3.12

Crash prevention and the smoking of crack-cocaine

Institution/
contact address:

Addiction Research Institute (IVO)

Heemraadssingel 194

3021 DM Rotterdam

Tel.: (010) 425 33 66

Contactperson/
researcher(s):

Drs. P. Blanken & C. Barendregt.

Goal of the study:

Goal of the project is to study (1) the ways in which marginalized drug users smoke crack cocaine and the strategies drug users employ to control or regulate their cocaine smoking patterns, and (2) to develop and implement prevention strategies that can enable drug users to control or regulate their cocaine smoking patterns.

The study can be broken down into two phases: A research phase (for which IVO is the responsible organization) and a second phase (for which the Trimbos Institute is the responsible organization) in which - based on the results of the research - cocaine crash prevention strategies will be developed and implemented. These crash prevention strategies will aim at on the one hand marginalized drug users who (also) smoke cocaine, and on the other hand (outreach) workers in drug treatment facilities.

Type of study:

A field investigation in which both quantitative and qualitative data are collected.

Research
questions:

First phase:

What strategies do drug users apply in order to control or regulate their cocaine smoking pattern?

To what extent do setting (i.e., situational) factors influence the patterns of cocaine smoking?

Second phase:

Which mechanisms of self-control or self-regulation can be transferred to other smokers of crack cocaine?

Which of the setting related factors can be influenced or applied in an attempt to prevent uncontrolled cocaine smoking patterns?

Population
studied:

Both in Arnhem (n=90) and Rotterdam (n=180) marginalized smokers of crack cocaine have been randomly recruited in their natural context. That is: The subjects were approached at drug user free zones (IT in Arnhem, the Pauluskerk in Rotterdam), (house) dealing addresses, and copping areas (i.e., street dealing). In order to be eligible for participation the subject had to be an active smoker of crack-cocaine.

Design and
instruments:

The research phase of the project studies drug use patterns in the natural context in which cocaine smoking takes place. The study concentrates on the cocaine smoking episode, the resulting cocaine craving and the hours directly following the smoking episode. Accordingly, three consecutive assessments have taken place:

observation of a cocaine smoking episode, by means of a structured observational protocol;

a (self-administered) cocaine craving questionnaire (based on Tiffany et al. (1993). The development of a cocaine craving questionnaire. Drug and Alcohol Dependence,3419-28);

between two to 24 hours after the observation, the subject were interviewed with respect to the observed cocaine smoking period, the cocaine craving experienced, the strategies employed in order to reduce cocaine craving and to control cocaine smoking patterns (during the two hours directly following the observation, and in general), and some additional information with respect to drug use (history) and back ground data.

Data are collected by well-trained community field workers.

Startdate:

May 1996.

Duration:

18 months.

Initiative:

Combined initiative of IVO, Trimbos Institute, Gelders Center for Addiction care (GCV), Mainline Foundation, and the Rotterdam Municipal Health Service (GGD).

Collaboration:

Trimbos Institute, Gelders Center for Addiction care (GCV), Mainline Foundation, and the Rotterdam Municipal Health Service (GGD).

Funding:

IVO, Trimbos Institute, Gelders Center for Addiction care (GCV), & Ministry of Health, Welfare and Sport (VWS).

Results:

In Arnhem, 90 persons were observed whilst smoking cocaine-base. They all smoked - mainly ready-to-smoke - cocaine from a base pipe. Two thirds of those observed also smoked heroin on tinfoil. After the use episode the drug users under observation reported on their craving for cocaine. This craving can apparently be divided into two aspects: (1) the intention to continue using cocaine and (2) the experience of a strong desire for cocaine. It is striking that a strong desire does not necessarily result in actual use of the drug. In the interview, in which 84 of the 90 observed drug users participated (93%), the majority said that the reason behind their craving was the cocaine itself (88%) and that having money was an important cause of the craving. It appears that many users went on to use heroin (64%) and/or cocaine (48%) to help fight the craving for cocaine following the observation period and completion of the ‘TrekMeter’ (craving meter). For the majority of all users the craving they had reported at the end of the observed cocaine smoking episode had disappeared again in less than 30 minutes.

In Rotterdam, all 183 observed drug users were smoking ready-to-smoke cocaine-base. Instigated by the ‘ban-on-basing’-rule cocaine was chased from tinfoil much more often in the Pauluskerk, while in the settings of drug dealing addresses and drug users’ apartments cocaine was primarily smoked from a small base-pipe. (In contrast to the Arnhem study there were hardly any drug users smoking cocaine-base in outdoor settings). Forty percent of the observed respondents were chasing heroin from tinfoil as well. At the end of the observed cocaine use episode drug users assessed their cocaine craving on a self-report questionnaire. The reported craving again falls apart in two dimension, as was shown in Arnhem as well, and can for the major part be understood in terms of having a strong desire for cocaine, having an urge for cocaine, and using cocaine as soon as there will be a chance.

During the interview, to which 172 of the 183 observed drug users participated (94%), the majority of base-cocaine smokers report that their craving is caused by the substance cocaine itself and also that having money is an important cocaine craving trigger. Many of the respondents have used heroin (47%) and/ or cocaine (57%) in the (two hour) period following the observed smoking episode. Finally, for the majority of respondents cocaine craving had disappeared after approximately two to three quarters of an hour.

The reports discuss the role environmental or setting factors (an official area for use, addresses for dealing and/ or using and outside locations) play in the use of - and the craving for - cocaine and the extent to which drug users continue, or not, to smoke cocaine-base.

Reporting:

Report, journal article.

References:

Barendregt, C., Blanken, P. , & Gouwe, D. van der. (1998). Als de kat van huis is …: Gekookte coke in een gebruiksruimte. In D. van der Gouwe (Ed.), Base coke in de scene: Achtergronden van het gebruik, perspectieven op interventie, (pp. 61-65). Utrecht: Trimbos instituut.

Blanken, P., Barendregt, C., & Hendriks, V. (1997). Een onderzoek naar het roken van cocaïne-baseen zelf-controle mechanismen: Op is op. Niets is voor altijd! (IVO-Series 14). Rotterdam: Addiction Research Institute (IVO)/ Erasmus University Rotterdam.

Blanken, P., Barendregt, C., & Zuidmulder, L. (1998). Het roken van cocaïne-basein de scene: Notities uit de natuurlijke context. In D. van der Gouwe (Ed.), Base coke in de scene: Achtergronden van het gebruik, perspectieven op interventie (pp. 27-44). Utrecht: Trimbos instituut.

Blanken, P., Barendregt, C., & Zuidmulder, L. (1998). Cocaïne-basein Rotterdam en de rookruimte van de Pauluskerk. IVO Bulletin – Het Rotterdams Drug Monitoring Systeem,1(3).

Comments:

The study is part of IVO’s Drug Monitoring System (DMS) and is embedded in IVO’s social epidemiological field research on patterns of psychoactive substance use in the natural context.

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