Clinical Textbook of Addictive Disorders 3rd ed - R. Frances, S. Miller, A. Mack (Guilford, 2005) WW

194 III. SUBSTANCES OF ABUSEonset and more frequent use of cocaine than cocaine-dependent individualswho do not smoke (Budney, Higgins, Hughes, & Bickel, 1993).Non-substance-related Axis I disorders are also common among cocaineaddicts. The rates for current depressive disorders vary between 11 and 55%(Carroll et al., 1994; Griffin, Weiss, Mirin, & Lange, 1989; Haller, Knisely,Dawson, & Schnoll, 1993), whereas those for lifetime depression range from 40to 60% (Kleinman et al., 1990). Bipolar depression appears to be overrepresentedamong cocaine users. In a large, community-based sample, 42.1%of cocaine abusers were found to have bipolar disorder (Karam, Yabroudi, &Melhem, 2002). Because of the specific actions and effects of cocaine, it issometimes difficult to determine whether depression is independent of cocaineuse or the result of chronic self-administration. However, depression that predatesdrug use or persists beyond the 1–2 weeks characteristic of cocaine withdrawalmay indicate a coexisting disorder. Also, if a cocaine abuser becomesacutely depressed or suicidal after ingesting only very small amounts of the drug,a primary depressive disorder may be indicated (Kosten et al., 1987). In mostcases of comorbid depression and cocaine use, depression precedes cocaine useby an average of 7 years (Abraham & Fava, 1999). Panic disorder is prevalentamong cocaine abusers, and the literature contains a number of case reports ofindividuals who developed panic disorder following cocaine use (Aronson &Craig, 1986; Bystritsky, Ackerman, & Pasnau, 1991). Among 122 cocainedependentoutpatients, 30.2% of women and 15.2% of men met DSM criteriafor PTSD (Najavits et al., 1998). Furthermore, in a large epidemiological study,rates of PTSD among cocaine-dependent individuals were 10 times higher thanamong non-cocaine-dependent individuals. Findings suggest that cocaine dependenceis a risk factor for PTSD, because it usually precedes the trauma andplaces individuals in situations where traumatic events are more likely to occur(Cottler, Compton, Mager, Spitznagel, & Janca, 1992).Attention-deficit/hyperactivity disorder (ADHD) is an important comorbidcondition. In a large longitudinal study, approximately 21% of adults withADHD were cocaine dependent, compared to 10% of agemate controls (Lambert& Hartsough, 1998). Studies indicate that between 12 and 35% of cocaineaddicts meet childhood criteria for ADHD (Carroll & Rounsaville, 1993;Levin, Evans, & Kleber, 1998; Rounsaville et al., 1991). Compared to cocaineabusers without comorbid ADHD, those with ADHD are more likely to bemale and to also meet criteria for conduct disorder and antisocial personalitydisorder. Cocaine abusers with ADHD evidence earlier age of onset of use,more frequent and severe use, more alcoholism, and more prior treatment episodes.Men who score high on an ADHD measure also report more use ofcocaine for the purpose of self-medication (Horner, Scheibe, & Stine, 1996).Although somewhat controversial, several case reports suggest that stimulants(e.g., magnesium pemoline, and methylphenidate) can be successfully used totreat patients with comorbid cocaine abuse and ADHD (Khantzian, Gawin,