SUBJECTIVE REPORTS OF WITHDRAWAL AMONG COCAINE USERS - RECOMMENDATIONS FOR DSM-IV

The proposed DSM-IV criteria for substance use disorders have included , as an option, a subtyping for physiologic dependence, characterized by either tolerance or withdrawal. Even if this option is not chosen a t this stage of system revision, this weighting scheme justifies wider surveillance of these symptoms, especially for the more newly describ ed cocaine dependence disorder. Wider surveillance of withdrawal is po ssible with the CIDI Substance Abuse Module (SAM), a WHO/ADAMHA diagno stic interview which covers criteria of substance use disorders accord ing to the DSM-III, III-R, ICD-10 and proposed DSM-IV systems. To aid in this effort, we used the SAM, which includes a master list of all s ymptoms (n = 16) in the DSM manuals related to withdrawal from any sub stance to assess withdrawal symptoms from all substances. In this stud y, we hypothesized that the persons who used opiates with cocaine migh t misattribute their symptoms to cocaine; thus, we compared the respon ses of persons who used cocaine and opiates (opiate users) with the re sponses of persons who used cocaine without opiates (non-opiate users) . Data from two St. Louis studies were combined for these analyses, us ers not in treatment or newly enrolled to drug-free or methadone treat ment from a NIDA demonstration project and users selected for the St. Louis DSM-IV Field Trial. Of the 196 persons included from the field t rial, 80% reported lifetime cocaine use compared with 91% of the 412 p ersons from the demonstration project. The symptoms mentioned in the d iagnostic manuals were among the most frequently endorsed by both coca ine use groups. However, other symptoms not included in the manual wer e reported with equal or higher frequency to those in the manual regar dless of opiate use. 'Feeling anxious or irritable' and 'having troubl e concentrating' were symptoms endorsed by about 40% and 35% of the sa mple, respectively. No significant difference between the opiate and n on-opiate group was found, lending strength to the conclusion that the se might be cocaine withdrawal symptoms. Also, these two symptoms were not found to be frequently attributed to withdrawal from any other su bstance. Controlling for the effects of age gender, onset of cocaine u se and opiate use, we found that these two symptoms were predicted by an earlier age of onset of cocaine use. Although more epidemiologic an d clinical work along these lines are needed in this area, our recomme ndation is that these two symptoms be considered for the DSM-IV Cocain e Withdrawal Syndrome.