use disorder criteria reflect neuroadaptation to prolonged and heavy substance use (i.e., tolerance and withdrawal) and effects of substance use on psychosocial functioning. Tolerance or withdrawal are not essential for a diagnosis of stimulant use disorder. When occurring within the same 12-month period, presence of two or three of the criteria in the following list indicate mild disorder; four or five indicate moderate disorder; and six or more of these criteria indicate severe substance use disorder. This represents a change from the DSM-IV (APA, 2000), which differentiated between substance abuse (thought to be a less severe diagnosis) and dependence. Indeed, most of the studies cited in this chapter referred to recruitment of participants meeting criteria for stimulant abuse or dependence. In order to be consistent with the DSM 5 criteria, DSM-IV stimulant abuse will be referred to as mild stimulant use disorder, whereas DSM-IV stimulant dependence will be referred to as moderate-to-severe stimulant use disorder.

  1. Recurring use of the stimulant that results in failure to satisfy important school, home, or work obligations (e.g., substandard work performance, frequent absences, suspensions, school expulsions, disregard for children or household due to stimulant use).

  2. Recurring stimulant use in contexts that are physically hazardous (e.g., operating a machine or driving an automobile when impaired due to stimulant use)

  3. An intense urge, desire, or craving for the stimulant

  4. Continued use of the stimulant regardless of recurrent or persistent interpersonal or social difficulties caused or made worse by effects of the stimulant (e.g., physical fights or arguments with relatives or friends regarding consequences of intoxication)

  5. Tolerance, defined by either of these patterns, occurring due to stimulant use outside of medical supervision (e.g., for narcolepsy or attention-deficit hyperactivity disorder): (a) needing substantially more of the stimulant in order to experience intoxication or desired effects or (b) experiencing substantially reduced effects from continued use of the stimulant in the same amounts

  6. Withdrawal, in either of the following forms, due to stimulant use outside of medical supervision (e.g., for narcolepsy or attention-deficit hyperactivity ...

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