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Learn More. Numerous studies have pointed out the risks of cocaine use for mental health. Most clinical studies report a high psychiatric comorbidity, mainly among crack users. In this paper the association of mental health problems with sociodemographic variables and patterns of use is analysed, based on data from a multicentre European study including a field survey of cocaine users in different settings.
Bivariate analyses revealed that mental health problems were influenced by all variables under consideration, i. However, in a regression analysis, intensity of use, physical health, severity of dependence and social situation were found to be predictors of mental health problems, while crack use by itself was not. These findings suggest that mental health consequences are related more to the intensity than to the form of cocaine use. Considerable debate has surrounded the potential dangerousness of cocaine, since many people continue to use the drug on a recreational basis without reporting problems.
The health risks of cocaine use include a of medical complications, such as cardiovascular or respiratory disorders, that in some cases can lead to death. Acute cocaine use can lead to the wanted effects of euphoria, self-assurance, increased attention, reduced appetite, less tiredness, among others, but can also lead to unwanted effects such as anxiety and paranoia, egocentric behaviour, dysphoria, anorexia and delusions. After cocaine withdrawal, a typical symptom is anhedonia. A greater severity of cocaine dependence is associated with a more severe depressive symptomatology after withdrawal 1.
Health related effects of cocaine are largely related to the route of use. Routes of use have important implications for pattern of use, drug effect and risk of dependence, with smoking and intravenous use associated with greater absorption, a shorter more intense high and a greater tendency toward a binge pattern of use 23. Different routes of using cocaine are associated with different negative consequences 4. Crack users have a greater of symptoms, and higher levels of anxiety, depression, paranoid ideation, and psychoticism 56. Other symptoms, such as aggression and violence, are associated more with crack than with cocaine powder.
Psychiatric comorbidity among cocaine dependent users is not only increased for other substance disorders, but also for personality disorders 7 - 9post-traumatic stress disorder 1011and depressive disorders 12 However, there remains a paucity of research evidence concerning the association of mental health problems with the complex interaction of length of cocaine use, the social context and the route of use.
This multicentre, multimodal field study was aimed at defining specific recommendations guidelines in order to ameliorate the care for regular cocaine and crack users. The project was initially carried out by research centres in nine European cities Barcelona, Budapest, Dublin, Hamburg, London, Rome, Stockholm, Vienna, Zurichwhile a tenth research centre Paris ed in during the course of the project. The treatment group was recruited mainly in outpatient maintenance clinics or, if not possible, in other inpatient or outpatient addiction treatment settings.
The marginalized group was recruited at places where drug users usually meet to sell, buy or use drugs, or in the surroundings of low-threshold addiction facilities e. The integrated group was recruited at different party places e. To exclude an overlap between the three target groups, each centre deter- mined specific recruitment locations, e. Besides affiliation to the respective target group, the inclusion criterion was the use of cocaine powder or crack cocaine at least once in the last month.
The three target groups were consecutively recruited according to a criteria oriented sample strategy. Subjects at the determined recruitment locations were first asked with regards to the inclusion criteria. If these were met, and after the subject gave informed consent, the interview took place.
Structured face-to-face interviews were conducted to assess the consumption behaviour, social and health status. The instrument used was an adjusted version of the Maudsley Addiction Profile MAP 14including a 10 item physical health symptom scale adapted from the Opiate Treatment Index, OTI, 15 and a 10 item scale to assess mental health problems derived from the anxiety and depression subscales of the Brief Symptom Inventory, BSI The adjusted version included items concerning patterns and history of cocaine and crack use, and some items concerning the social situation.
In addition to the current drug use data, lifetime data assessed according to the European Addiction Severity Index ASI 18 were reported for cocaine powder and crack cocaine. Because of the low prevalence of cocaine in Stockholm 19it was not possible to recruit a sufficient of cocaine users who met the inclusion criterion of having used cocaine powder or crack cocaine at least once in the past month. Therefore, the following analysis is based on data from nine European cities. There were small deviations from the originally intended sample size of 70 cocaine users in each group and each city.
The patterns of use varied greatly between cities and between the three target groups Thirty-two percent of the sample were female. The average age of the whole sample was On average, males In the last 30 days, the average of days with cocaine use was The severity of dependence according to SDS was 5. Fourteen percent of the sample reported no period of regular cocaine use period of at least six months with a use of more than two times per week in their lifetime.
In those with a period of lifetime regular use, the average duration of regular use was 6. With respect to problems with physical health, the sample reported an average of With respect to mental health problems, the sample showed an average BSI score of Stable: stable living situation and employed; partially stable: unstable living situation or unemployed; unstable: unstable living situation and unemployed. In order to understand which variables best predict mental health problems in this sample of cocaine users, a multiple linear regression analysis was performed, including the variables gender, age, social situation, days with cocaine use, crack use, length of regular use those with no lifetime regular use were set at 0 yearsseverity of dependence and problems with physical health.
However, crack use by itself and the length of regular cocaine use do not predict the extent of mental health problems. In the past, numerous studies have shown the risks of cocaine use for both physical and mental health. The focus with respect to mental health risks has come mainly from clinical studies, reporting a high proportion of psychiatric comorbidity.
Many studies have concentrated on the specifically high risk of health problems related to crack use. This paper is based on a field survey of cocaine users and explores the association of mental health problems with sociodemographic factors as well as patterns of use.
Since not only clinical cases were included in the survey, the study allows for a much wider view of cocaine use in the population, including users who do not consider their cocaine use a problem. Although not assessing a representative sample of the population, the survey includes a large sample of all the main subgroups of cocaine users in the society. The main result of the study is the association of mental health problems with various sociodemographic factors as well as patterns of use. This included the variable of crack use, with a ificantly higher mental health problems score for crack users than for users of cocaine powder.
However, the regression analysis was then able to show that crack use by itself was not a predictor of higher mental health problems. Predictors of mental health problems were the intensity of use, physical health and the social situation. These findings suggest that the severe consequences are related more to the intensity than the form of cocaine use. Although this position has been stated in a review in the past 3there have been numerous studies since then which all focus on the form of cocaine use crack cocaine versus cocaine hydrochloride rather than on the intensity of use.
With respect to the prevention of mental disorders among cocaine users, the high correlation of mental health problems and physical health problems points to the importance of screening for mental health problems among cocaine users in other medical settings such as general practitioners and emergency rooms, similar to the Drug Abuse Warning Network system implemented in the USA The with respect to the severity of dependence and the social situation emphasize the necessity of implementing harm reduction measures. Severity of cocaine dependence, as assessed by means of the SDS, mainly refers to psychological components of dependence, such as impaired control over drug taking and preoccupation and anxieties about drug use.
Hence, harm reduction measures that are aimed at safer, more controlled, less intensive use of cocaine may decrease mental health problems. Similarly, stabilising the social situation of drug users may have the same effect. Furthermore, the higher risks for female users, in line with the findings of McCance-Katz et al 22need to be addressed in prevention, treatment and research. Haasen, M. Prinzleve, H. Zurhold, M. Krausz Hamburg, Germany ; M. Casas, J. Matali, E. Bruguera Barcelona, Spain ; J. Gerevich, E.
Bacskai Budapest, Hungary ; G. Cox, N. Ryder, S. Butler Dublin, Ireland ; M. Gossop, V. Manning London, UK ; A. Pezous Paris, France ; A. Verster, A. Camposeragna Rome, Italy ; B. Olsson, M. Ekendahl, P. Andersson Stockholm, Sweden ; G. Fischer, R. Jagsch, A. Primorac Vienna, Austria ; J. Rehm, F. Guettinger Zurich, Switzerland. National Center for Biotechnology InformationU.
Journal List World Psychiatry v. World Psychiatry. Author information Copyright and information Disclaimer. Copyright World Psychiatric Association.
This article has been cited by other articles in PMC. Abstract Numerous studies have pointed out the risks of cocaine use for mental health. Keywords: Cocaine, crack, mental health problems, intensity of use. Measures Structured face-to-face interviews were conducted to assess the consumption behaviour, social and health status. Subjects Because of the low prevalence of cocaine in Stockholm 19it was not possible to recruit a sufficient of cocaine users who met the inclusion criterion of having used cocaine powder or crack cocaine at least once in the past month.
Table 1 Differences in mental health problems Brief Symptom Inventory score. Open in a separate window. Table 2 Regression analysis summary for variables predicting mental health problems. References 1. Uslaner J. Kalechstein A. Richter T, et al.
Association of depressive symptoms during abstinence with the subjective high produced by cocaine. Am J Psychiatry. Gossop M. Griffiths P. Powis B, et al. Cocaine: patterns of use, route of administration and severity of dependence.Effects of cocaine on mental health
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Cocaine and Psychiatric Symptoms