The Reasons for and Consequences of the Combined Use of Crack Cocaine and Alcohol in Brazil:
qualitative study
DOI:
https://doi.org/10.31686/ijier.vol8.iss9.2597Keywords:
crack cocaine, alcohol, crack cocaine and alcohol association, BrazilAbstract
The objective of this study was to investigate, through the speeches of crack cocaine users, the reasons that lead them to combine crack cocaine with alcohol and the consequences of this combination, in Brazil. The lack of public policies and effective treatments has led crack cocaine users in Brazil to seek alternatives to cope with problems related to drug addiction. One adopted alternative is the consumption of crack cocaine together with other psychotropic drug. This study used the principles and instruments of qualitative research. A purposeful sample was constructed using key informants and gatekeepers whose sample size (N = 30) was defined by the theoretical saturation point. The study participants were subjected to in-depth interviews, and the responses were subjected to content analysis for the identification of thematic units. Alcohol use played many roles, including increasing the courage of drug users to go to the point of sale for psychotropic drugs, reducing thirst, and prolonging the positive effects of crack cocaine. The combination of alcohol and crack cocaine is commonly used to modulate the effects of the latter. A vicious cycle is established in which the consumption of alcohol stimulates the consumption of cocaine and vice versa. The participants also reported cost savings but admitted an increase in aggressiveness. The combined use of crack cocaine and alcohol can become a strong conditioned stimulus for the consumption of the former. The formation of the active metabolite cocaethylene in this drug combination may explain the prolongation of the effects of crack cocaine. Moreover, both drugs act in the mesolimbic dopaminergic system and consequently produce a synergistic effect. Severe outcomes such as cardiotoxicity, which can lead to death, in addition to aggression and the possibility of relapse to crack cocaine use, make this drug combination a public health problem that is greater than the individual consumption of these psychotropic drugs.
Downloads
References
Dunn J, Laranjeira RR, Da Silveira DX, Formigoni ML, Ferri CP. Crack cocaine: an increase in use among patients attending clinics in São Paulo: 1990–1993. Substance Use & Misuse. 1996;31(4):519–27. DOI: https://doi.org/10.3109/10826089609045824
Nappo SA, Galduróz JCF, Noto AR. Crack use in São Paulo. Substance Use & Misuse. 1996;31(5):565–79. DOI: https://doi.org/10.3109/10826089609045827
Oliveira LG, Nappo SA. Characterization of the crack cocaine culture in the city of São Paulo: a controlled patterned of use. Rev Saude Publica. 2008;42(4):664 –71. DOI: https://doi.org/10.1590/S0034-89102008000400012
Grangeiro A, Silva LL, Teixeira PR. Resposta à aids no Brasil: contribuições dos movimentos sociais e da reforma sanitaria. Pan Am J Public Health. 2009;26(1):87–94. DOI: https://doi.org/10.1590/S1020-49892009000700013
Bastos FI, Szwarcwald CL. AIDS and pauperization: principal concepts and empirical evidence. Cad Saúde Pública. 2000;16(1):65–76. DOI: https://doi.org/10.1590/S0102-311X2000000700006
Fonseca EM, Nunn A, Souza-Junior PB, Bastos FI, Ribeiro JM. Descentralization, AIDS, and harm reduction: the implementation of public policies in Rio de Janeiro Brazil. Cad Saúde Pública. 2007;23(9):2134–44. DOI: https://doi.org/10.1590/S0102-311X2007000900021
Mesquita F, Kral A, Reingold A, Bueno R, Trigueiros D, Araujo PJ, et al. Trends of HIV infection among injection drug users in Brazil in the 1990s: the impact of changes in patterns of drug use. J Acquir Immune Defic Syndr. 2001;28(3):298–302. DOI: https://doi.org/10.1097/00042560-200111010-00016
Inciardi JA. In: Monteiro MG, Inciardi JA, editors. Brazil-United States. Binational Research. São Paulo: CEBRID – Centro Brasileiro de Informações sobre Drogas Psicotrópicas; 1993. p. 63–75.
Plano integrado de enfrentamento ao crack e outras drogas (Integrated plan for dealing with crack and other drugs. 2010. Available in: [http://www.planalto.gov.br/ccivil_03/_Ato2007-2010/2010/Decreto/D7179.htm] (accessed in December 20, 2019)
Fischer B, Cruz MS, Bastos FI & Tyndall M. Crack across the Americas – a massive problem in continued search of viable answers: exemplar views from the North (Canada) and the South (Brazil. International Journal of Drug Police. 2013;24(6): 631-3. DOI: https://doi.org/10.1016/j.drugpo.2013.09.003
Ribeiro LA, Sanchez ZM, Nappo SA. Surviving crack: a qualitative study of the strategies and tatics developed by Brazilian users to deal with the risks associated. BMC Public Health. 2010;10:671. DOI: https://doi.org/10.1186/1471-2458-10-671
Gonçalves JR, Nappo SA. Factors that lead to the use of crack cocaine in combination with marijuana in Brazil: a qualitative study. BMC Public Health 2015;15:706. DOI: https://doi.org/10.1186/s12889-015-2063-0
Chaves TV, Sanchez ZM, Ribeiro LA, Nappo SA. Crack cocaine craving:
behaviors and coping strategies among current and former users. Rev Saude Publica. 2011;45(6):1168–75.
FIOCRUZ- Oswaldo Cruz Foundation –2012. National Survey on the Crack Cocaine Use. Available in: [https://programadrogas.fiocruz.br/publicacoes/livros/51] (accessed in November 15, 2019).
Wiseman EJ, Mc Millan DE. Combined use of cocaine with alcohol, cigarettes. Am J Drug Alcohol abuse. 1996;22(4):577-587. DOI: https://doi.org/10.3109/00952999609001682
Magura S, Rosenblum A. modulating effect of alcohol use or cocaine use. Addict Behav. 2000;25:117-22. DOI: https://doi.org/10.1016/S0306-4603(98)00128-2
Brache K, Stockwell T, Macdonald S. Functions and harms associated with simultaneous polysubstance use involving alcohol and cocaine. Journal of Substance Use. 2012;17(5–6):399–416. DOI: https://doi.org/10.3109/14659891.2011.583313
WHO - World Health Organization. Global Status Report on Alcohol and Health: 2014. Available in: [http://www.who.int/substance_abuse/publications/global_alcohol_report/en/] (accessed in November 3, 2019).
II LENAD (II National Survey of Alcohol and Drugs), 2014. Available in: [http://inpad.org.br/lenad/] (accessed in November 4, 2019).
WHO - World Health Organization. Qualitative research for health programs. Geneva: Division of Mental Health; 1994.
Taylor SJ, Bogdan R. Introduction to Qualitative Research Methods. New York: John Wiley & Sons Inc; 1998. Patton M. Qualitative research and evaluation methods. 3rd ed. Thousand Oaks: Sage Publications; 2002.
Kvale S. InterViews: an introduction to qualitative research interviewing. Thousand Oaks: Sage Publications; 1996.
Creswell JW: Research design: Qualitative, quantitative and mixed methods approaches. 3rd edition: London: Sage Publications; 2009.
Siegel RK. Cocaine smoking. J Psychoactive Drugs. 1982;4(4):271–359.
Biernacki P, Waldorf D. Snowball sampling: problems and techniques of chain referral sampling. Sociol Methods Res. 1981;10(2):141–63.ABEP (Associação Brasileira de Empresas e Pesquisa). Critério de Classificação Econômica Brasil. 2012. DOI: https://doi.org/10.1177/004912418101000205
DSM: Diagnostic and Statistical Manual of Mental Disorders. 4th edition.Washington DC: American Psychiatric Publishing; 2000.
Bardin L. Análise de Conteúdo, vol. 70. 3rd ed. Lisboa: Edições; 2004
NVivo qualitative data analysis Software; 2012 QSR International Pty Ltd. Victoria Australia.Version10. Available in:
http://helpv10.qsrinternational.com/desktop/welcome/welcome.htm.
Accessed in May 26, 2017.
Haasen C, Krausz M. Myths versus evidence with respect to cocaine and crack: learning from the US experience. Eur Addict Res. 2001;7(4):159-60. DOI: https://doi.org/10.1159/000050736
Amlung MT , Morris DH, and McCarthy DM. Effects of Acute Alcohol Tolerance on Perceptions of Danger and Willingness to Drive after Drinking. Psychopharmacology (Berl). 2014;231(22):4271–4279. DOI: https://doi.org/10.1007/s00213-014-3579-1
Livingston JA, Testa M, Windle M, Bay-Cheng LY. Sexual risk at first coitus: Does alcohol make a difference? J Adolesc. 2015;43:148-58. DOI: https://doi.org/10.1016/j.adolescence.2015.05.018
Lau-Barraco C, Schmitz JM. Drug Preference in cocaine and alcohol dual-dependent patients. The American Journal of Drug and Alcohol Abuse. 2008; 34:211-217. DOI: https://doi.org/10.1080/00952990701877136
Fox HC, Talih M, Malison R, Anderson GM, Kreek MJ, Sinha R. Frequency of recent cocaine and alcohol use affects drug cracving and associated responses to stress and drug –related cues. Psychoneuroendocrinology. 2005;30:880-891. DOI: https://doi.org/10.1016/j.psyneuen.2005.05.002
Heil SH, Badger GJ, Higgins ST. Alcohol dependence among cocaine-dependent outpatients: demographics, drug use, treatment outcome and other characteristics. J Stud Alcohol. 2001;62:14–22. DOI: https://doi.org/10.15288/jsa.2001.62.14
Gossop M, Manning V, Ridge G. Concurrent use and order of use of cocaine and alcohol: behavioural differences between users of crack cocaine and cocaine powder. Addiction. 2006;101:1292-1298. DOI: https://doi.org/10.1111/j.1360-0443.2006.01497.x
Antoniazzi RP, Sari AR, Casarin M, Moraes CMB, Feldens AA. Assoation between crack cocaine use and reduced salivar flow. Braz Oral Res. 2017; 31:e42. DOI: https://doi.org/10.1590/1807-3107bor-2017.vol31.0042
Woyceichoski IEC, Costa CH, Araujo CM, Brancher JA, Resende LG, Vieira I, Lima AAS. Salivary buffer capacity, pH, and stimulated flow rate of crack cocaine users. Journal of Investigative and Clinical Dentistry. 2013;4:160–163. DOI: https://doi.org/10.1111/j.2041-1626.2012.00126.x
Knacksted LA, Ben-Shahar O., Ettenberg A. Alcohol consumption is preferred to water in rats pretreated with intravenous cocaine. Pharmacology, Biochemistry and Behavior. 2006;85:281-286. DOI: https://doi.org/10.1016/j.pbb.2006.08.012
McCance E. F., Price L. H., Kosten T. R., Jatlow P. I. Cocaethylene: pharmacology, physiology and behavioural effects in humans. J Pharmacol Exp Ther 1995;274: 215–23.
Pan W. J., Hedaya M. A. Cocaine and alcohol interactions in the rat: contribution of cocaine metabolites to the pharmacological effects. J Pharmacol Sci 1999;88: 468–76. DOI: https://doi.org/10.1021/js980283h
Graziani M, Nencini P, Nistico R. Genders and concurrent use of cocaine and alcohol: Pharmacological aspects. Pharmacological Research. 2014; 87:60-70. DOI: https://doi.org/10.1016/j.phrs.2014.06.009
Bunney EB, Appel SB, Brodie MS. Cocaine potentiates ethanol-induced excitation of dopaminergic reward neurons in the ventral tegmental area. Journal of Pharmacology and Experimental Therapeutic 2000; 293(2);383-389.
Borges G, Cherpitel C, Orozco R, MasDonald S, Giesbrecht N, Moskalewics J, Swiatkiewicz G, Cremonte M. Alcohol as a trigger for medical emergencies. Subst Use Misuse. 2013;48(7):484-489, 2013. DOI: https://doi.org/10.3109/10826084.2013.778277
Zerhouni O, Begue L, Brousse G, Carpentier F, Dematteis M, Pennel L, Swendsen J, Cherpitel C. Alchool and violence in the emergency room: a review and perspectives from psychological and social sciences. Int J Environ Res Public Health. 2013;10(10):4584-4606. DOI: https://doi.org/10.3390/ijerph10104584
Salloum IM, Daley DC, Cornelius JR, Kirisci L, Thase ME. Disproportionatelethality in psychiatric patients with concurrent alcohol and cocaine abuse. Am J Psychiatry 1996;153:953–5. DOI: https://doi.org/10.1176/ajp.153.7.953
Pennings EJM, Leccese AP, de Wolff FA. Effects of concurrent use of alcohol and cocaine. Addiction. 2002;97(7), 773–783. DOI: https://doi.org/10.1046/j.1360-0443.2002.00158.x
Marks KR, Pike E, Stoops WW, Rush CR. Alcohol administration increases cocaine craving but not cocaine cue attentional bias. Alcohol Clin Exp Res. 2015; 39(9),1823-1831. DOI: https://doi.org/10.1111/acer.12824
McKay JR, Alterman AI, Rutherford MJ, Cacciola JS, McLellan AT. The relationship of alcohol use to cocaine relapse in cocaine dependent patients in an aftercare study. J Stud Alcohol. 1999;60:176-180. DOI: https://doi.org/10.15288/jsa.1999.60.176
Rubio G, Manzanares J, Jiménez M, Rodríguez-Jiménez R, Martínez I, Iribar-ren MM, et al. Use of cocaine by heavy drinkers increases vulnerability to developing alcohol dependence: a 4-year follow-up study. J Clin Psychiatry. 2008;69:563–70. DOI: https://doi.org/10.4088/JCP.v69n0407
Regier DA, Farmer ME, Rae DS, Lacke BZ, Keith SJ, Judd LL, Goodwin FK. Comorbidity of Mental disorders with Alcohol and other Drug Abuse. Results from the Epidemiologic catchment Area (ECA) study. Jama. 1990;264(19):2511-18. DOI: https://doi.org/10.1001/jama.264.19.2511
Carroll KM, Rounsaville BJ and Bryant KJ. Alcoholism in treatment-seeking cocaine abusers: Clinical and prognostic significance. J. Stud. Alcohol. 1993; 54:199-208. DOI: https://doi.org/10.15288/jsa.1993.54.199
Higgins ST, Budney AJ, Bickel WK, Foerg FE, and Badger GJ. Alcohol dependence and simultaneous cocaine and alcohol use in cocaine-dependent patients. J. Addict. Dis. 1994;13:177-189. DOI: https://doi.org/10.1300/J069v13n04_06
Ahmadi J, Kampman KM, Oslin DM, Pettinati HM, Dackis C, Sparkman T. Predictors of treatment Outcome in Outpatient Cocaine and Alcohol Dependence treatment. Am J Addict. 2009;18(1):81-86. DOI: https://doi.org/10.1080/10550490802545174
Brady KT, Sonne E, Randall CL, Adinoff B, Malcon R. Features of cocaine dependence with concurrent alcohol use. Drug Alcohol Depend. 1995;39:69-7. DOI: https://doi.org/10.1016/0376-8716(95)01128-L
Laizure SC, Parker RB. Pharmacodynamic evaluation of the cardiovascular effects after the coadministration of cocaine and ethanol. Drug Metab Dispos. 2009;37(2):310–314. DOI: https://doi.org/10.1124/dmd.108.023531
Wilson LD, Jeromin J, Garvey L, Dorbandt A. Cocaine, ethanol, and cocaethylene cardiotoxity in an animal model of cocaine and ethanol abuse. Acad Emerg Med. 2001;8:211–22. DOI: https://doi.org/10.1111/j.1553-2712.2001.tb01296.x
Bailey DN. Plasma cocaethylene concentrations in patients treated in the emergency room or trauma unit. Am J Clin Pathol. 1993;99:123–7. DOI: https://doi.org/10.1093/ajcp/99.2.123
Foltin RW, Fischman MW. Ethanol and cocaine interactions in humans: cardiovascular consequences. Pharmacol Biochem Behav 1998; 31: 877–83. DOI: https://doi.org/10.1016/0091-3057(88)90399-1
Lucena J, Blanco M, Jurado C, Rico A, Salguero M, Vazquez R, Thiene G, Basso C. Cocaine-related sudden death: a prospective investigation in south-west Spain. Eur Heart J. 2010;31(3):318-29. DOI: https://doi.org/10.1093/eurheartj/ehp557
Downloads
Published
Issue
Section
License
Copyright (c) 2020 Janaina Rubio Gonçalves, Solange Aparecida Nappo
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
Copyrights for articles published in IJIER journals are retained by the authors, with first publication rights granted to the journal. The journal/publisher is not responsible for subsequent uses of the work. It is the author's responsibility to bring an infringement action if so desired by the author for more visit Copyright & License.
How to Cite
Accepted 2020-08-28
Published 2020-09-01
