Abstract
ABSTRACT Objective: São Paulo‘s Crackland is the biggest and oldest open drug use scene in Brazil, yet little is known about the profile of crack cocaine treatment-seeking individuals living in this region. The aim of this crossectional study was to describe the demographics and clinical characteristics of treatment-seeking crack users living in the Crackland region. Methods: A sample of nighty eight individuals were screened for DSM-V substance use disorders, including substance use, impulsiveness, and psychiatric symptoms. Recent crack cocaine use was also tested using biologic specimens. Results: Results indicated severe social vulnerability, as participants experienced high rates of homelessness (46.9%), unstable housing (50%), unemployment (60.4%) and early school drop-out (27.5%). The average age of crack use onset was 20 years (SD = 6.9) and the mean duration of continuous crack use was 15 years (SD = 9.7). Most participants presented with concomitant mental health disorders, particularly alcohol use disorder (87.8%), as well high rates of psychiatric symptomatology and impulsiveness. More than half of the sample reported at least one previous inpatient (73.5%) and outpatient (65.3%) addiction treatment attempt. Conclusion: This population profile should inform mental healthcare services, promoting the provision of tailored assistance by targeting specific demands at all levels of treatment.
Highlights
For the last half-century, crack cocaine (“crack”) use has steadily increased in Brazil, making the country the biggest crack cocaine market in the world[1]
This study was conducted at Unidade Recomeço Helvetia (URH), a State-funded public treatment program situated in the heart of Crackland
Unstable housing was common for the participants, with half of them living in some form of assisted housing and nearly half (46.7%) of them living on the streets of Crackland
Summary
For the last half-century, crack cocaine (“crack”) use has steadily increased in Brazil, making the country the biggest crack cocaine market in the world[1]. The last few decades have been marked by a steep increase in the demand for crack cocaine use disorder (CUD) treatments[2], with crack use becoming the leading cause of hospitalization, when compared to any other illicit substance use[3]. Crack use is associated with severe psychiatric comorbidities, such as alcohol and multiple substance use disorders, anti-social personality disorder, major depression, and anxiety[6,7,8,9]. When compared to the general population, individuals who use crack are more likely to be unemployed, homeless, involved in illegal activities such as drug trafficking, and have a history of incarceration[2,5,10,11]. Mortality among crack users is 12 times higher than in the general population[14]
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