Cocaine use often is associated with psychiatric comorbidity, e.g., antisocial personality disorder (ASPD; 24%), major depressive disorder (MDD; 18%), posttraumatic stress disorder (PTSD; 12%) (Falck et al., 2004), and a threefold risk of panic attacks (O’Brien et al., 2005). Studies have shown that almost half of patients in treatment for a cocaine use disorder may have comorbid ASPD (Carroll et al., 1997), one-third to one-half a history of PTSD (Back et al., 2000; Brady et al., 2004; Mills et al., 2005), and 20% an affective disorder (Carroll et al., 1997). ASPD (Arndt et al., 1994) and depression (Carroll et al., 1997; Ziedonis & Kosten, 1991) have been shown to be associated with poorer response to addiction or psychiatric treatment by cocaine abusing or dependent adults. PTSD similarly has been shown to be associated with poorer response to addiction treatment by opiate dependent (Hien et al., 2000) and mixed substance use disorder (Ouimette et al., 2003) patients, including higher rates of cocaine use (Hien et al., 2000).
