Let’s Talk About Crack Cocaine
hopefaithlove identified a missing link in the discussion about Substance Use Disorder: the topic of crack cocaine. We don’t talk about it nearly as much as we talk about meth and opiates. Why is that?
"On this site I hear so much about meth and opiates but not much about crack cocaine. Why is that? That’s my Loved One’s drug of choice. But it’s not talked about…"
We're ready to talk about crack cocaine.
Hello hopefaithlove. We’re ready to talk about crack cocaine. The topic just hasn’t come up and we have fewer members whose Loved Ones' drug of choice is crack cocaine. What we write and publish is mainly determined by our members’ questions and concerns, which explains the limited posts on this subject on our blogs.
Crack is a derivative of the more expensive cocaine. Crack is cheaper, typically smoked rather than snorted, and produces a quicker high than cocaine. Follow this link for an exhaustive description of the drug from drugpolicy.org.
National databases combine cocaine and crack use. There is a resurgence of stimulant use in parts of the country, including methamphetamine in Massachusetts. In my evaluation work in our county jail, the rate of stimulant use follows right behind opiate use. Folks are released to community Medication Assisted Treatment (MAT) programs, who assist them for the opiate use but have little to offer the person who also uses cocaine.
The treatment world IS moving forward
There is little available, pharmaceutically, that substitutes or blocks the high of cocaine. Here are the established treatment or therapy approaches that have proven to be successful for cocaine/crack users (we provide a synopsis of each, as well as more extensive academic resources on the subject in our Resource Supplement):
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This type of therapy combines traditional psychotherapy with interventions that aim to reduce cocaine use and/or the problematic effects of cocaine dependence. Focus may be placed on reduced use, moderation, reduced risky practices and/or abstinence.
There is a widely held belief that more black Americans smoke crack cocaine. While the drug emerged in poorer and more culturally diverse neighborhoods, there is actually only a small disparity between black Americans who report ever having used crack (5%) and white Americans (3.3%).[1]
When I first read your question, the immediate response I jumped to was that Allies’ membership is largely white, thus fewer questions about crack. I realized I held that old belief myself, supported by what I had lived in central Washington DC, as a chronic and poly-substance user.
I thought “White people don’t use much crack.” I was wrong.
Somewhere inside me I was holding onto a notion that fit into a cultural and racial assumption, which, as we are luckily coming to understand more and more, is only a misconception. I had thoughtlessly accepted and internalized this belief. It’s these largely unexamined beliefs we must do better to hold to the light. I suspect they are deep and widely spread within many of us.
Hopefaithlove, welcome to Allies in Recovery and thank you for this important question. You are allowing us to talk about a topic we don’t often have the opportunity to address on our site. I hope you are finding answers to your questions and concerns in the learning modules and on our blogs. Our hearts go out to you and your family. Remember, we are here to support you as you set out to learn more about your daughter’s struggles with SUD. Please write in again should you need guidance going forward.
Drug Policy Alliance (2018, August). 10 Facts about Cocaine.
https://www.drugpolicy.org/drug-facts/cocaine
My son started smoking crack years ago while on Suboxone. He claimed the Suboxone calmed the physical cravings but not the mental. He found a way to get around the Suboxone and get high. Less chance of overdosing on crack and beer than on heroin. Sad logic.
Dear Leah, we are sorry to publish your comment only now. We held it back until I had time to look at a recent study I worked on that provided inmates the opportunity to start medication-assisted treatment (MAT) before leaving jail. Case managers then followed them out of jail, helped them to re-admit to a community MAT clinic, and provided case management for 6 or more months.
What happened with your son — going on Suboxone and then turning to cocaine and beer to get high — does indeed happen. The theory of addiction says as much: addiction is like Whack-A-Mole, take away one “object” of addiction, and up jumps another.
Interestingly, you are not the first mom to tell me the exact same story.
I looked at the data from the jail study. Six months after leaving jail, there wasn’t a significant drop of cocaine use amongst the study’s participants. This means the number of people who go into Suboxone treatment, who also used cocaine, is roughly the same number at 6 months post release on Suboxone. This makes sense, remember Suboxone only treats one type of drug: opioids.
Substance use disorder in general requires a more holistic treatment approach. Treatment that looks at the whole person, not only at the addiction, is indeed more likely to be effective. MAT on its own is usually not sufficient to address the very complicated situation that is addiction.
In Unbroken Brain: A Revolutionary New Way of Understanding Addiction, Maia Szalavitz talks about how the physical addiction to a drug plays a minor role in withdrawal:
“It’s just that the physical symptoms aren’t the main problem. What makes drug withdrawal hard to take is the anxiety, the insomnia, and the sense of losing the only thing you have that makes life bearable and worth living […] It’s the mental and emotional symptoms — the learned connection between drugs and relief and between lack of drugs and pain — that matter.”
Maia would also say the emotional part of becoming abstinent is 90% of the problem. And it feels like your son’s behavior after going on Suboxone is only the result of a poorly bandaged wound.
What our jail study didn’t look at (and will now, thank you for your input) is whether or not people who went to jail reporting they did not regularly use cocaine, come out of jail on MAT and start using a new drug, like cocaine, cannabis, etc… Is MAT, dispensed alone, in part responsible for novice cocaine use, like your son’s?
I don’t know what your experience of CRAFT has been thus far but know we are here if you need anything. Please do reach out again if you need help navigating the site or applying CRAFT to your situation.
My (adult) daughter is currently in treatment (4th time), court ordered. I’m happy she’s safe. She’s not using and is doing good. However, I am struggling to show support because I have been disappointed time and again. She does great in a structured setting. It’s when she comes back home. She’s good for a couple weeks then she gets “stressed” and before long she’s back at it. I’m not sure how to handle her time at home and to help her with her recovery in the real world.
What a relief it must be to know your daughter is safe.
Just to help educate folks on the site. The use of stimulants (cocaine, crack, methamphetamine, amphetamines) causes a psychological “withdrawal cliff” from which the user plunges into a black, hollow mood that won’t leave, because a nervous anxiety then prevents you from sleeping. This treasonous free-fall (every 20 minutes for cocaine) sends the person back for the next line or hit, and around and around it goes. This is why users binge, sometimes for days on end. (Check out our what’s news piece: about methamphetamine).
She has always relapsed when she came home, will this time be any different?
Read my full response to hopefaithlove here: https://alliesinrecovery.net/discussion_blog-she-does-great-in-a-structured-setting-now-shes-he