Crack cocaine in the Dublin region - Health Research Board

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Attracting and retaining clientsThe Drug Treatment Agency (DTA) in the UK emphasises a number of key practiceswhich improve the success of cocaine treatment. According to the DTA, once theinitial contact with a treatment service is made, rapid intake, proactive reminders,and practical help with attendance improve treatment uptake rates. Once cocaineusers start treatment, they tend to stay longer and respond better if they feel thattheir concerns are being positively addressed and that their key worker is empathicand understanding. This indicates the crucial role that key workers play in assessing,motivating and retaining clients. The provision of complementary therapies is importantto attract clients into treatment, enhance their well-being and retain them in treatment.A similar approach to that in the UKL has been tried with intranasal cocaine users inTallaght and was deemed very successful.The Department of Community, Rural and Gaeltacht Affairs funded the Tallaghtcommunity-based project involving St Dominic’s Community Response Project andKillinarden’s Community Addiction Response Programme for problematic intranasalcocaine users (Goodbody Economic Consultants 2006). The interventions plannedwere advertising service availability, project meetings, relationship building, individualcare plans, individual counselling, and holistic therapies. The project commencedin February 2005. The project employed six staff members on a part-time basis. Theservice was provided through two evening sessions and one afternoon session. Thecocaine treatment service was promoted through a media campaign and proactiveoutreach work. The project communicated with cocaine users and concerned persons bytelephone and received an average of 20 calls per week. During its first year, 99 cocaineusers attended the project, of whom 60 (61%) returned more than once. The uptake ofcomplementary treatments, such as acupuncture and Indian head massage, was high. Afurther 60 people were assisted by the outreach worker. Seven clients were interviewedat the end of the project, of whom four were abstinent from all drugs and two said thattheir suicidal thoughts had ceased. According to the evaluators, Goodbody EconomicConsultants, the project was effective and very good value for money.Brief interventionBernstein and colleagues (2005) conducted a randomised control trial to determinewhether brief motivational counselling was more effective that written informationin reducing cocaine use among clients attending an outpatient clinic in Boston. Sixmonths following intervention, they found marginally higher rates of abstinenceamong those who attended brief motivational counselling than among those whoreceived written information. For those reporting both cocaine and opiate use, theabstinence rates were 22% among those who were given brief motivational counselling,compared to 17% among those who received information; among cocaine users, thecorresponding abstinence rates were 17% and 13% respectively. It is interesting toCrack cocaine in the Dublin region: an evidence base for a crack cocaine strategy127
note that providing information on cocaine itself and its associated treatment optionsdid encourage some respondents to seek help. Indeed, despite the title of this paper,the differences in abstinence rates for the two interventions were neither clinicallynor statistically significant. The data presented in this paper indicate that informationor brief intervention would be effective if provided at accident and emergency, harmreduction and opiate treatment services. The information brief or leaflet should coverthe dangers of cocaine use, the symptoms of dependence and the treatment servicesavailable.Cognitive behavioural therapy and counsellingCognitive behavioural therapy is a system of psychotherapy which attempts to reduceexcessive emotional reactions and self-defeating behaviours by modifying underlyingerroneous thinking and maladaptive beliefs. According to experts in this area, thecognitive approach, when applied to substance abuse, helps individuals deal with theproblems leading to emotional distress and gain a better perspective on their relianceon drugs. Specific cognitive strategies are said to help individuals establish strongerinternal controls and reduce their urges to take drugs. In addition, cognitive therapycan help patients to combat depression, anxiety or anger, which increase addictivebehaviours.Since there were no systematic reviews in the Cochrane Library that examined theevidence of effectiveness of psychotherapeutic interventions (such as cognitivebehavioural therapy) in the treatment of cocaine dependence, some individual studieswere reviewed for the purposes of this article.Crits-Christoph and colleagues (1999) examined combinations of psychosocialtreatments for cocaine dependence. They compared four different treatments –cognitive therapy, psychodynamic therapy, individual drug counselling, and groupdrug counselling alone. The first three treatments mentioned included group drugcounselling along with the specific individual therapy. Treatments were intensive andprovided over a six-month period. The clients were followed up at six and at twelvemonths. The authors found that, when compared to the two forms of psychotherapyand to group drug counselling alone, individual drug counselling plus group workshowed the greatest improvement in the number of days the clients did not use cocaineover a one-month period. The authors were surprised by this finding because in 1991Carroll and colleagues reported that relapse-prevention therapy (a form of cognitivebehaviour therapy) was more effective than interpersonal psychotherapy, and hadhigher abstinence and recovery rates. In 1994, Higgins and colleagues reported thatrelapse prevention therapy with the addition of incentives was more effective thanrelapse prevention therapy alone. The clients who received incentives were more likelyto complete their treatment and had a longer duration of cocaine-negative urines.128 Crack cocaine in the Dublin region: an evidence base for a crack cocaine strategy
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HRB Research Series6Crack cocaine i
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This publication should be cited as
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HRB Research Series publicationsto
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ContentsList of tables and figures
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7 Social consequences of crack use
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List of tables and figuresTablesTab
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AbbreviationsADRUGNDUHRBISCCSGLDTFN
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Glossary of termsBenzos: The street
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Executive summaryBackground and stu
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phone and buyers are directed to sp
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Part 1IntroductionCrack cocaine in
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In the light of these concerns, it
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extensive reporting in the US about
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Ten interviews were conducted with
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also offers potential to trace supp
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Part 2Crack cocaine in the Dublin r
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2.2 Criminal justice data - cocaine
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Prevalence of crack use among homel
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Local survey dataA survey in 2006 o
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Respondent 1: I’d say it’s stil
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3 Dublin crack cocaine market3.0 Ov
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sold on the street for as little as
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Like, I was down on M… Street in
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3.4 Marketing crackFour interviewee
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While crack was generally bought al
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• Although a number of dealers, o
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4.2 Crack use and genderAccording t
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From about 16 to 21 I would say - t
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Table 4.4Number of new cases who li
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5.2 Crack and other drugsMany of th
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Whether treated cases reported crac
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cases of intravenous cocaine use, t
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Table 5.5Number (%) of new cases wh
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Part 3Consequences of crack useCrac
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etween heroin, cocaine and crime. T
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So, they would talk about the kind
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Crack and prostitutionNine services
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On the other hand, reports from two
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Page 80 and 81: The data provided by the NDTRS in S
Page 82 and 83: But you know it would be about kind
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Page 86 and 87: 7.6 Key findings• A significant p
Page 88 and 89: There are considerable long-term ps
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Page 93 and 94: 9 Treating crack use9.0 OverviewIn
Page 95 and 96: Some services were in a position to
Page 97 and 98: Both opiate-dependent and non-opiat
Page 99 and 100: • more outreach work to identify
Page 101 and 102: 10 Policing crack markets10.0 Overv
Page 103 and 104: local communities. There is growing
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Page 107 and 108: Table 10.1 Number of new cases who
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Page 111 and 112: 11 Discussion and research implicat
Page 113 and 114: 11.2 Responding to crack markets an
Page 115 and 116: 11.3 Reducing the harm that crack c
Page 117 and 118: Shoplifting, burglary and robbery w
Page 119 and 120: Bourgois P (2003b) Crack and the po
Page 121 and 122: Furey M and Browne C (2004) Opiate
Page 123 and 124: Loughran H and McCann ME (2006) A c
Page 125 and 126: San Diego Police Department (1998)
Page 127: Appendix A:An evidence base for tre
Page 131 and 132: MedicationsA number of studies have
Page 133 and 134: interpersonal psychotherapy. Americ
Page 135 and 136: Jurisdiction Intervention/Descripti
Page 137 and 138: Jurisdiction Intervention/Descripti
Page 139 and 140: Appendix C:Recent HRB series public
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Crack cocaine in the Dublin region - Health Research Board

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