Risk and Prognostic Factors 
Temperamental. Comorbid bipolar disorder, schizophrenia, antisocial personality disor-
der, and other substance use disorders are risk  factors for developing stimulant use disorder
and for relapse to cocaine use in treatment samp les. Also, impulsivity and similar personality
traits may affect treatment outcomes. Childhood  conduct disorder and adult antisocial per-
sonality disorder are associated with the la ter development of stim ulant-related disorders.
Environmental. Predictors of cocaine use among teenagers include prenatal cocaine ex-
posure, postnatal cocaine use by parents, and exposure to  community violence during
childhood. For youths, especially females, risk  factors include living in an unstable home
environment, having a psychiatric conditio n, and associating with dealers and users.
Culture-Related Diagnostic Issues
Stimulant use–attendant disorders affect all ra cial/ethnic, socioeconomic, age, and gender
groups. Diagnostic issues may be  related to societal consequenc es (e.g., arrest, school sus-
pensions, employment suspension). Despite sm all variations, cocaine and other stimulant
use disorder diagnostic criteria perform eq ually across gender and race/ethnicity groups.
Chronic use of cocaine impairs cardiac left ventricular function in African Americans.
Approximately 66% of individuals admitt ed for primary methamphetamine/amphet-
amine-related disorders are non-Hispanic whit e, followed by 21% of Hispanic origin, 3%
Asian and Pacific Islander, and 3% non-Hispanic black.
Diagnostic Markers
Benzoylecgonine, a metabolite of cocaine, typi cally remains in the urine for 1–3 days after
a single dose and may be present for 7–12 days in individuals using repeated high doses.