Reasons for and Consequences of the Combined Use of Crack Cocaine and Alcohol in Brazil:

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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.