been little need for treatment. Increased dosages and frequent patterns of use, as seen during the second and fourth cycles, have resulted in abuse, and these trends have been paralleled by an increase in the number and diversity of treatment services.

Therefore, it is important to recognize that behavior in the current fourth cycle includes several patterns of use associated with low doses and low toxicity, albeit large numbers of users (e.g., coca tea drinkers and some social intranasal users). Consequently, it might be more efficient to focus medical treatment resources on specific types of users who are almost always abusers (e.g., cocaine smokers) rather than targeting all users per se. However, it is equally important to note that even within a particular group such as crack users, individuals may differ substantially in the severity of their dependence. Thus, treatment services must remain adaptive to the needs of clients and flexible in approaches.

In cases of cocaine intoxication and acute toxic reactions, treatment can be guided by clear diagnostic criteria including physical and behavioral indices. But diagnosis of cocaine abuse and dependence do not rest on such clear signs as intoxication or even route of administration. Rather, such determinations rely more heavily on an individual's self-reported history of cocaine use. Self-reported histories are not completely trustworthy: they may be lacking in important details, they may be self-serving, or people give confused histories because of intoxication. Therefore, treatment services might benefit by utilizing the RIAH toxicology test as an aid to diagnosis and to monitor treatment itself.

Notes

1  

Pratt (1943) records the purchase as cocaine. The original entry in the day books of Corneau & Diller records the purchase as "cocaine." This spelling was sometimes used for coca extract products, for a coca wine named "Cocaine," for a cocaine-based local anesthetic preparation, and for a coconut oil hair product named "Cocaine."

2  

This statement is based on unpublished raw data and archival information obtained from B. Hester, Khoka Productions, Inc., Jacksonville, Florida.

3  

Several earlier works, beginning with a 1787 dissertation (Julian, P.A. Disertacion Sobre Hayo o Coca dans la Perla de la America, Lima, 1787), are cited by Chevrier (1868) and referenced in the bibliography by Mortimer (1901).

4  

Based on information obtained from B. Hester, Khoka Productions, Inc.,



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