Sociodemographic Characteristics, Patterns of Crack Use, Concomitant Substance Use Disorders, and Psychiatric Symptomatology in Treatment-Seeking Crack-Dependent Individuals in Brazil

ABSTRACT

Crack cocaine (crack) dependence is a severe disorder associated with considerable morbidity and mortality, constituting a major public health problem in Brazil. The aim of this study was to improve understanding of the profile of treatment-seeking crack-dependent individuals. We recruited 65 crack-dependent individuals from among those seeking treatment at an outpatient clinic for alcohol and drug treatment in the city of São Paulo, Brazil. Assessments, conducted between August 2012 and July 2014, focused on sociodemographic characteristics, the pattern/history of crack use, treatment history, concomitant substance use disorders, psychiatric symptomatology, and impulsivity. In the study sample, males predominated, as did unemployment, homelessness, and low levels of education. On average, the participants had smoked crack for 10 years. Most had previously been treated for crack dependence. Concomitant DSM-IV diagnoses of dependence on other substances were common, dependence on tobacco and alcohol being the most prevalent. Participants presented significant psychiatric symptomatology and impulsivity, with nearly half of the sample presenting psychotic symptoms, 90% presenting depressive symptoms, and 80% presenting anxiety symptoms. Most treatment-seeking crack-dependent individuals in Brazil are living in extremely poor social conditions and are struggling with the severe, chronic, and comorbid features of this disorder.

KEYWORDS:

• Ambulatory treatmentBrazilcrack dependence
• profile features

Notes

1. Although the quantity of cocaine in each crack rock can vary considerably, we reported the number of rocks of crack rather than the number of grams because crack in Brazil is sold in rocks and not in grams of cocaine. Consequently, crack users commonly report the number of rocks smoked and do not know how to determine the number of grams of cocaine smoked.

2. “Crackland” is a region of downtown São Paulo where thousands of crack users living under extremely vulnerable social conditions gather to consume crack openly in the streets.

Additional information

Funding

This study was supported by grants from Fundação de Amparo a Pesquisa de São Paulo (FAPESP) during the design, conduct, and stages of data analyses and interpretation (Regular Research award number 2011/01469-7, Ph.D. Scholarship award number 2013/04138-7, Postdoctoral fellowship award number 2017/05371-8). This study was also supported by a grant from the Clinical Trials Network Pacific Northwest Node (award number 5 U10 DA013714-10) from the National Institute on Drug Abuse (NIDA).