Crack Abuse Research Articles

Cohort Differences in Drug-Use Pathways to Crack among Current Crack Abusers in New York City

Much prior literature has focused on substance use progression through alcohol, tobacco, and marijuana leading from a time of no drug use as a youth to the possibility of serious drug abuse. This article extends this literature by empirically examining retrospectively the sequence of hard drugs used as reported retrospectively by 994 hard drug abusers from New York City. The sequence was strongly mediated by birth year. Nearly all (81%) current crack abusers born prior to 1953 had previously injected heroin. At the other extreme, prior heroin injection was rare (10%) among crack abusers born since 1967. Many (37%) of these younger crack abusers initiated use of crack just after having used gateway drugs. Theoretical and policy implications of these findings are discussed.

Cocaine expectancies: Client retention and participation in crack abuse treatment

Cocaine expectancies: Client retention and participation in crack abuse treatment

Crack Abusers and Noncrack Abusers: Profiles of Drug Use, Drug Sales and Nondrug Criminality

Based on more than one thousand interviews with drug abusers in 1988 and 1989, the drug use patterns, selling behavior, and other crimes (robbery, burglary theft, etc.) of crack abusers are compared with those of heroin injectors, cocaine snorters, marijuana-only users, and nondrug users. Several striking differences in the frequency of crack use and dealing emerge among the various drug user types. Crack abusers were found to be using drugs at high rates and were receiving high incomes from drug sales and nondrug criminality. Among crack abusers, crack use greatly exceeded the cost and frequency of use of other specific drugs, which they were also consuming. For all user subgroups, crack selling was the most frequent crime and generated the largest cash income. Important patterns of polydrug use were found among most drug user groups. These findings have important implications for policies directed toward drug abusers.

Nine Years of the Freebase Cocaine Epidemic in the Bahamas

Nine years after the beginning of the epidemic of freebase (crack) cocaine abuse in the Bahamas, this historical study was done to characterize the natural course of the epidemic and to estimate the effectiveness of control measures. The authors' data include the incidence of new cases at the only psychiatric hospital in the Bahamas and at the primary community psychiatric clinic in the nation. The Bahamian response included 1) demand reduction, 2) supply reduction, and 3) reduction of money laundering. The annual number of new cases of crack abuse presenting for treatment declined from 1987 to mid‐1991 in both facilities, but in 1992 it began rising again in the inpatient setting only. The changes in recent years have been accompanied by an increase in violent crimes against persons, especially robberies. (American Journal on Addictions 1994; 3:14–24)

Social support systems in crack abusers with chemically dependent parents

Social support systems in crack abusers with chemically dependent parents

Studying crack abusers: strategies for recruiting the right tail of an ill-defined population.

This study attempts to better understand a limited segment of the drug-abusing population, especially individuals who repeatedly use crack and other drugs. This article addresses the methodological strategies and underlying paradigms informing the recruitment of hard-to-reach and ill-defined subpopulations of crack abusers and noncrack drug abusers. Subjects were recruited from diverse social contexts: streets or communities where most drug users do their business, arrested persons who were released, jail inmates, probationers and parolees, prison inmates, and treatment settings. A systematic comparison of subject attributes across recruitment locales and with other, similar target groups is presented. The utility and external comparability of the recruitment techniques are supported by the findings.

Infant Morbidity in Harlem: A Status Report

To the longstanding cycle of poverty, disease, and despair that has afflicted several generations of Harlem residents have now been added epidemics of crack abuse, AIDS, syphilis, and pervasive violence. The community's children have been especially vulnerable to these calamities. Harlem's traditional institutions of strength, aid, and comfort--its extended families, churches, the hospital, and the government--have become nearly overwhelmed by mounting social disorganization and an apparent lack of resources. It may be possible to combat such problems by re-examining some of the assumptions we have used to deal with them, by energetically addressing their more manageable components, and by greatly increasing support for viable community institutions such as the public hospital. At the same time, we will need to learn many more facts about crack, AIDS, poverty, and shattered families so that, whenever possible, our efforts will be informed and our choices intelligent.

Crack-Related Perforated Gastropyloric Ulcer

Cocaine is a potent topical vasoconstrictor that causes nasal mucosal and dermal ulceration. Use of the purified cocaine derivative "crack" has reached epidemic proportions in large cities. In 18 months we operated on 24 patients with perforated peptic ulcers. Five of the patients were young (27-38 years) male crack users without prior history of gastric symptoms who presented with a perforated gastric ulcer related to smoking crack. Three had had symptoms for only 1-5 days before admission. All five were afebrile, had a rigid abdomen, normal leukocyte count, and free intraabdominal air upon radiography. Five other age-matched, non-crack-using patients served as case controls. Their duration of symptoms was 1-24 months, they had elevated leukocyte counts on admission, and, in contrast to the crack users, four of these patients had duodenal perforations. The clinical presentation of the crack smokers and the unusual localization of the perforations imply different pathogenetic mechanisms than are commonly seen in perforated ulcer disease. With increasing abuse of crack, greater numbers of patients with this new complication may be expected to present to emergency services in urban areas.

A case of late-onset crack dependence and subsequent psychosis in the elderly

While rapidly spreading “crack” addiction is a major concern in our community, current research in this area is focused mainly on adolescents and young adults. We discuss a case of crack addiction developing for the first time in an elderly person and subsequent complications. We believe no such cases have been previously reported. We hope this will be helpful to practicing clinicians and stimulate research to understand cocaine and crack abuse patterns in the elderly.

Crack abuse

Crack use has increased dramatically because the drug is cheap, highly addictive, and easy to use. As a result, an increased frequency of cocaine-related medical problems has been noted. The effects of crack abuse on fetal outcome and neurobehavioral development are becoming more apparent. In addition, the role of crack use in furthering transmission of sexually transmitted diseases has been documented, and the implications for AIDS transmission have been speculated on. Crack use enhances social disorganization, particularly in poor urban areas, where increased child abuse, neglect, and prostitution are common. Ever present are the financial incentives to increase the number of crack users. Cocaine was once considered a drug for the elite, rich, and famous. Crack clearly has changed that notion.

Black Adolescent Crack Users in Oakland: No Quick Fix-Reply

In Reply.— We are in agreement with Dr Silverman that no quick fix is likely to have a dramatic impact on sexual behaviors that are mediated by drug and alcohol abuse and that responsible safe sex behavior requires than the use of condoms. We would further concur that educators and policymakers should not be tempted into believing that providing crack users with condoms can or should replace more difficult and costly programs, particularly... drug treatment programs. In proposing a campaign of condom distribution, our intent was not to suggest that condoms are a panacea for the many problems associated with crack use. Rather, our findings should suggest to educators, policymakers, and health care professionals that the sexual behaviors of crack users are as problematic as their crack abuse, and that effective treatment programs for such users should include concerted efforts to reduce the user's risk of becoming infected with

Psychopathology among Cocaine Abusers Entering Treatment

A number of different indicators of psychopathology were assessed in this study of 76 cocaine and crack abusers who entered outpatient treatment in New York City between June and December 1987. The majority (75%) had used cocaine for 4 years or more, and the majority (62%) spent over one thousand dollars a month on cocaine in the 6 months before entry into treatment. Forty-seven percent of the sample were found to be clinically depressed. Phobic disorders were the only other axis I diagnoses found in addition to depression, and all persons who were found to have phobic disorders also were diagnosed as having some form of depressive disorder. The four most common axis II diagnoses were antisocial personality (21%), passive-aggressive (21%), borderline (18%) and self-defeating (18%). Subjects were classified as falling into one of the following three categories of a newly developed "psychopathology classification": a) no diagnosed psychopathology except substance abuse or dependency; b) one or more axis II diagnoses, but no axis I diagnoses except for substance abuse or dependency; c) at least one axis I diagnosis in addition to drug disorders whether or not accompanied by an axis II diagnosis. Mean scores on subscales and total score on the SCL-90, as well as total score on the Beck Depression Inventory, were ordered by category of the classification scheme, with those having no diagnosed psychopathology except substance abuse having the lowest score and persons in the third category having the highest score.(ABSTRACT TRUNCATED AT 250 WORDS)

Birth Outcomes for Infants of Drug Abusing Mothers

Birthweight, gestational age, and Apgar scores of drug-exposed infants were compared to those of drug-free infants using data collected from birth certificates. Infants born to abusers of opiates and cocaine as well as opiates and cocaine together were also compared to one another. The presence of adverse neurologic signs, need for intensive care, and length of hospitalization after delivery were compared among different types of drug-exposed infants using data collected in a program for infants at risk for developmental delay. Infants of all drug abusers weighed an average of 423 g less than controls; mean gestational age for infants in the different drug groups ranged from four to ten days less than for controls. Opiate-exposed infants were significantly more likely to show adverse neurologic signs than were those with exposure only to cocaine, and were more likely to need intensive care. Infants of polydrug (cocaine + opiate) abusers fared worse than infants born to abusers of single drugs with respect to birthweight, gestational age, and length of hospital stay. Outcomes for infants of crack abusers were worse than those for infants exposed to other forms of cocaine with respect to birthweight and adverse neurologic signs. Our findings suggest that special outreach and follow-up efforts may be needed to facilitate the optimal development of these infants.

Crack and fatal child abuse

Crack and fatal child abuse

Crack and Fatal Child Abuse

To the Editor.— Crack, a preprocessed cocaine alkaloid, emerged in the Bahamas in 1983. 1 In late 1985, crack became available on the streets of New York City. 2 This potent, highly addictive smokable form of cocaine has been associated with physical complaints as well as psychiatric complaints that include depression, irritability, paranoia, and violent behavior. 3 The incidence of child abuse and neglect is known to be higher in families in which parents or caretakers are alcoholics or narcotic addicts. Reporting of child abuse and neglect has increased nationally 212% from 1976 to 1986 to more than 2 million cases a year. The number of fatalities also has risen. 4 At our hospital, since March 1988 we have seen three unrelated patients, ages 1 month, 2 years, and 3 years, as victims of fatal child abuse from battering. In two of the cases crack was specifically noted to have

Pneumomediastinum as a complication of “crack” smoking

Three cases of pneumomediastinum related to smoking cocaine in the form of “crack” are presented. The patients complained of chest or neck pain occurring 1 to 6 hours after smoking crack. All three did not immediately divulge a history of cocaine use. There was spontaneous resolution of pneumomediastinum in every case, and the creation of pneumomediastinum appeared to be directly related to the route of drug use. The abuse of crack and the mechanism of spontaneous pneumomediastinum are discussed.

Crack abuse and suicide: Is there a correlation?

Crack abuse and suicide: Is there a correlation?

Intracranial Hemorrhage After Cocaine Abuse

To the Editor.— Cocaine abuse and its medical, psychiatric, and neurological complications have been well documented. 1 However, the incidence of intracranial hemorrhage in cocaine abuse must be exceedingly low, as only three cases have been reported in the American literature 2,3 despite a large and growing population of cocaine abusers. Use of a new and more potent form of cocaine, has recently reached epidemic proportions in many major cities, especially New York. 4 To our knowledge, no reports of intracranial hemorrhage associated with its abuse have been reported. In a two-week period, we evaluated five men aged 21 to 40 years with intracranial hemorrhage, one subsequent to confirmed abuse of crack, taken intravenously, one following intravenous cocaine abuse, and three with cocaine present in large amounts in their urine. Three of the patients had large intracerebral hematomas and two had subarachnoid hemorrhages. Two of the patients subsequently died,