Acts of violence such as verbal arguments, physical fights, threats, death threats, theft, and drug trafficking were significantly higher among crack users. A decrease in frequency of sexual intercourse was observed among users of injected drugs, though prostitution was observed as a means of obtaining drugs.
A high number of crack cocaine users had a history of previous imprisonment, many for drug-related infractions. The data presented are in accordance with other reports in the literature, and they show a correlation between drug use, imprisonment, violence, and drug trafficking. A high HIV prevalence and associated risky sexual behaviors were observed among crack cocaine users. The society and the authorities that deal with violence related to crack users and drug trafficking should be aware of these problems.
Substance Use in Women
Drug users are a group that deserves special attention by the health care system, due to their high rates of exposure to infections, particularly those transmitted through the use of contaminated materials syringes, needles and related components and through unprotected sexual intercourse. In addition to the increased individual risk of acquiring these infections, drug users play an important role in the transmission of diseases in their communities.
The use and abuse of illegal drugs appears to be associated with drug trafficking and violence. In many countries, such as Thailand, the United States, and some European nations, heroin is easily accessible, but it is not as easily available in most of countries in South America. The use of crack cocaine, or crack, was first reported in in Europe and the US 7 as a new drug with quick, stimulating effects. Crack cocaine is a byproduct of cocaine, obtained from the leaves of a shrub named Erythroxylon coca.
The refining process begins with the transformation of the leaves into a product known as basic cocaine paste BCP. The paste can then be turned into either crack cocaine through chemical treatment with sodium bicarbonate, or into a white powder cocaine when it is refined with ether acetone or sulfuric and hydrochloric acids. In its powdered form, the drug can be inhaled, used orally or intravenously; the paste basuko , merla and rock crack cocaine forms can be smoked either on their own or together with tobacco or cannabis-marijuana pitillos or mesclado.
The powdered and rock forms of the drug are less costly, albeit far more virulent and harmful to health. According to information from federal and state authorities, as well as field studies and clinical reports, crack cocaine abuse in Brazil is on the rise. Violence also seems to be associated with the use and illegal trafficking of illicit drugs - a fact that has received great attention in the media.
Beato Filho et al. A study by Inciardi 15 shows that homelessness among boys and girls prompts drug abuse and violence. The users may not only be the offenders in cases of violence, but also the victims. According to some studies, the growing wave of violence is attributable to drug use and trafficking. It is reasonable, therefore, to suppose that one important factor associated with violence is drug trafficking.
Taking into consideration that there are few studies that focus on crack use, this study was carried out with the objective of gathering data on the behavior and attitudes of the specific group of drug users in relation to drug abuse, violence, sex and drug trafficking in Brazil. We hypothesize that there is a relationship between crack and other drug use, involvement in violence, and behaviors that predispose individuals to the transmission of sexually-transmissible diseases.
This cross-sectional study was carried out between April and January All individuals admitted to the below-mentioned institutions during the study period were included in the analysis. Participants were individuals who had reported using illegal drugs in the past 6 months. The number of selected patients was based on the calculated sample size for this study.
Crack Cocaine Use and Adherence to Antiretroviral Treatment Among HIV-Infected Black Women
Participants were interviewed by completing a standard questionnaire that has been validated in previous studies and consisted of mainly closed-ended questions. Interviewers, all of whom were psychologists, properly informed participants of the nature of our research. Participation in the study was voluntary, and confidentiality was guaranteed. All participants agreed to and signed an informed consent form.
Questionnaires were first checked for their scope and consistency of information by researchers who participated in the project but who were not directly involved with administering the questionnaires. Any questions giving rise to doubts were rendered null and void by the researcher, in consultation with the interviewer. The solutions, likewise, were worked out jointly. Violence was defined as any act against others or oneself threats, death threat, verbal arguments, physical fights, sexual assault, thefts, injury caused by traffic accidents and witnessing murder among acquaintances or drug traffickers.
The questionnaire included questions about the involvement with any of these types of violent acts. The questionnaire also inquired about history of drug use injected or other, and the frequency of use and sexual practices, including use of condoms and number of partners. The variables studied were:. A second test third-generation test, by Ortho Diagnostics Systems was also performed. Positive cases were confirmed by Western-blot Sanofi-Pasteur. All questions were framed in the context of the previous six months.
A descriptive analysis was performed, and associations between variables were verified. All associations were controlled based on the kind of drug used. A total of individuals were recruited for this study. Twenty-seven individuals agreed to answer the questionnaire, but refused to have their blood collected for testing. The majority of these participants said they were afraid of injections while others alleged that they had been tested on other occasions and had not received the results.
Additionally, four blood samples were inappropriate for testing.
Therefore, the sample was comprised of subjects, all of whom responded to the questionnaire and had blood samples collected for serological analysis. The social profile of the cohort, which shows gender, age, education level, sources of income, marital status, residence in the last six months, period of drug use, use of injecting drugs, and past imprisonment is summarized in table 1. Of the subjects who had a history of previous imprisonment , half were drug-related. These individuals had a period of less than a year between the first and last arrests arrest being defined here as detainment in prison for at least one night.
There was no significant difference regarding condom use between the groups of drug users who did and who did not mention homosexuality. A comparison between males and females, found a higher frequency of prostitution and exchange of sex for drugs and crack cocaine use among females. Details are shown in Table 2. Legal drugs were used earlier in life than illegal ones Of the legal drugs, tobacco was the first to be used, followed by alcohol Of the illegal drugs, marijuana was used earlier than others The average age of initiation into marijuana use was similar to that of alcohol no statistical difference found.
Initiation of inhaled cocaine use had a later onset, compared with marijuana The uses of both crack and injected drugs had an early age of onset In this study, 46 participants reported using injected drugs. Nearly half of these 21 said the change in habit was due to the use of crack. The reduction in the use of injectable drugs was observed only among crack users. Curiosity was the reason for the change for 51 participants Table 3 shows some violence variables and involvement with drugs among these subjects. The average number of deaths witnessed or known about was 5. Table 4 shows the association between the different violence related variables and the use of various drugs.
Drug and violence associations observed in a sub-sample of individuals who reported violence linked to drug use. Using logistic analysis, the uses of different drugs were assessed as explanatory variables for different forms of violence. The results are summarized in Table 5. Verbal arguments were related to crack and mesclado when examined separately Table 4.
DrugFacts: Substance Use in Women | National Institute on Drug Abuse (NIDA)
When adjustment for drugs were implemented, only crack remained associated with violence, showing little variation in risk Table 5. Fights verbal arguments and physical fights were related to alcohol and crack when examined separately Table 4 and remained associated when evaluated in conjunction with alcohol and crack Table 5. Involvement in both verbal and physical fights was not related to the use of any drug in particular, however, an association was observed in participants who reported using more than one drug in conjunction.
In the sample, all users of inhalants 8 reported having stolen with the intent to obtain drugs. All of those who reported the use of tranquilizers 4 stated that most of the crimes and violence they had been involved in were related to drug trafficking. Theft was found to be related to crack and mixed marijuana use Table 4.
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However, when assessing various drugs together, based on ORs, crack use was found to be more influential, mesclado less, and marijuana the same Table 5. Robbery to obtain drugs was found to be related to the use of crack and mesclado Table 4 when considered independently.
When controlling for the use of various drugs together, crack and mesclado ORs showed little variation Table 5. Violence and perpetration of crimes are related to drug trafficking the purchasing and sale of drugs Table 4. No association was observed for drug trafficking and use with verbal or physical fights.
The prevalence of HIV infection in this sample of drug users was 6. The use of crack showed no association with HIV infection. Having a tattoo showed no association with HIV infection. Drug users are a group that deserves special attention by the health care system, due to their high risk of exposure to infections, mainly those transmitted sexually and parenterally, as a result of precarious behavior.
They are also more exposed to violence. Research on drugs and violence is becoming more common in the literature, and these studies encompass knowledge from many areas, including education, medicine, sociology, criminology, epidemiology, and psychology. An understanding of the causes, correlations, and consequences of drugs and violence is necessary for implementing effective public policies for their control and prevention.
Research has consistently found a strong relationship between drug use and crime 22 , 23 , and it also shows that criminal behavior increases following addiction and arrests for drug offenses. Goldstein 25 states that drugs and violence are related to one another in three possible ways; 1 Psychopharmacologically, in which people may engage in irrational or violent actions as a result of the short-term or long-term effects of using specific drugs; 2 Economic-compulsive, in which some drug users pursue economically oriented violent crime, such as robbery, to acquire income to support their costly drug habits; and 3 Systemic, referring to the traditionally violent patterns of interaction involved in the system of drug distribution.
Compared to previously published literature, 22 — 24 this study found a high number of subjects who had a history of previous imprisonment , and half of these cases were drug-related, demonstrating a close relationship between drugs and incarceration. The relationship between drug use and previous imprisonment is one way of observing the connection between drugs and violence itself. This tells us that violence is expressed in extreme forms among users of crack.
Violence and the use of crack and other types of cocaine have previously been found to predict victimization and appear to show a causal relationship with intimate partner violence. Drug use and delinquent behavior can often be traced to factors such as poverty, educational difficulties, including poor performance in school and lack of communication with educational authorities, and high unemployment rates among other factors.
For these youths, the crack trade is attractive as a lifestyle and career track. The involvement of crack users in drug dealing is extremely high, as seen in the results presented here, and should be addressed by other studies. In this study, one of the main substances mentioned in situations involving violence was crack. This was expected, as the literature shows an increase in crack consumption in Brazil since 8 , 31 , 32 and an association between users of injected drugs and users of crack.
The lack of association between HIV infection and tattoos in this study is perhaps because no differentiation was made in the questionnaire between professional tattooists, who practice proper instrument hygeine and amateur tattooing. HIV infection was associated with a history of other sexually transmitted diseases. The main characteristic of smoked crack is its powerful stimulating effect. This is likely what makes it a highly addictive drug, attracting increasing numbers of people to use it.
Almost all were users of crack 41 , and 21 said this change of habit was due to the use of crack.