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

200 III. SUBSTANCES OF ABUSEIQ scores (though still in the normal range) on the Stanford–Binet for childrenprenatally exposed to cocaine in combination with other drugs; this study alsoidentified mediating variables such as home environment, head circumference,and child behavior. In addition, a large study found that cocaine-exposed childrenwere twice as likely to be significantly delayed developmentally throughoutthe first 2 years of life and were twice as likely to require intervention as thenoncocaine polydrug-exposed comparison group. These cognitive delays werenot due to exposure to other drugs or to covariates. Furthermore, poorer cognitiveoutcomes were related to higher levels of prenatal cocaine exposure(Singer et al., 2002). In addition to cognitive delays, 2-year-olds who had beenprenatally exposed to both PCP and cocaine were found to utilize less matureplay strategies and to evidence less sustained attention, more deviant behaviors,and poorer quality interactions with caregivers (Beckwith et al., 1994).In summary, findings on the consequences of prenatal cocaine exposurerelative to child development are inconsistent. Early concerns about severe,permanent neurobehavioral deficits appear to have been exaggerations; however,evidence remains that prenatal exposure to cocaine may contribute to thedevelopment of more mild or subtle neurobehavioral difficulties, such as poorerlanguage functioning. In studying this population, it will be essential forresearchers to control for confounding factors such as age, race, socioeconomicstatus, and other drug use; this is especially true, because some studies havefound environmental factors to be equal even more important determinants offunctioning.ASSESSMENTInitial evaluation of the cocaine abuser begins with a medical, psychiatric, andpsychosocial history, as well as a physical examination. Confirming and augmentingthe patient’s history through collateral reports of family members andsignificant others is often helpful. On an emergency basis, the following laboratorytests need to be considered, based on the patient’s clinical presentation:complete blood count, chemical profile (SMA-12), urinalysis, urine and/orblood toxicology, electrocardiogram, and chest X-ray. Indications for acute hospitalizationinclude (1) serious medical or psychiatric problems either caused bythe stimulant drugs or independently coexisting, and (2) concurrent dependenceon other drugs, such as alcohol or sedative hypnotics, necessitating a moreclosely supervised withdrawal. A validated, widely accepted tool to assess addictionseverity specifically to cocaine has not yet been developed. However,DSM-IV-TR (American Psychiatric Association, 2000) diagnostic criteria forcocaine intoxication, withdrawal, delirium, delusional disorder, dependence,and abuse are based on the symptoms described in this chapter. Evaluation to