When Polonsky said of Odom's crack use, "I can't say [it was] necessarily out of control," Levin seemed astonished. "It sounds like what you're saying is there is such a thing as controlled crack use," he said. Polonsky quickly added, "I think there's tons of people who do it recreationally, and that doesn't necessarily make them addicts."
Crack Creative Market 2006 Crack
The HBO comedy Girls got it exactly right. In one episode, über-uptight Shoshanna accidentally smokes crack at a Brooklyn warehouse party, thinking the pipe she is casually passed contains weed. Hilarious, yes, but not ludicrous. Drugs follow money. And they follow young, edgy creative-hipster types eager to go through some kind of dark, skid-row rite of passage. Yesterday's scourge of the underclass is today's indulgence of the idle class.
"There's a stigma to crack that excites certain people," says one 36-year-old fashion photographer who works on New York's Lower East Side. He says he knows "tons of people" in fashion, music, and art who either have smoked rock or would be willing to try it as long as "someone else in the room has it and knows what they are doing."
I randomly saw this play out on an autumn Sunday night in New York City's East Village. At a hip dive bar, I met Neil, an Internet executive, and his friend Keith, who works in the financial industry (both asked that their full names be withheld). When they rolled out of the bar at around 1:30 A.M., after an evening punctuated by blow and Adderall, Keith suggested they cap the night with crack. Neil bought four tiny blue Baggies, each containing a one-hit rock, for $10 a pop from a kid on a bike, then picked up a $3 glass stem from a corner deli. He and Keith started smoking their crack in the taxi on their way home to the industrial-chic Gowanus section of Brooklyn. "It's like coke times 100," said Keith, letting out an acrid belch of smoke.
More than an intense new nightcap, crack serves, rehab experts attest, as a résumé-builder for the in-crowd. The incredibly powerful high is a draw, of course, but so is the fact that its name is synonymous with addiction and lets a user feel a deep and dangerous connection to balls-out substance abusers like William S. Burroughs and Sid Vicious.
"If you love it, and if you're not a pussy, you will be smoking thousands of dollars' worth in a month," says former crackhead Richard Taite, who used to smoke the rock with lawyers and celebrity progeny in Bel Air and now runs the Cliffside Malibu rehab facility. On the other hand, some people have stronger wills, says Tom Horvath, founder of Practical Recovery in Los Angeles, who includes moderation among his recovery tools. "If you have your life together and are seeking experiences, why shouldn't it be possible to do it moderately?" he says.
More recently, celebrities have rationalized hitting the rock. After George Michael was busted for it in London in 2008, he suggested to The Guardian that there was nothing wrong with dabbling. "People want to see me as tragic with all the . . . drug taking," he said. "I don't even see them as weaknesses anymore. It's just who I am." Charlie Sheen said he liked getting high, but he advised people to "stay away from the crack . . . which I think is pretty good advice. . . . If you can manage it socially, then go for it, but not a lot of people can, you know?" Right, it's only for the alphas.
Truth be told, in terms of the population at large, not a lot of people are trying crack. According to the 2011 National Survey on Drug Use and Health, the number of first-time users declined from 337,000 in 2002 to 76,000. Of the 22.5 million Americans who use illicit drugs, only 625,000 smoke crack. It's not the statistics that are striking; it's what they represent.
"We know there are lots of Wall Street dudes smoking crack, no question," says Joe Schrank, cofounder of the treatment program Rebound Brooklyn. "We see financial guys, artists, tech geeks, people with money or pedigree and good families, anyone who wants to try something a bit stronger than what they're already doing."
In other words, crack is neither the end of the line nor a gateway drug. It finds you because you're already at a party doing a bump of coke and someone comes up and says, "Hey, you like that? Then you gotta try this." "It's a script that gets followed every time," says Scott Bienenfeld, M.D., an addiction expert at Rebound Brooklyn. "No one ever says, 'Try this, it's weaker.' It's always, 'Hey, supersize me.'"
For a better demonstration of the problem, it published data from a nationwide survey conducted in Brazil, in which crack has a significant prevalence among illicit drugs, reaching 1.4 million people aged 12 to 65 years who have used the drug before. The same report presents worrying data regarding alcohol consumption patterns, in which about 2.3 million people met the criteria for alcohol dependence in Brazil [2].
Alcohol is the most widely used psychoactive substance in the national context, and the use of crack cocaine, a smoked form of cocaine, has become popular because of its affordability and low price. The consumption of these substances, especially crack, has gained exponential importance in recent years due to the consequences of dependence on the individuals [2] [3]. In this context, due to the public health burden related to psychoactive substance abuse and the associated morbimortality consequences, studies are needed to identify the contributing factors for the development of psychoactive substance use disorders.
Although some scientific researches have focused on identifying the difference in exposure to early stress in the different groups according to drug use, there is still a gap in the Brazilian context, primarily concerning crack and alcohol users.
In a study that analyzed four different groups (alcohol dependent, addicted to other drugs, depressive patients, and a control group without a diagnosis of mental disorder) the results identified a higher frequency and intensity of early life stress in the alcohol and other drug groups when compared to the depression and control groups [27]. However, researchers do not report the primary substance in the drug-dependent group. Recently, one of the only articles in the national context found in the databases was published that evaluated the experience of childhood maltreatment in groups with different drugs of choice. The authors found a higher intensity of early stress in alcohol users when compared to cocaine, crack, and tobacco users. However, the study did not analyze the influence of early stress on the severity of drug dependence [28].
It is worth mentioning the importance of analyzing specific groups of drug users, especially those dependent on alcohol and crack. There is little information available about the prevalence of early stress experienced by these two groups of drug users, especially in Latin America. The evaluation of these experiences denotes importance, considering that alcohol is the most consumed drug in the country. Crack has a high dependence factor, associated with high social vulnerability, besides being one of the main substances that lead users to seek outpatient treatment in public psychosocial care services in Brazil [29].
From this perspective, this research aims to identify the prevalence of early life stress in drug users, to compare the intensity of trauma in alcohol and crack users, and to relate the power of injury to the severity of drug dependence.
The present study hypothesizes that drug users, who are undergoing outpatient treatment, have a high prevalence of early life stress and that the frequency and intensity of trauma would differ according to the drug used. Furthermore, another hypothesis is that a higher power of early stress could result in differences in the severity of dependence between alcohol and crack users.
Participants from the Crack group also reported having used alcohol, although the diagnosis and treatment in the health service are related to the use of Crack. The results on the age of first use of alcohol showed a significant difference between the groups regarding the beginning of alcohol consumption (F = 5.14; df = 1; p = 0.02), and the Alcohol group started the consumption of alcohol at a later age when compared to the Crack group. Regarding the age of first use of crack, 56 individuals claim to be users or have tried the drug during their lifetime. When comparing the groups, no significant differences were found between them (Table 2).
Analyzing the influence of early life stress and its subtypes on the drug use found a significant influence of emotional abuse (OR = 2.64; 95% CI; 1.20 - 5.80) and sexual abuse (OR = 2.17; 95% CI; 0.97 - 4.88) in the Crack user group. That is, in the sample analyzed, crack users are 2.6 times more likely to have been emotionally abused, and 2.1 times more likely to have been sexually abused during childhood when compared to the Alcohol group. Regarding physical abuse, a tendency was found (OR = 1.93; 95% CI; 0.88 - 4.22), indicating that users of the Crack group are 93% more likely to have suffered physical abuse. In analyzing the influence of neglect, no statistically significant differences were found in either emotional neglect (OR = 0.47; 95% CI; 0.16 - 1.40) or physical neglect (OR = 0.56; 95% CI; 0.12 - 2.49) (Table 4).
The present study is one of the first in the Brazilian context to analyze the frequency, severity, and influence of early life stress from five types of childhood trauma on alcohol and crack dependence. The study results show the importance of the problem concerning early life stress and the need for attention to this situation, considering that drug use and the severity of dependence may be related to traumatic events experienced during childhood and adolescence.
Participants on the present study was selected by simple random sampling in an outpatient unit for the treatment of substance use disorders, which highlights the problem involving alcohol and crack use in Brazil. It is important to report that no individuals declined to take part in the research after being approached by the researcher. The high prevalence of alcohol dependents in the sample reflects the national panorama of alcohol consumption, being the most consumed drug in the country [2]. Regarding crack use, although the national prevalence of its use has remained stable in recent years [2] [41], the abusive consumption results in severe consequences for the user. It is evidencing the harm of crack consumption by the demand of these users in seeking outpatient treatment [42]. 2ff7e9595c
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