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Cultural Impact

Introduction

Crack cocaine is a very addictive substance that had a unique beginning. Cocaine was initially extracted from the coca plant in 1862 and used in various medicines, some that could be purchased over the counter. It was even one of the common ingredients in the first Coca-Cola drink (Baumer, p. 312   ). Powder cocaine was first used recreationally by affluent member of society. It was very expensive to buy pure cocaine. Crack cocaine became a cheaper substitute for pure powder cocaine. Crack cocaine is produced by adding water and baking soda to pure cocaine. The substance is then baked and “cracked” into small pieces. This product produces an intense high, but only lasts about fifteen minutes. Crack cocaine became popular in the 1980’s and has had lasting negative effects on the black community. Black males are more likely to use crack cocaine than members of any other race. Crack cocaine has negatively affected the African-American community in several ways: crack cocaine usage increases sexual risk taking behaviors and violence among its users, users are at a higher risk of mental health issues, and chronic users develop health issues over time that could lead to heart attacks, strokes, and other gastronomical complications. Nonetheless, there are treatment plans geared toward helping African –American individuals overcome crack addiction. These programs range from out-patient to extended in-patient stays. They are operated by various organizations from hospitals to religious organizations.

Risky Behavior

Many crack addicts take part in risky sexual behaviors in order to fund their habits. When one thinks of prostitution or the exchange of sex for something else, one often thinks of women only. However, in the drug world men exchange sex for drugs just as often as women do. For example, one study conducted in an urban area found that both men and women engaged in trading oral sex for drugs or money; further, male respondents who acknowledged trading sex for drugs or money were more likely than women respondents to acknowledge having engaged in anal sex in trading for drugs ( Maranda, M.J., Han, C., & Rainone, G.A , p. 318) Also, more women reported using condoms than men, but also confirmed that if the customer insisted on not using a condom they would oblige. The study found that women often traded sex in efforts to gain access to more crack or to mentally escape the horrors of prostitution, while men reported heightened sexual urges when they were high on crack cocaine.  Maranda, M.J., Han, C., & Rainone, G.A reported, “Some women reported that they traded sex to support their drug addiction, others seemed to use drugs to cope with trading sex.” Consequently, the AIDS epidemic is growing due to the crack epidemic.  Maranda, M.J., Han, C., & Rainone, G.A adds that the best way to prevent the spread of HIV is to prevent behaviors that put people at risk. Using drugs often make people participate in risky behaviors in efforts to gain access to the drug.  (Maranda, M.J., Han, C., & Rainone p. 320)

Mental Illness

Crack cocaine use has also has been linked to onset mental issues.  Chronic crack use has been reported to produce side effects such as anxiety, paranoia, egocentric behavior, dysphoria, anorexia, and delusions. According to Baumer,

“Different routes of using cocaine are associated with different negative consequences. Crack users have a greater number of symptoms, and higher levels of anxiety, depression, paranoid ideation, and psychoticism. Psychiatric comorbidity among cocaine dependent users is not only increased for other substance disorders, but also for personality disorders.” (Baumer, p. 319).

Years of chronic use has been linked to more serious mental illnesses like schizophrenia. Scientists believe that because crack alters brain activity the imbalance can lead to the disease. Crack use blocks certain neurotransmitters and substances that allow brain cells to communicate with each other. The brains of people with the schizophrenia have less gray matter and some areas of the brain display less or more activity, just as the brains of crack users.  Baumer adds that using drugs also adds to the probability that a person will be violent. When persons with mental illness or drug dependency become violent, it is usually directed towards a family member (Baumer, p. 321)

Effects on Black Community

            Although crack cocaine is use by people from various races, it attacked the black community the hardest. Cocaine use has been linked to the increases in murder and incarcerations. High school drop-out rates have also increased since the introduction of crack cocaine. It is estimated that crack markets account for between 40-73 percent of drop in black males’ high school graduation rate. In essence, the introduction of crack cocaine to the black community did three things: increased the probability of a black being murdered, increased risk of incarceration, and increased the likelihood of selling crack as a potential income in the black home. All of the scenarios limit the benefits of a proper education. Consequently, high school seems less attractive to the black because he/she will only end up in jail, or he/or she could be earning some fast money by selling it.

Incidence and Prevalence

            According to the data from the National Survey on Drug Use and Health (NSDUH), young black adults  aged 18 to 25 years of age represent the highest rates of lifetime (60.5%), past year (34.6%) and past month (20.3%) use of crack cocaine. In 2007, 17 percent of state inmates and 18 percent of federal inmate’s admitted that they commit their crimes while high or in efforts to get money for drugs.  Also, 60 percent of prisoners polled reported prior drug use, while 79 percent reportedly were still using drugs. Sadly, nearly 75 percent of addicts that enter a recovery program will relapse. In 2008, 18.8 percent of blacks reported using crack cocaine, while the national average of crack use in 19.9 percent. Astoundingly, blacks only make up about 11.3 percent of the U.S. population.

Treatment Options

            Implementing an intervention program can be difficult; it depends on each individual addict. If the addict has family, the family needs to be equipped with the tools to help the addict. However, if the addict is alone, he needs an appointed support system to help him maintain his sobriety. Financial difficulty is the main obstacle that addicts deal with. Most of them do not have insurance or the funds to pay for a treatment program. Often non-profit organizations may be willing to help out financially. There are some free programs that addicts may enter into, but these programs are often overcrowded and cold take as long as a year waiting period before being admitted. Some addicts chose to go through a detox program and then continue with an out-patient facility. With out-patient, the addict is able to go home daily, but is required to attend certain meetings. With in-patient facilities the addict is required to remain in the facility for the duration of the program. Often many addicts are more successful with in-patient facilities. Sadly, many of them relapse after they complete the program and are back in their old environments. Consequently, many therapists suggest that the addict moves to another location in order to have a better chance at remaining sober.  Consequently, the program has to be designed based upon the needs of the addict and his/her family.

                                     Specific Treatment for African-Americans

A range of treatment programs have been developed in the last few decades that endeavor to address the issue of substance abuse within members of the African-American community. A 2006 report (Liddle et al) examined an intervention and treatment program developed within the larger context of family therapy that was designed to address the specific needs and concerns of adolescent African-American males in terms of substance abuse. This program aims to be “culturally specific,” and is based on a several core components intended to provide a therapeutic framework that both considers and derives utility from a number of cultural references and touchstones relevant to the African-American community in general and adolescent African-American males in particular.

            The therapeutic framework is predicated on the notion that African-American adolescent males live in an “intersection” of cross-cultural frameworks (Liddle et al, 2006). These include the overarching mainstream American culture, the American minority culture, and the African-American-specific culture. As such the therapeutic framework utilizes culturally-relevant components, such as music and movies, which address issues related to the specific issue of substance abuse as well as larger issues about family, inner-city life, and other cultural components that may be relevant to African-American male adolescents. This culturally-specific therapeutic framework is intended to promote a strong level of engagement and participation among subjects, as opposed to a top-down model of information dissemination.

            The culturally-specific therapy is considered to be an adjunct of the larger model of Multi-Dimensional Family Therapy (MDFT), and it attempts to address the “oppositional culture” and the “code of the street” in which young African-Americans are often raised. By developing a treatment program which embraces these cultural components –rather than attempting to subvert the or simply ignore them- the treatment approach seeks to draw out positive cultural references that support the avoidance of substance abuse and to emphasize and reinforce such references as a means of promoting abstinence and avoidance of drug and alcohol use. In short, the MDFT approach attempts to make it “cool” to not use drugs and alcohol by promoting this view through the use of culturally-specific references that are likely to be acknowledged and accepted by subjects. The report asserts that this culturally-specific MDFT approach shows strong promise as an effective approach to helping young African-American males develop and individual identity that aligns well with their larger cultural frameworks and promotes the choice not to use drugs and alcohol.

Implications

            Crack addiction is just as much an emotional and psychological addiction as it is a physical addiction. Many crack addicts are afraid of being without the drug.  Crack addicts are often dual drug users, which mean their crack addiction is often brought on by the use of some other illicit drug. As a result, healthcare providers must address the problem in a dual method. They must first address the psychological issues that the addict may be dealing with. Once that is done, they can give the addict tools to use to handle stress and other life issues without turning to crack as a coping mechanism. Most African Americans are afraid of being labeled as mentally ill or a “crack head”. As a result, healthcare providers have to careful to treat them with respect in order to gain their much needed trust. Health care providers and mental health workers must collaborate, which will bring expertise from both backgrounds to the forefront in order to help crack addicts gain and maintain sobriety. Most importantly, health care providers must convey that they understand that crack addicts are essentially just like any other person. They have just made bad decisions, but have the potential to become productive members on society once again.

References

Baumer, Eric P. (1994).  Poverty, Crack, and Crime: A Cross-City Analysis. Journal of Research in Crime and Delinquency, 31. 311-327.

 Liddle, H. A., Jackson-Gilfort, A., & Marvel, F. A. (2006). An empirically-supported and culturally-specific engagement and intervention strategy for African-American adolescent males. American Journal of Orthopsychiatry75(2), 215-225.

Maranda, M.J., Han, C., & Rainone, G.A. (2004). Crack cocaine and sex. Journal of Psychoactive Drugs, 36, 315-322.

Substance Abuse and Mental Health Services Administration (2012). Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings. Retrieved from http://www.samhsa.gov/data/nsduh/2k11results/nsduhresults2011.pdf