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Between the Lines
Chapter 3    General impressions (part 2)
3.4    Frequency and amount
The frequency of use can vary from incidental to daily use, which is an indication of the role cocaine fulfils in the life of the user. In the American literature, a distinction is made between: experimental use, in which no pattern can be discovered; social-recreational use, approximately ten times a year at a party or another social event; routine use, in which, usually at work, small amounts are used on a regular basis; intensive use, in which daily use takes place at work or out of boredom, and cocaine has come to hold an important place in the life of the user; and compulsive use, in which the use takes place under all circumstances, at all times (Siegel 1984, Stone et al. 1984, Inciardi 1986). The frequency of cocaine use appears to be strongly varying also among the respondents from Rotterdam; from a few times a year to daily use. In the period of heaviest use, half (54%) of the respondents ingest daily (at least four times a week). During the same period well over a quarter (28%) ingest weekly (at most two or three times a week), 13% monthly (at most two or three times a month) and 5% less than monthly (at most ten times a year). Compared to the non-deviant cocaine users from Amsterdam, the Rotterdam respondents use more frequently: in the period of their heaviest use 33% of the Amsterdam respondents ingest daily, compared to 54% of the Rotterdam respondents. The similarities and differences in frequency, amount and so on, will be extensively discussed in the following chapter.
Not only frequency of use, also the amount of cocaine taken is widely divergent. Amongst daily users there are those who ingest less than half a gram a day, and there are those who ingest more than five grams a day. According to the American classification, this can be referred to as intensive or compulsive use. The respondents who use cocaine approximately ten times a year usually ingest less than one gram a month. This may be described as social-recreational (or experimental) use. For the sake of comparison, the amount of cocaine taken in one month has been calculated for each respondent. Figure 3.4 shows that in the period of heaviest use approximately the same number of respondents ingest less than one gram a month, as ingest more than 100 grams a month, 17% and 19% respectively(7). Not only do the Rotterdam respondents use more frequently as compared to the Amsterdam respondents, they also ingest larger amounts of cocaine in the period of heaviest use.
Figure 3.4
Amount of cocaine in one month, in the period of heaviest use (in %)
Amount of cocaine in one month, in the period of heaviest use
3.5    Effects
Cocaine directly stimulates the central nervous system. It has a short-lived but violent effect: excitement, restlessness, talkativeness, reduced feelings of tiredness, self-overestimation, and a feeling of being able to think extraordinarily quickly and clearly. The strongly stimulating effect on the brain can produce both feelings of well-being and euphoria and sometimes of dysphoria. Muscular strength and staying power can temporarily increase, together with a reduction in appetite (Van Rossum 1979, Van Epen 1983 and 1984, Van Ree and Esseveld 1985, Van Limbeek 1986). The immediate effect of cocaine is strongly rewarding. The emotional state of the user can vary rapidly from one extreme to the other. A direct effect of more than a half hour is not to be expected (Petersen et al. 1983). Especially with methods which work more violently than snorting the effects can pass within minutes. Incidentally, the alleged effect on sexuality is disputed (see section 3.9) (Van Ree and Esseveld 1985). Intermittent 'cocainism' à la intermittent alcoholism occurs (following three 'dry' months the user is suddenly 'under water' for a whole week). Furthermore, many authors assert that a number of effects are, in general, strikingly similar to those of amphetamines (speed), except that the effects of the latter last longer. On the other hand, cocaine does have a reputation for working at a more 'spiritualised' level. It is possible that cocaine performs similar functions for certain user groups as speed does for others.
Regarding the long term, the literature reports that perforation of the nasal septum as a result of snorting is less common than is thought (Van Epen 1984). Psychological problems such as nervousness, irritability and perception and concentration disturbances can however occur. In the case of long term excessive use, hallucinations are possible, including 'bugs on the skin' and a heavily dejected feeling (cocaine dysphoria). Cocaine depression is also described in the literature (Van den Berg 1984). On the other hand, delusions of grandeur, often combined with aggression (cocaine psychosis), and delusions of jealousy or marital unfaithfulness are well known. It is not uncommon for the user to resort to alcohol, pills or eventually opiates to suppress these delusions. In general, the level of use is an important factor for regular users.
As far as is known, Dutch hospitals do not often treat cases of cocaine psychosis. Nonetheless, in the long run psychiatric and psycho-social consequences seem more likely than serious physical complaints (Siegel 1985). A small subgroup of Cohen's respondents who volunteered themselves for examination also revealed no serious physical problems, whereas some defects in their mental functioning were observed (1989). According to Van Limbeek (1986), however, the effects of cocaine in this respect are heavily exaggerated. Almost all the psychiatric complications of cocaine use mentioned in the literature lack any form of clinical evidence. Furthermore, where such complications do appear it is questionable whether the drug is not simply working as a release mechanism: a latent psychological disturbance is made manifest.
Half (55%) of the Rotterdam respondents admit to problems that are related to the use of cocaine. This concerns a great variety of problems: from a hangover the next day (psychological and/or physical), lack of money, to violent feelings of craving. A quarter of the respondents have severe problems due to cocaine use: they have physical, psychological, social as well as economical problems, or call themselves addicted to cocaine(8). Figure 3.5 shows that respondents who do have problems but are not addicted, mainly mention psychological problems. These concern for example slight feelings of guild, but also symptoms of paranoia. Social or economical problems are less often mentioned. According to Cohen's findings, physical problems are also seldom mentioned as the most important problem.
Figure 3.5
* addicted: the respondent mentions physical, psychological, social as well as economical problems, or terms himself addicted.
The extent to which cocaine use eventually leads to problematic behaviour is still an open question. An American study, primarily among students, revealed that the majority were able to maintain a pattern of social-recreational use over a span of eight years, including periods of reduced or non-consumption. There was thus no evidence of an inevitable increase in dependency (Siegel 1984). Erickson et al. (1987) and, in the Netherlands, Cohen (1989) revealed a similar picture. Others indicate however that it in fact takes years, perhaps even ten or more, before real dependency problems appear. In this respect the problem is comparable to that of alcohol. This would mean that a cocaine addict would only come into contact with drug care and treatment after years of use. Since it is assumed that there is only a relatively short tradition of intensive use in the Netherlands, it is still too early for much meaningful comment. According to this vision, the final effects of cocaine use in the long term are perhaps more serious than for heroin. Workers in drug assistance agencies, in particular, now regard the drug as less innocuous than they did ten years ago. The relationship between length of use and the occurrence of problems will be further discussed in the following chapter.
Finally, in discussing the effects of cocaine the non-specific medical complications may be mentioned, such as Aids due to injections and possibly also in connection with prostitution. Among prostitutes in New York, Sterk (1988) found not only a connection between intravenous (injected) cocaine and crack use and seropositivity, but also at least as strong a connection between the latter and non-intravenous harddrug use. The explanation almost certainly lays in the many changing sexual partners as a prostitute, often in direct exchange for crack. According to the respondents from Rotterdam, a connection between Aids and intravenous cocaine use does not exist in their cases.
3.6    The addiction concept
Traditionally, a distinction is made in addiction studies between physical and psychological addiction. In the case of opiates there are clear physical withdrawal symptoms (kicking the habit), which is why they are referred to as heavily addictive substances. According to available information these symptoms are entirely absent for cocaine, or they only appear after extremely excessive and/or prolonged use of the drug. By and large it is also thought that tolerance scarcely ever develops with cocaine. The user may want increasing amounts during a given run(9), but this has supposedly no influence on the amount needed the next day to satisfy his (addiction) needs. Nonetheless, so-called drug-seeking behaviour does manifest itself in cocaine users and what is more, their craving for the drug can be enormous. This craving is seen as the core around which a far-reaching psychological dependency can develop. In this sense cocaine would have to be termed heavily addictive. This concerns a different addiction concept than is used for the opiates (Van Rossum 1979, Zuidhof 1984, Van Epen 1988, Peele 1985). It is however (as yet) unknown how quickly, how strongly and among how many users the phenomenon of craving occurs.
Cocaine appears to give the user a brief moment of complete satisfaction, followed by rock bottom that calls for immediate restoration. Therefore, the user always wants it again and again (Van Meerten 1992). In that sense cocaine is a seductive and intensely compelling drug; it is the most unsatisfying and limitless stimulant in existence (Spotts and Shontz 1984). In other words: with this psychogenic addiction (its origin lies in the psyche), once the cocaine has run its course the user receives an abrupt emotional set-back and he thinks he physically needs the drug. This is craving (Inciardi 1986). A psychogenic addiction can also manifest itself physically (Peele 1985, Kleber 1992). When asked the difference, opiate addicts often say that heroin and/or methadone is really needed and cocaine not, but that, despite this, once a user started taking cocaine he keeps on seeking it. Three quarters of Cohen's sample of non-deviant users claim to have experienced craving, half of them within three years of first use (1989). Long term cocaine dependency is frequently mentioned in connection with self or ego destruction.
It is no coincidence that the strong psychological addiction to cocaine has reopened the discussion on the duality between body and mind, traditionally prominent in the addiction literature (Peele 1985). The question wether cocaine is physically addictive is not relevant; if enough is used, psychological dependency develops extremely quickly (Spotts and Shontz 1984). The demarcation between body and mind, in the final analysis traceable back to Descartes, has perhaps become too much of a barrier in our patterns of thought.
Cocaine is such a demanding drug that it seems capable of bringing excessive users into serious difficulties. Since the Mid-Eighties the CADs in the Netherlands have seen the arrival of the cocaine addict, as opposed to those who are addicted to opiates etc. These are people who often started using cocaine in their social life, but have remained better integrated than poly-drug and heroin addicts. If they come into contact with the law it is only after a long time (Van Limbeek 1986). The experience of the CADs in Rotterdam and Amsterdam shows that a portion of the group of non-deviant, socially integrated cocaine users comes into contact with drug programmes only after about fifteen years of social use. These are people with social bonds and responsibilities (Fabriek 1987). Excessive alcohol use is also common. Users come into contact with the CAD when, for example, cocaine begins to assume an increasingly central position in their lives, especially in the eyes of those in their immediate surroundings. The experiences of the Rotterdam CAD have shown that these clients can generally be helped by involving their entire social system (partner, family and social contacts, etc.) in the treatment.
As stated above, a quarter of the respondents from Rotterdam encounter severe problems due to the use of cocaine: they experience physical, psychological, social and economical problems, or say they are addicted. A tenth (11%) of the respondents who never used opiates encounter severe problems: these are the so-called primary cocaine addicts. In Rotterdam the larger part (85%) of the respondents with addiction problems have been in contact with drug assistance agencies. Chapters four and five will go more deeply into this.
3.7    Cocaine, alcohol and other drugs
The literature generally states that cocaine users take, or have considerable experience with, (various) other drugs. Soft drugs, sedatives and alcohol are the most common. Virtually every cocaine user has some experience with marijuana or hashish. More important is the fact that in America in the Seventies the social-recreational setting and culture surrounding the use of both drugs initially showed strong similarities (Kozel and Adams 1985, Erickson et al. 1987). Only a minority has experience with opiates (Spotts and Shontz 1980, Siegel 1984, Erickson and Murray 1989). Sedatives and sleeping pills are mainly used as calming agents after a cocaine run.
Discounting alcohol, cannabis is the first drug most (87%) of the respondents from Rotterdam used; 7% started out with cocaine, 4% with amphetamines and 2% with heroin. From this it becomes clear that most respondents have experience with other drugs in addition to cocaine, for example cannabis, amphetamines, hallucinogens, tranquillizers and opiates. XTC is a relatively recent drug a large part of the respondents is acquainted with (see section 3.10). Only 2% have experience with only cocaine. Earlier in this chapter it is mentioned that one third (33%) of the Rotterdam respondents also use or used opiates. In contrast with the Amsterdam study, these respondents can be seen as opiate addicts(10).
The combination of cocaine and alcohol is mentioned very often in the literature (in the Netherlands: Fabriek 1987, Sandwijk et al. 1988, Cohen 1989). The effects of alcohol in the bloodstream appear to be largely neutralised by the use of cocaine. If while out on the town, for example at a disco, a person discovers he has had a little too much to drink for optimal enjoyment, cocaine offers a solution; it seems to clear the head. Alcohol increases the desire for cocaine, and cocaine makes you thirsty (Van Hunnik 1989). You can go on all night in this way. Nightlife and parties at home allow cocaine, at least in theory, to become strongly integrated in our society. Also in the interviews alcohol is frequently mentioned. In chapter five, in which types of cocaine users are distinguished, the relation between alcohol and cocaine will be further discussed.
3.8    Connections with deviant and criminal behaviour
Consciousness-influencing substances which are newly attracting publicity are quickly blamed for criminal behaviour. However, it seems difficult to prove scientifically whether such a connection can be made for specific substances (Watters et al. 1985, Leuw 1988). Furthermore, people who only use cocaine are not a very easily traceable group for the police, so that accurate data are not available. Regular use of cocaine is not necessarily accompanied by criminal behaviour. One third of Cohen's respondents have at some time been connected with criminal activities. Excluding the offence 'dealership', this proportion drops as low as 15%. Only a negligible percentage has been involved in ten or more criminal acts other than dealing (Cohen 1989). The author concludes, however, that his material does not permit firm conclusions on the connection between cocaine use and criminal activity.
At the level of the user, a distinction can be made between criminal activity surrounding small-scale trading, income generating crime, and other crime-reinforcing effects of cocaine. The small-scale trading takes place partly in the same circles as (the acknowledged problem drug) heroin (Intraval 1989 and 1991, Grapendaal et al. 1991). Criminal behaviour is normal in that world. In addition, there is said to be a separate dealer circuit exclusively for the socially integrated cocaine users. Possibly there are fewer links in the chain between the importer and consumer of cocaine (Lewis 1989). This could mean, ironically, that individual dealers, including those in socially integrated and even elite circles, have much more serious criminal connections (since they are dealing in larger quantities) than is the rule in the more diluted small-scale dealing in heroin (Lewis 1989). One third (32%) of the Rotterdam respondents are (or have been) involved in cocaine trafficking in one way or another. Only a few respondents appear to be connected with international trafficking. The others are active in small-scale dealing or (re)sell small quantities of cocaine to close friends. A quarter of all the dealing activities consist of (re)selling cocaine to close friends, almost three quarters of activities within the small-scale trade.
As far as acquisition crime is concerned, cocaine costs as much as heroin on the black market. Furthermore, an intermittently much higher level of use than is normal for opiates can necessitate a high level of income generation for the excessive cocaine user (Van Limbeek 1986, Grapendaal 1989). Among the Rotterdam respondents too income generating crime is seen, especially in the period of heaviest use. In this period almost half (48%) of the respondents is criminally active. The larger part of the criminality consists of property offenses (60%), followed by drug trafficking (32%).
Some people think that physical offenses against persons are more common with cocaine than with heroin (Spotts and Shontz 1980, McBride 1981). Other criminal consequences have mainly to do with the uninhibiting effect of cocaine: macho and dare-all behaviour, and physical and psychological self-overestimation. It is not known whether the drug is consciously used in this manner (if this did turn out to be the case, it could indicate intention despite awareness of the possible outcome). Finally there is the matter of cocaine use and violent crime. It is generally thought that alcohol, amphetamines, and substances which lower, rather than raise consciousness play a greater role than cocaine in violent crime. Further, it has already been suggested that cocaine in combination with other substances may function as a lever in this context. Analysis of incidental cases has shown that cocaine can play a substantial role in violent crime, again in combination with alcohol (Van Epen 1988, Budd 1989). However, only 4% of the Rotterdam respondents state that violent offenses are their most important criminal activities in the period of heaviest use; (group) vandalism is not even mentioned. Finally, we can note that, unlike opiate users, cocaine users are rarely involved in public order disturbance.
To summarize, we may say that the use of cocaine is not as such connected with criminal behaviour. In the period of heaviest use almost half of the Rotterdam respondents commit crimes, in particular property offenses, followed by drug trafficking. However, to what extent the respondents were already criminally active before they used cocaine, cannot be determined on the basis of the available research material. Only a few respondents (4%) mention violent offenses to be the most important crimes they commit in the period of heaviest use. In such cases it is not known if the offenses should be attributed to cocaine, alcohol, speed, or to a combination of these substances.
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Table of Contents
Chapter 1    Introduction
Chapter 2    Methodology
Chapter 3    General impressions
Chapter 4    The main characteristics
Chapter 5    Typology
Chapter 6    Spread, dispersion and extent
Chapter 7    Conclusions and discussion
Appendix A    Glossary
Appendix B    Occupation classification
Appendix C    Patterns of use
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