and speed of onset. However, in all forms of the substance, cocaine is the active ingredient.
Cocaine hydrochloride powder is usually “snorted” through the nostrils or dissolved in
water and injected intravenously.
Individuals exposed to amphetamine-type stimulants or cocaine can develop stimu-
lant use disorder as rapidly as  1 week, although the onset is  not always th is rapid. Re-
gardless of the route of administration, tole rance occurs with repeated use. Withdrawal
symptoms, particularly hypersomnia, increa sed appetite, and dysphoria, can occur and
can enhance craving. Most individuals with stimulant use disorder have experienced tol-
erance or withdrawal. 
Use patterns and course are similar for di sorders involving amphetamine-type stimu-
lants and cocaine, as both substances are po tent central nervous system stimulants with
similar psychoactive and sympathomimetic effects. Amphetamine-type stimulants are
longer acting than cocaine and thus are used fewer times per day. Usage may be chronic or
episodic, with binges punctuated by brief no n-use periods. Aggressive or violent behavior
is common when high doses are smoked, ingested, or administered intravenously. Intense
temporary anxiety resembling panic disorder or generalized anxiety disorder, as well as
paranoid ideation and psychotic episodes that resemble schizophrenia, is seen with high-
dose use.
Withdrawal states are associated with temporary but intense depressive symptoms that
can resemble a major depressive episode; the depressive symptoms usually resolve within
1 week. Tolerance to amphetamine -type stimulants develops and leads to escalation of the
dose. Conversely, some users of amphetami ne-type stimulants develop sensitization,
characterized by enhanced effects.
Associated Features Supporting Diagnosis