Crack cocaine craving: behaviors and coping strategies among current and former users

Comparing key characteristics of young adult crack users in and out-of-treatment in Rio de Janeiro, Brazil

Background

Crack use is prevalent among street drug users in Brazilian cities, yet despite recent help system reforms and investments, treatment utilization is low. Other studies have identified a variety of – often inconsistent – factors associated with treatment status among crack or other drug users. This study compared socio-economic, drug use, health and service use characteristics between samples of young adult crack users in- and out-of-treatment in Rio de Janeiro, Brazil.

Findings

Street-involved crack users (n = 81) were recruited by community-based methods, and privately assessed by way of an anonymous interviewer-administered questionnaire as well as biological methods, following informed consent. In-treatment users (n = 30) were recruited from a public service in-patient treatment facility and assessed based on the same protocol. Key indicators of interest were statistically cross-compared. Not-in-treatment users were less likely to: be white, educated, stably housed, to be involved in drug dealing, to report lifetime marijuana and current alcohol use, to report low mental health status and general health or addiction/mental health care; they were more likely to: be involved in begging and utilize social services, compared to the in-treatment sample (statistical significance for differences set at p < .05).

Conclusions

In-treatment and not-in-treatment crack users differed on several key characteristics. Overall, in-treatment users appeared to be more socio-economically integrated and connected to the health system, yet not acutely needier in terms of health or drug problems. Given overall low treatment utilization but high need, efforts are required to facilitate improved treatment access and use for marginalized crack users in Brazil.

Patterns, determinants and barriers of health and social service utilization among young urban crack users in Brazil

Background

Crack use is prevalent across the Americas, and specifically among marginalized urban street drug users in Brazil. Crack users commonly feature multiple physical and mental health problems, while low rates of and distinct barriers to help service use have been observed in these populations. This study examined profiles and determinants of social and health service utilization, and unmet service needs, in a two-city sample of young (18–24 years), marginalized crack users in Brazil.

Methods

N = 160 study participants were recruited by community-based methods from impoverished neighborhoods in the cities of Rio de Janeiro (n = 81) and Salvador (n = 79). A mixed methods protocol was used. Participants’ drug use, health, and social and health service utilization characteristics were assessed by an anonymous interviewer-administered questionnaire completed in a community setting; descriptive statistics on variables of interest were computed. Service needs and barriers were further assessed by way of several focus groups with the study population; narrative data were qualitatively analyzed. The study protocol was approved by institutional ethics review boards; data were collected between November 2010 and June 2011.

Results

The majority of the sample was male, without stable housing, and used other drugs (e.g., alcohol, marijuana). About half the sample reported physical and mental health problems, yet most had not received medical attention for these problems. Only small minorities had utilized locally available social or health services; utilization appeared to be influenced by sex, race and housing characteristics in both sites. Participants cited limited service resources, lack of needs-specific professional skills, bureaucratic barriers and stigma as obstacles to better service access. However, most respondents stated strong interest and need for general social, health and treatment services designed for the study population, for which various key features were emphasized as important.

Conclusions

The study contributes substantive evidence to current discussions about the development and utilization of health and treatment interventions for crack use in Brazil. Based on our data, crack users’ social, service needs are largely unmet; these gaps appear to partly root in systemic barriers of access to existing services, while improved targeted service offers for the target population seem to be needed also.

O crack no contexto familiar: uma abordagem fenomenológica

O presente estudo teve como objetivo conhecer o significado para a família da convivência diária com um membro usuário do crack. Trata-se de uma pesquisa qualitativa, descritiva, de natureza fenomenológica, que tomou como base para coleta dos dados empíricos a realização da entrevista fenomenológica com duas famílias de dependentes do crack, em um Centro de Atenção Psicossocial em Álcool e Outras Drogas. A análise e categorização das descrições vivenciais se processou à luz da analítica da ambiguidade, fundamentada na fenomenologia de Maurice Merleau-Ponty. Como resultados emergiram três categorias - Sobrecarga no cuidado: demonstração de amor e sofrimento; Peripécias e fantasias do usuário de crack: entre as dúvidas e as certezas; e A sombra infinda do crack à luz da cura pela fé. O estudo apresenta uma nova perspectiva sobre o uso do crack no contexto familiar, através da percepção intersubjetiva, reveladora das ambiguidades, que abre possibilidades para desvelar a vivência do outro.

Cocaine use during pregnancy and health outcome after 10 years

BACKGROUND

Women who used cocaine during pregnancy may become at risk for increased physical and mental health problems.

METHODS

Three hundred and twenty-one (158 cocaine use during pregnancy (PC), 163 no cocaine (NC)) women were assessed using the Health Survey Questionnaire (SF-36V2) 10 years after infant birth. Factors related to mental and physical health, and co-occurring with PC, were evaluated using multiple regression.

RESULTS

Controlling for age and education, PC women reported poorer total perceived mental health (PMH) (46.3±.9 vs. 50.7±.9, p<.001), more bodily pain (48.1±1.0 vs. 51.5±1.0, p<.02) and poorer health perceptions (46.8±.9 vs. 49.7±.9, p<.03) than NC women. PC women had lower BMI (29% vs. 32%, p<.006), higher current alcoholic drinks per/week (4.05±15.5 vs. 1.29±3.51, p<.005) and number of cigarettes per day (9±10.6 vs. 4±6.5, p<.0001) and greater total life strain (Family Inventory of Life Events and Changes (FILE)) (4.6±4.9 vs. 3.2±3.2, p<.004) than NC women. Regression analyses indicated that body mass index (BMI) mediated the effect of prior cocaine use on perceived physical health (PPH) and total life strain had additive effects. Current cigarette use and total life stress partially mediated the effects of cocaine use on PMH and also had additive independent effects.

CONCLUSIONS

PC use is a marker for poor health after 10 years. Mediators of these relationships (BMI, stressful life events and current tobacco use) should be considered when designing interventions to promote health.