Crack Users Show High Rates of Antisocial Personality Disorder, Engagement in Illegal Activities and Other Psychosocial Problems

Abstract

The aim of this study was to compare three groups of Brazilian psychoactive substance (PAS) abuse patients (crack cocaine users, cocaine snorters, and non-cocaine PAS users) in terms of psychiatric comorbidities and severity of psychosocial problems. A cross-sectional, multi-center study was conducted at five Brazilian research centers. A total of 738 current PAS abusers seeking specialized treatment (outpatient and inpatient clinics) were assessed using the sixth version of the Addiction Severity Index (ASI-6): 293 patients using crack cocaine were compared with 126 using powder cocaine and 319 using non-cocaine PAS (mostly alcohol and marijuana). Psychiatric comorbidities were assessed in a smaller sample (290 cases), originating from three of the centers, using the Mini International Neuropsychiatric Interview Plus (MINI-Plus). Crack and powder cocaine users were significantly younger than non-cocaine PAS users (31.1 ± 8.1 and 32.9 ± 8.8 vs. 42.4 ± 12, respectively; p < .001). Crack users presented a higher rate of antisocial personality disorder (25%) than powder cocaine (9%) and non-cocaine PAS users (9%), even when adjusted for confounding factors (Pr = 2.6; 95% CI 1.10-6.40). According to ASI-6 summary scores, crack users presented a significantly higher rate of occupational, family, and legal problems and reported more illegal and violent activities such as burglary and theft (23%) and threatening or assaulting (32%) than non-cocaine PAS users. Our findings, combined with the recent increase observed in the prevalence of crack use in Brazil, highlight the severity of psychiatric symptoms and psychosocial problems related to this powerful drug and corroborate the already suggested association between crack/cocaine, violence, and legal problems. Treatment programs for crack users should routinely consider the possibility of associated psychiatric comorbidities, such as antisocial personality disorder, which may affect treatment outcomes.

Vulnerabilidades clínicas e sociais em usuários de crack de acordo com a situação de moradia: um estudo multicêntrico de seis capitais brasileiras

“…Estudos sobre o perfil de usuá-rios de crack demonstram que eles estão mais expostos a ambientes violentos, a envolvimento com crimes e a aumento de fatores de risco para a sua saúde 1,31 . Nesse sentido, tais indivíduos têm uma maior probabilidade de detenção e envolvimento com o crime 21 .…”

“…Outro dado relevante é a maior prevalência de sintomas depressivos encontrada nos usuários de crack moradores de rua, somada a um maior risco de cometer suicídio. Esse achado está de acordo com um estudo prévio que aponta uma importante prevalência de uso de cocaína e comorbidades psiquiátricas, em especial sintomas depressivos 31 .…”

Childhood Trauma and Resilience: Vulnerabilities to Develop Crack/Cocaine Dependence

“…Crack cocaine use, in particular, poses a challenge for health professionals and investigators since a wide proportion of users have little motivation for treatment, and its use leads to impairment in many psychosocial aspects such as unemployment, cognitive impairment and risk for infectious diseases due to risky sexual behavior [2][3][4][5]. Although its prevalence is not high among other types of drug use -life use is around 4,2% -it has high potential to cause dependence, and its abuse is associated with a number of negative outcomes for the individual, families and community, including death due to violence and criminal behavior [6,7]. However, there is a group of patients that develop a more stable pattern of use and are somehow more resilient to the impairment caused by this substance [8].…”

Sintomas psiquiátricos e características sociodemográficas associados à tentativa de suicídio de usuários de cocaína e crack em tratamento

“…Os participantes autodeclarados afrodescendentes tiveram as maiores taxas de TS antes do tratamento atual. Os achados deste estudo foram semelhantes aos de outras investigações que avaliaram risco de suicí-dio de sujeitos com a mesma característica clínica [25][26][27] .…”