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Between the Lines
Chapter 7    Conclusions and discussion
Cocaine is a drug with a number of very different aspects. It is a far less straightforward drug than heroin, for example. It has been known for some time that cocaine is no longer the privilege of a small elite group found mainly in the higher socio-economic echelons. Furthermore, present day users include also opiate addicts. Cocaine has, to some extent, lost its aura of glamour and is no longer considered the champagne or caviar of drugs. In Rotterdam, too, cocaine use appears in different groups of the population. In this chapter we will discuss the most important conclusions and recommendations of our research project on the nature, the extent and the spread of cocaine use in Rotterdam. We will begin with several general conclusions and policy recommendations and then turn our attention to some methodological aspects.
7.1    Conclusions and recommendationss
Nature
No other drug shows a greater diversity in the ways it is taken. Cocaine is sniffed, smoked, used by way of chasing the dragon, injected, smeared on gums or genitals, or swallowed. All forms or combinations of these methods are employed, too. Sniffing is the most widespread method. More than half of the respondents use sniffing as their main method, followed by injecting (15%), basing (5%) and chasing the dragon (3%). A quarter of the respondents use cocaine in more than one way. The way in which the drug is taken will largely determine the effect it has. There is a strong correlation between frequency of use and the amount taken. It is possible to identify two rough categories. On the one hand there is sniffing and smoking, in which the effects are generally mild and the cocaine is used socially, mostly sporadically and in small quantities. On the other hand there is basing, chasing the dragon and injecting which usually cause strong short term effects with the user quickly wanting more cocaine. In such cases, cocaine is often taken daily and in great quantities. It is particularly in relation to these latter methods that we may speak of compulsive cocaine consumption. Chasing the dragon and injecting are the methods normally employed by opiate users. Basing is also popular among non-opiate users. Although the effects to some extent resemble those of injecting and chasing the dragon, basing has a more positive image among non-opiate users. They believe that if you inject you are a junkie, whereas if you base you are not.
From what has just been said, it is clear that when speaking of cocaine one must distinguish two more or less distinctive drugs, depending on the method of use. Sniffing appears to often take place in a socially integrated setting, without too much personal or social inconvenience. Basing is a more risky method of use. It often (quickly) leads to compulsive use and the problems associated with this. The chance of a user becoming addicted by using this method is quite high. Nor is sniffing wholly without danger. A number of users whose sole method of taking cocaine is sniffing have developed a compulsive pattern of use.
It seems that cocaine is not such a harmless drug as some people claim. Addiction depends not only on the duration of use but, more particularly, on the method employed. Compulsive use occurs among opiate users as well as non-opiate users. Cocaine addiction appears to be different from heroin addiction. People often refer to the 'psychological' dependence of cocaine, whereas heroin is said to produce a more 'physical' form of dependence. What our study also did indicate is that a number of compulsive users stop of their own accord when excessive cocaine use leads to an overload of problems. In these circumstances aspects such as social-economic status and social bonds are important.
A number of studies have shown that there is a complex relationship between drug use and criminal behaviour. This applies not only to heroin but also, and to an even greater degree, to cocaine. For many users there seems to be no relationship between use of cocaine and criminal behaviour. For a number of others, however, the use of cocaine fits into an already existing criminal lifestyle. In addition, there is the criminal behaviour which is connected to cocaine taking as such. In this context, two aspects may be distinguished:
The following picture emerged of dealing at street level.
   
  • Acquisition crime is strongly dependent on the method used, the frequency of use and the amounts used, and the primary sources of income. Although some people assume that violent crime under the influence of cocaine is on the increase, we found little evidence to support this in our study.
  • While there is evidence of aggression and vandalism under the influence of cocaine, the level is less than expected. When it does occur, it is difficult to determine if the cause is cocaine or alcohol or speed, or a combination of these substances. Other drugs, particularly alcohol, are often taken simultaneously with cocaine. Cocaine taking is frequently accompanied by large intakes of alcohol. To some extent, cocaine neutralizes the effect of alcohol but, at the same time, it creates thirst.
Another important topic is the public nuisance caused in connection with cocaine. Here, also, two aspects may be distinguished, namely the nuisance caused by use and the nuisance caused by dealing.
  • Cocaine taking by people who do not use opiates does not often lead to trouble. Opiate users, especially those who base and/or inject, appear to get somewhat more aggressive when using cocaine.
  • Dealing at the user level only in cocaine causes little or no nuisance. In places where heroin and cocaine are sold, this increases slightly. A (international) study on the supply side may give more insight into this.
The features mentioned above cannot, as such, be ascribed to cocaine. The cocaine which the user buys is never pure, it is often laced with other substances. The question however is, which other drugs. There are strong indications that a lot of cocaine is mixed with amphetamines (speed). It is possible, therefore, that it is the effects of these drugs which are observed rather than the effects of cocaine. The same applies, incidentally, to XTC. A study, in which samples of cocaine (and XTC) are collected at user level as randomly as possible and then analyzed, could give more information on this.
Eight categories of cocaine lifestyles have been identified in this study. They can be roughly divided into three groups, according to the role of cocaine in the different lifestyles. In the first group, consisting of the Burgundian type, the experience type and the situational type, cocaine is of only limited significance. Cocaine does not play a dominant role in the lives of these people, there are no problems with the drug and the method used is mainly limited to sniffing. It is only within the experience type that there are people who, in order to try it out, have based a few times. Within the second group, the distinctive type, the hedonist type and the routine type, cocaine plays a more important role. It is used more often and in greater amounts. The use of cocaine causes problems in different areas, which are, in the first instance, often denied. These problems are sometimes solved by using less cocaine for a while, only to pick up the thread again later on. These three types constitute a risk group which should be given attention. The danger is that the hedonists, in particular, will come to find basing attractive and will be confronted with the consequences of this method. The third group, comprising the poly-drug type and the cocainists, have a lifestyle centred around cocaine. There is evidence of a high frequency of use (daily) with large amounts being consumed. Particularly the cocaine addicts state that personal problems were a reason for them to start taking the drug. The poly-drug type also uses heroin but when they take cocaine, the problems seem to get a different and more serious character. Agitated behaviour, aggression and paranoia have frequently been noted. It was in an effort to limit these negative effects of cocaine that some respondents started taking heroin.
Spread, dispersion and extent
There is clear evidence of a certain democratization in the use of cocaine: it occurs in all social strata of the population. In line with most drug use, there are more male than female users. The drug is taken by young and old, with emphasis on the age category 20 to 30 years. More than one tenth of the respondents is of non-Dutch origin. The social backgrounds of the users show wide variations. One third have had higher education and one fifth lower technical school. Users are found among the employed and unemployed, school pupils, students and housewives. There is also a great variation in the sectors in which users are employed: ranging from pub/cafe work, technical, artistic, cultural and professional occupations, to criminal circuits and the sex industry.
In our study, we have identified five circuits in which people take cocaine: the entertainment circuit, the workplace, the home circuit, hobby/sports and the hard drug scene. The place where cocaine is most often consumed is at home (almost half the respondents and the users named by them are in this circuit) followed by the entertainment circuit (27%). During the period of heaviest use, the hard drug scene becomes almost as significant as the two above mentioned circuits. The respondents are acquainted not only with users from their own circuit but also from the other circuits. People may be aware of each other's use of cocaine, but, in most cases, the drug plays only a limited role in their relationships with other cocaine users. This is especially true of older users. These findings clearly illustrate the open nature of cocaine use. In Rotterdam, a rough distinction can be drawn between two groups of users: the first four circuits which show a degree of interrelationship and the hard drug scene.
It appears that cocaine and nightlife are still closely intertwined. In pubs, cafes and discotheques control on the use of cocaine is becoming increasingly strict. This is one of the reasons for the shift to outdoor use, in cars, telephone cells, parks and so on, and to the home (with close friends).
Various user markets have been identified:
  • The street: for instance around Rotterdam Central Station. Sometimes, 'cooked coke' is also sold there. This location shows a clear overlap with the heroin market.
  • Heroin dealer premises: these are situated in different parts of Rotterdam. There is a strong interrelationship with heroin dealing. These premises are mostly visited by poly-drug users.
  • Cocaine dealer premises: these too are found throughout Rotterdam. Only cocaine is sold in these premises and most of them cause no disturbance and are therefore never, or only rarely, known to the police.
  • Porters or house dealers: in various pubs, cafes and discotheques in the city. There appears to be a separate market, not linked to the heroin market. Sometimes hash, speed or XTC are also available.
  • Home delivery: this concerns a number of dealers spread across the city. As far as we can tell most of these dealers sell only cocaine though one or two may also deal in hash. This market is separate from the heroin market.
In order to determine the number of cocaine users, a number of new estimators have been developed. With the necessary degree of caution it is possible to state that the closest possible estimation of the number of Rotterdamers who have taken cocaine at least 25 times and/or five times in the last six months is around 12,000 (2% of the total population). This is no small figure when one takes into account that the latest estimation showed that there are some 2,500 opiate addicts in the city. This would mean that approximately 9,000 Rotterdamers are using (have used) cocaine on a more or less regular basis. As we stated earlier, a number of these people will be requiring help from the (drug) assistance agencies in the coming years.
Prevention and intervention
Two aspects need to be distinguished in the context of a prevention and intervention policy.
a. Health/addiction
It is predicted that the number of cocaine users with dependence problems will increase, both among poly-drug users and those taking only cocaine. This means that an increasing number of users will be knocking on the door of the (drug) assistance agencies. Seeing the effect of cocaine, it is advisable to consider new treatment methods which are of a more therapeutic nature. In the United States, for example, behaviour therapy combined with antidepressants is often used. Another approach, the 'coping' model, employed by some social workers may offer opportunities for targeted intervention. It is important to draw a clear distinction between provisions for the more socially integrated cocaine addicts and those for poly-drug users. The former wish to avoid any identification with the latter.
In addition to good intervention programmes, information on the various facets of cocaine should be presented openly and clearly, and related to the different risk groups. We have to note, however, that it will not be easy to draw up an effective prevention policy which will embrace the different ways in which cocaine is used or its diverse effects. One individual may sniff for years without any problem. Another who is basing will often (and very quickly) have dependency problems and may be involved in criminality. It is vitally important that this difference between categories of users is emphasized and clearly understood. An additional risk factor for those who are injecting is the link with Aids. Not only are dirty syringes a risk, but also unsafe sex.
Examples from the United States and Great Britain show that use of crack can lead to major social problems, particularly for the socio-economically disadvan-taged groups. This is linked to the compulsive working of crack and the criminal violence often linked to dealing and use. Every effort must be made to prevent crack making inroads into the Netherlands.
b. Nuisance/criminality
Acquisition crime is to be expected particularly among compulsive users. This also occurs in cases of non-opiate users in their period of heaviest use. The effect of cocaine in removing inhibitions may well make it easier for someone to commit property offenses. Aggression and vandalism do not appear to occur very often under the influence of cocaine. However, when an offence is committed it is difficult to know if it is due to cocaine, alcohol, or speed, or a combination of these substances. It may well be that certain opiate addicts exhibit more aggressive behaviour under the influence of cocaine. Further research is needed to obtain a better insight into this.
As far as dealing, which is restricted to cocaine, is concerned, there is little evidence of trouble. Visual and public order nuisance are more likely to occur when heroin is (also) being traded. There is, however, the impression that (large scale) cocaine trafficking is more aggressive and violent. Furthermore, there appears to be more intermingling of the so-called upper and underworld in cocaine trafficking.
7.2    Methodological asspects
Social scientific research of drug use in the Netherlands regularly employs so-called qualitative methods. In our Rotterdam study we preferred to use a combination of qualitative and quantitative methods. This approach made the results more universally applicable and at the same time made it possible to carry out various analyses of the collected data. Using snowball sampling, not only for obtaining respondents but also for gathering relational data, is relatively new. Using the data of the snowball sample to estimate the number of cocaine users is a new method which has been developed in the context of this study by Intraval together with the Statistics and Measurement Theory Department of the University of Groningen (see Frank and Snijders 1992). This cooperation has also resulted in further methodological research focused on underpinning random samples with the snowball method and other related methods.
The interviews provided not only extensive information about the respondent, but also about friends and acquaintances who are taking cocaine. Through this network data, more insight has been obtained into relationship patterns between cocaine users and the contacts between the various circuits in which cocaine is used. This forms a useful addition to the information obtained from the in-depth interviews (which give, in particular, a good impression of the nature of cocaine use). The analysis of the research data has been subjected to both the qualitative maximum-minimum comparison method and several quantitative methods: loglinear analysis, principle component analysis and, in the processing of the network data, the recently developed method of multi-level analysis. These analysis techniques are used in particular to clarify certain statistical connections in the data. The findings are then reported in a non-formal statistical manner. In applying these techniques we were confronted with the problem that the initial sample of respondents is not random, while the techniques employed are based on the supposition that this is the case. We have tried, nevertheless, to ensure that the initial sample does not deviate too much from a random sample by selecting the subjects as carefully, and as separate, as possible. It is impossible to be sure that this has worked. This is, however, an unavoidable hazard in a study of a hidden population such as cocaine users. Based on the experience gained during our study, we can make the following recommendations for future research.
  • Using snowball samples in studies of populations of drug users and a combination of qualitative and quantitative research methods is an effective approach. It is important, in such a study, that the initial sample is as random as possible. It is difficult to achieve this fully in populations which are difficult to reach, but it can be approached by means of a careful sample procedure which is as independent as possible.
  • Qualitative analysis in which the use of drugs is placed within the concept of lifestyles provides the best opportunity for research into a phenomenon as diffuse as cocaine use.
  • In future studies efforts should be made to achieve a closer alignment of the so-called qualitative and quantitative data.
  • It is possible to estimate the size of populations of drug users on the basis of 'one-wave' snowball samples as long as the initial sample is large enough in relation to the estimated populations and the people in the initial sample are approached as independently as possible. Further methodological/statistical research is needed to get an optimal random initial sample by using different circuits, settings or social 'milieus'. Furthermore, such an initial sample should be seen more as an approach of a stratified random sample rather than a simple random sample.
  • In the analysis of network data in this type of research the personal network approach is more useful than the total network approach. Multi-level analysis is the most appropriate method.
  • Analyzing relationship patterns, or social networks, of drugs users or other relevant populations is a valuable addition to the research methods that have been commonly used so far. It produces results which are important for both researchers and policy makers. It must be noted, however, that useful answers to relationship questions will be forthcoming only if trust has been established between the respondent and the interviewer. A bond is built up in the extensive interview which enables relationship questions to be answered more readily.
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Table of Contents
Preface
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
Summary
Literature
Appendix A    Glossary
Appendix B    Occupation classification
Appendix C    Patterns of use
 
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