Temporal Progression of Cocaine Dependence Symptoms in the US National Comorbidity Survey

• NCJ Number: 195257
• Journal: Addiction Volume: 97 Issue: 5 Dated: May 2002 Pages: 543-554
• Author(s): Howard J. Shaffer; Gabriel B. Eber
• Date Published: 2002
• Length: 12 pages
• Publication Format: Article
• Publication Type: Report (Study/Research)
• Language: English
• Country: United Kingdom

Annotation

This study examined the retrospective recall of DSM-III-R cocaine dependence symptom progression among a large sample of cocaine users along with the relationship of these symptoms to psychiatric comorbidity.

Abstract

Cocaine dependence first appeared as a diagnostic category in 1987 with the publication of DSM-III-R. Although the temporal sequencing of alcohol symptoms has a long history, little such attention has been given to cocaine dependence. In an effort to remedy this research gap, this study used data from the U.S. National Comorbidity Survey (NCS) to temporally sequence DSM-III-R criterion "A" cocaine dependence symptoms based on age of symptom onset. Each of these numerical symptom strings was examined to determine its prevalence and association with comorbid psychiatric disorders. The NCS is a national survey that was conducted in the 48 contiguous States between 1990 and 1992. Cocaine users represented 16 percent of the sample. Although hundreds of symptom sequence permutations were possible, only a few were highly prevalent. Subjects whose early onset symptoms were neuroadaptive (e.g., tolerance and withdrawal) were more likely to develop cocaine dependence than subjects whose early symptoms were characterized by psychosocial consequences. Also, certain temporal patterns were found to increase or decrease the presence or absence of cocaine dependence and psychiatric comorbidity. Further, the study found psychiatric comorbidity preceded rather than followed cocaine-use onset disproportionately. The study thus found that, like alcohol users, cocaine users follow a limited array of symptom-sequence pathways from first use to dependence. By better understanding and examining the temporal progression of drug-use symptoms, clinicians might improve screening and assessment activities and determine more effectively the extent of risks associated with continued premorbid drug use and enhanced treatment matching. The study recommends that clinicians develop evaluation instruments that specifically ask patients to sequence their cocaine-use symptoms temporally. 7 tables and 59 references