Disorders due to use of cocaine

Disorders Due to Use of Cocaine are characterized by the pattern and consequences of cocaine use. Cocaine is a compound found in the leaves of the coca plant, Erythroxylum coca, which is indigenous to countries in northern regions of South America. Cocaine has a limited place in medical treatment as an anaesthetic and vasoconstrictive agent. It is commonly used illicitly and widely available across the world, where it is found in two main forms: cocaine hydrochloride and cocaine freebase (also known as ‘crack’). Cocaine is a central nervous system stimulant, and Cocaine Intoxication typically includes a state of euphoria and hyperactivity. Cocaine has potent dependence-producing properties and Cocaine Dependence is a common cause of morbidity and of clinical presentations. Cocaine Withdrawal has a characteristic course that includes lethargy and depressed mood. A range of Cocaine-Induced Mental Disorders is described. Cocaine is also associated with several health sequelae, including myocardial infarction and stroke arising from coronary and cerebral artery spasm, respectively.

Diagnostic Categories that Apply to Cocaine

Following is a list of specific diagnostic categories of that apply to cocaine:

• 6C45.0 Episode of Harmful Use of Cocaine
• 6C45.1 Harmful Pattern of Use of Cocaine
• 6C45.2 Cocaine Dependence
• 6C45.3 Cocaine Intoxication
• 6C45.4 Cocaine Withdrawal
• 6C45.5 Cocaine-Induced Delirium
• 6C45.6 Cocaine-Induced Psychotic Disorder
• 6C45.70 Cocaine-Induced Mood Disorder
• 6C45.71 Cocaine-Induced Anxiety Disorder
• 6C45.72 Cocaine-Induced Obsessive Compulsive or Related Disorder
• 6C45.73 Cocaine-Induced Impulse Control Disorder
• 6C45.Y Other Specified Disorder Due to Use of Cocaine
• 6C45.Z Disorder Due to Use of Cocaine, Unspecified

An additional category of disorder induced by psychoactive substances is included in another part of the ICD-11 chapter on Mental, Behavioural, and Neurodevelopmental Disorders. This is cross-listed in the section below on Substance-induced Mental Disorders for reference:

• 6A41 Catatonia Induced by Substances or Medications

The first three diagnoses listed above (Episode of Harmful Use of Cocaine, Harmful Pattern of Use of Cocaine, and Cocaine Dependence) describe the pattern of cocaine use. One of these three diagnoses, or Disorder Due to Use of Cocaine, Unspecified, for cases in which the use pattern in unknown at the time of evaluation, is considered to be the primary diagnosis. That is, one of these four diagnoses should be assigned when making a diagnosis of a Disorder Due to Cocaine Use.

The remaining diagnoses reflect the impact of the pattern of cocaine use and are thus considered to be associated with one of the primary use pattern diagnoses. These diagnoses should therefore be assigned together with the relevant primary diagnosis. For example, 6C45.1/ 6C45.5 is Harmful Pattern of Use of Cocaine associated with Cocaine-Induced Psychotic Disorder, 6C45.2/6C45.70 is Cocaine Dependence associated with Cocaine-Induced Mood Disorder, 6C4Z/6C45.3 is Disorders Due to Substance Use, Unspecified associated with Cocaine Intoxication (i.e., the pattern of use in this last case is unknown).

Cocaine-induced Mental Disorders are characterized by psychological, cognitive, or behavioural symptoms that develop during or soon after cocaine intoxication or withdrawal or use. The duration or severity of the symptoms is substantially in excess of the characteristic syndrome of Cocaine Intoxication or Cocaine Withdrawal.