Abstract
BackgroundCrack-cocaine dependence is a serious public health issue, related to several psychiatric and psychosocial problems. Crack-cocaine users are usually embedded in a context of great social vulnerability, often associated with violence, poverty, family conflict and easy and early access to alcohol, tobacco and other drugs.MethodsThis cross-sectional study enrolled a consecutive sample of 577 patients admitted to 20 therapeutic communities located in Southern Brazil, between September 2012 and September 2013. A structured interview assessed life-time exposure to risk and protective factors for drug use, such as parental monitoring in childhood, deviant behaviors and peer pressure.ResultsPresence of family conflict (p = 0.002), maltreatment (p = 0.016), and deviant behavior prior to age 15 in a bivariate analysis predicted an earlier age of crack-cocaine initiation, whereas adolescents experiencing parental monitoring during adolescence started use later (p < 0.001). In the multivariate model, perceptions related to ease of access of illicit drugs (marijuana: p = 0.028, 95% CI = − 3.81, − 0.22; crack-cocaine: p < 0.001, 95% CI = − 7.40, − 4.90), and deviant behavior (threatening someone with a gun: p = 0.028, 95% CI = − 2.57, − 0.14) remained independent predictors of early age of crack-cocaine initiation.ConclusionsEarly onset of crack-cocaine use seems to be associated with exposure to family conflict, easy access to drugs and deviant behavior. Treatment and preventive programs should take these factors into account when designing and implementing community interventions.
Highlights
Crack-cocaine dependence is a serious public health issue, related to several psychiatric and psychosocial problems
Other studies investigated specific populations - for example, adolescents in street situations [14], few multicenter studies focused on crackcocaine users. This if the first multicenter study in Brazil assessing risk and protective factors for early onset of crack-cocaine use with patients from Therapeutic Communities (TCs) who identified crack-cocaine as the substance that made them seek treatment. Setting This is a cross-sectional study which included Therapeutic communities (TC) (n = 20) affiliated with the Brazilian Federation of Therapeutic Communities (FEBRACT), which aims to train the Brazilian TCs according to the recommendations of the World Federation of Therapeutic Communities (WFTC)
All TCs were registered with the Brazilian National Secretariat for Drug Policy (SENAD) and compliant with Brazilian Health Regulatory Agency (ANVISA) standards [34], this guaranteed the inclusion of study participants from TCs with similar standards of treatment
Summary
Crack-cocaine dependence is a serious public health issue, related to several psychiatric and psychosocial problems. Crack-cocaine users tend to develop severe pattern of dependence in a very short period of time [3,4,5]. The use of this drug is associated. The II Brazilian National Alcohol and Drugs Survey (BNADS) found that the mean age of initiation for cocaine consumption in Brazil was 18.8 years [15]. Another survey with Brazilians adolescents in treatment found that the mean age at first use of crack-cocaine was 13.3 years [4]
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