The Drug Experience: Cocaine, Part 3

Dan Waldorf and colleagues were ‘pleasantly surprised’ by the relative ease with which so many cocaine users managed to quit. Their research emphasises the importance of one’s personal and social identity in influencing drug use. (895 words)


In the last two Briefings, we focused on the most comprehensive ethnographic study of heavy cocaine users, conducted by Dan Waldorf and colleagues in Northern California. They interviewed 267 current and former heavy users of cocaine, a sample that did not include people in treatment programmes or in prison. Most of the respondents were ‘solidly working- or middle-class, fairly well-educated, and steadily employed.’

This research challenged many of the prevailing myths. In the present Briefing, we look at the process of giving up use of cocaine. Waldorf and colleagues interviewed 106 quitters—30 of these had received some form of treatment, whilst 76 stopped using cocaine without treatment.

When respondents were given a list of personal reasons for quitting, the most common (47% of sample) was given as health problems. The next most cited reasons were financial problems (41%), work problems (36%) and pressure from spouse and/or lover (36%). Only 7% cited actual arrest, although 28% cited fear of arrest as a reason for quitting.

Respondents were also given an open-ended summary question on the most important reason or reasons to quit. A total of 61% mentioned some form of psychological problem or stressful state caused by cocaine as the most important reason to quit. The next most common reasons were financial problems (23%), and severe or recurrent health problems or concerns (19%).

There was great diversity in actions that respondents took to quit using cocaine. Some made a number of attempts to stop before they actually succeeded. They despaired over the hold the drug had over them and had great difficulty in maintaining a resolve to stop using.

However, over a half of the sample stopped using on their first try, although this was not always easy. Two-thirds of the untreated cases stopped on their first attempt, whilst only one in five of treated cases did so.

More than 40% of all quitters reported making some sort of geographic move as part of their successful attempt to quit. Two-thirds of these people said they moved to another city or state, at least in part to help them stay away from cocaine.

The most frequently used strategies for stopping to use cocaine were social avoidance strategies. Nearly two-thirds of the quitters said they had stopped going to places where cocaine was being used, or had made conscious efforts to avoid seeing cocaine-using friends. Over 40% had also sought out new friends who did not use cocaine.

More than 75% of the sample became more concerned about their physical health whilst quitting, and acted upon these concerns. Two-thirds improved their eating habits, and a half undertook new programmes of physical conditioning.

Over half of the quitters sought out new interests, with 39% participating in sports to help them avoid using cocaine. Similarly, 55% of the sample used informal help, such as family or friends, to stop using cocaine.

Only 17% of the sample started using other drugs after quitting cocaine. Of those that did, the majority used only marijuana, which almost all had used before and during their cocaine use. Whilst 21% drank more alcohol, most drank less after giving up cocaine.

Most of this diverse sample had used cocaine heavily for a good number of years—but few were ever merely cocaine abusers. Moreover, their use had not led them to becoming stigmatised. The majority worked regularly, maintained homes, and were responsible citizens:

‘… a commitment to their everyday lives gave them a stake in normalcy and bonded them to the conventional world.’

The sample were different to heroin addicts in other studies, many of whom came from disadvantaged backgrounds, had been criminalised and stigmatised, and had few private resources (e.g. education, jobs).

For many of the present sample, prolonged use of cocaine stopped being fun and started disrupting, rather than enhancing, everyday lives. Since these lives had meaning and value, the difficulties caused by cocaine became powerful spurs for cessation.

The researchers were ‘pleasantly surprised’ by the relative ease with which so many cocaine users managed to quit. Their strategies were in general fairly common-sensical social avoidance strategies, designed simply to put distance between themselves and the drug.

Most of the quitters were able to manage the cravings they experienced after stopping cocaine use. They realised that cravings were only transitory—distractions caused them to subside. New interests and activities provided such distractions. Many quitters found cravings:

‘… little different from yearnings one might feel for an old lover – one feels the desire, but with time it subsides and one thinks of him or her less and less.’

These findings emphasise the importance of one’s personal and social identity in influencing drug use. A commitment to a conventional identity and everyday life helps form the social-psychological and social-organizational context within which control and cessation of drug use is possible.

It is commonly stated that drugs come to dominate identities and lives. This was true in the most problematic cases in the Waldorf study.  However, for the bulk of the sample, identities and lives usually dominated drug use. This is a critical fact that must be remembered when we try to help people overcome problems caused by drugs and alcohol.

Recommended reading:

Cocaine Changes: The Experience of Using and Quitting by Dan Waldorf, Craig Reinarman and Sheigla Murphy. Temple University Press, USA.

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The Drug Experience: Cocaine, Part 2

While cocaine is portrayed as having a very high addiction potential, the majority of people who use the drug do not have a problem. Research by Dan Waldorf and colleagues reveals a number of social and social psychological factors that influence how a person uses a drug. (887 words)


Cocaine is often portrayed as having a very high addiction potential, and that most people who use it are risking serious physiological and psychological harm. Whilst some cocaine users do develop difficulties, the majority do not.

The most comprehensive ethnographic study of heavy cocaine users was conducted by Dan Waldorf and colleagues in Northern California. They interviewed 267 current and former heavy users of cocaine, a sample that did not include people in treatment programmes or in prison. Most of the respondents were ‘solidly working- or middle-class, fairly well-educated, and steadily employed.’

These researchers showed that about a half of interviewees maintained a controlled pattern of cocaine use, some of them for even up to a decade. According to Waldorf, controlled use can be defined as either, ‘regular ingestion without escalation to abuse or addiction, and without disruption of daily social functioning’, or ‘a pattern in which users do not ingest more than they want to and which does not result in any dysfunction in the roles and responsibilities of daily life.’

Based on their observations, Waldorf and colleagues described the ideal type of controlled users:

  • ‘Controlled users tended to be people who did not use cocaine to help them manage pre-existing psychological problems, and did not also abuse other drugs, especially alcohol.
  • Controlled users generally had a multiplicity of meaningful roles which gave them a positive identity and a stake in conventional life (e.g., secure employment, homes, families). Both of these anchored them against drifting toward a drug-centered life.
  • Controlled users, perhaps because they are more anchored in meaningful lives and identities, were more often able to develop, and stick to, rules, routines, and rituals that helped them limit their cocaine use to specific times, places, occasions, amounts, or spheres of activity.’

This research suggests that a stake in conventional life and identity are central for understanding continued controlled use. Such stakes seem to keep a person’s drug use from overtaking their life and identity. They also facilitate an individual reasserting control after a period of problematic use (I will discuss this issue in a later Briefing).

The fact that these social and social psychological factors mitigate against cocaine misuse and related problems suggests that not everyone need develop a problem with cocaine, even when using heavily as this population was.

At the same time, it follows that those people with the least stake in conventional life may be at the highest risk for problematic cocaine use. Cocaine, and in particular crack, have had a marked impact in poor neighbourhoods, causing problems to many individuals and communities.

Obviously, these forms of social control are not fool-proof for maintaining controlled use. Some people with a large investment in conventional life did lose control of their cocaine use and develop serious problems. Waldorf and colleagues report that:

‘… after scouring our other interview transcripts, we could not put our fingers on any one magical ‘factor X’ that explained why some people get into trouble and others did not.’

Other researchers in the US and other countries have reported controlled use of cocaine by a significant proportion of users (see Decorte, 2000 for review).

Waldorf and colleagues recognise that some well-intentioned parents and policy makers might not want to broadcast findings about controlled use for fear of facilitating the denial of some misusers or increasing the risks for some new users.

However, they contend that the:

‘… considerable possibilities for exercising control over cocaine use can be seen as cultural resources that can facilitate personal capacities for control and social capabilities for harm reduction.’

The researchers made the very good point that if the only frameworks in society for interpreting one’s drug-using behaviour are addiction and abstinence, then the idea that one can and should exercise control can atrophy. The interviews revealed that one important reason that control was possible for so many of the participants was that they believed that it was possible. They believed that cocaine was ‘not necessarily addicting, that it could and should be used in a controlled fashion.’

Whilst cocaine is often portrayed as a powerful reinforcing psychoactive drug, we sadly do not often hear that its powers are also mediated by users’ norms, values, practices, and circumstances. We underestimate the powers of social, social psychological and cultural aspects, whilst overestimating the pharmacological power of the drug.

Waldorf and colleagues point out that heavy cocaine users have taught us:

‘… that beyond the drug itself, how users think about and behave towards drugs matters a great deal. Cultural norms matter. Subcultural practices matter. How closely we look out for each other matters. The uses to which we put consciousness-altering substances matters. The personal and social resources of users matter. The values placed on productive daily lives matters. And, of course, the social distribution of opportunities for productive lives matters…’

Recommended reading:

Cocaine Changes: The Experience of Using and Quitting by Dan Waldorf, Craig Reinarman and Sheigla Murphy. Temple University Press, USA.

The Taming of Cocaine: Cocaine Use in European and American cities by Tom Decorte. VUB University Press, Belgium.

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> Part 3

The Drug Experience: Cocaine, Part 1

Exploring the dynamic world of heavy cocaine use as revealed in a provocative, high-quality study by Dan Waldorf and colleagues. This research, conducted in the US in the 1980s, challenged many of the prevailing myths about cocaine. (875 words)


There is a good deal of misinformation about cocaine, which does little to help society tackle the problems that excess use of this drug can produce.

In their book Cocaine Changes: The Experience of Using and Quitting, Dan Waldorf and his colleagues state that they set out to study cocaine users and present their world as they see it, without making moral judgements about the drug-using behaviours.

The research involved interviewing 267 current and former heavy users of cocaine from Northern California. The sample did not include people in treatment programmes or in prison, as is common in other research. Most of the respondents were ‘solidly working- or middle-class, fairly well-educated, and steadily employed.’

Nearly all the respondents first tried cocaine when it was offered by a trusted friend. Many of the sample reported that they did not get high the first time they snorted cocaine. They had to learn both to experience and then to appreciate the subtle euphoric effects of the drug.

The majority of respondents increased their use gradually—there was no uniform progression or pattern. The slow escalation was likely due in part to the general greater availability of the drug. Two other factors were often cited as contributing to escalating use: a slow increase in tolerance for the drug, and the seductive and insidious nature of the drug itself.

The tolerance reported with cocaine appeared to be somewhat different to that observed with opiates. Whilst some users reported increasing their doses of drug, they did not generally report decreased effects of the same dose. Rather than needing more of the drug to get the same effect, they reported wanting the same effect again and again.

Many participants ‘… agreed that cocaine’s euphoric effects offered not only a sense of well-being, but a feeling of mastery or power that was so reinforcing it often led them to use more frequently than they planned or expected.’

The researchers described four relatively discrete patterns of use. Hogs showed a consistent, very heavy daily use. This pattern of use caused more dramatic effects, greater compulsion, as well as marked painful ‘comedowns’ and depression.

Nippers used regularly, often every day, but only in relatively small amounts. These users kept their drug use subordinated to work and family responsibilities, and often avoided the negative effects associated with heavy use.

Bingers used cocaine heavily and then lay off the drug for days or weeks. Use was often constrained by personal finances or by prolonged negative effects. Some bingers found their binges getting longer and longer. Ceremonial or occasional users used the drug on special social occasions.

The researchers reported a considerable movement by individuals from one form of use to another. Although some users followed a downward spiral from experimental use to addiction, as many others nipped and then binged and then nipped again. Others moved from heavy binge use or sustained abuse to ceremonial use.

One striking aspect of the study was the proportion of people who used the drug on a controlled basis—approximately 50%.

Long-term daily use of cocaine or regular heavy binges often led to problems. The most frequently mentioned were nasal irritations, insomnia, paranoia, strained relationships with wife or husband, depleted savings, hangover days at work, and periodic sexual difficulties. The most frequent and severe problems were reported by the heaviest users.

Some of these problems were reported as serious, but many were not. Most of the respondents appeared to find most of the problems manageable most of the time. They seemed to get pleasure from cocaine, and accepted the problems as part of the territory.

Most of the sample agreed that moderate use of cocaine can be an exceedingly enjoyable experience —it produced euphoria, more energy, a certain intellectual focus, enhanced sensations, an increased sociability and social intimacy.

However, daily use or regular binges transformed the experience of the cocaine high. The initial euphoria slowly and subtly became dysphoria, feelings of well-being turned into feelings of being unwell and unhappy. Feeling energetic was replaced with feeling apathetic.

These changes in physical feelings were accompanied by transformations in social experience. The person used the drug in isolation, rather than in social groups as was done initially.

Some heavy users noted psychological transformations. The world that had once been good to live in became a place that was far less hospitable—paranoia increased and depression sometimes developed.

A shift in the balance between positive and negative effects of cocaine occurred. The shift to the negative often resulted in considerable psychological pain, and a questioning of the rationality and desirability of continuing to use the drug.

At this time, those people with conventional stakes in families, homes, jobs, communities and identities tended to find the resources and resolve to abstain or reduce their drug use.

Those with fewer such stakes and social supports were more likely to feel indecisive and helpless to overcome their cocaine use problem.

Recommended reading:

Cocaine Changes: The Experience of Using and Quitting by Dan Waldorf, Craig Reinarman and Sheigla Murphy. Temple University Press, USA.

> pdf document

> Part 2

 

 

Factors Facilitating Recovery: Overcoming Withdrawal Symptoms

People who decide to stop taking drugs or drinking alcohol after using or drinking for long periods of time, need to be aware that they might experience withdrawal effects which can be irritating, debilitating and even life-threatening.

Many of these withdrawal signs, which can be psychological and physical in nature, are generally opposite to the effects the person experienced when the drug was being taken. For example, abrupt withdrawal from long-term use of Valium (diazepam) and other benzodiazepines, drugs which are prescribed to alleviate anxiety and insomnia, can lead to pronounced anxiety, insomnia, agitation, intrusive thoughts and panic attacks.

In addition, people withdrawing from benzodiazepines can experience physical withdrawal signs, such as burning sensations, feeling of electric shocks, and full-blown seizures. The duration and strength of these withdrawal signs is in part dependent on the amounts of drug having been used and the duration of time the person has been using the drug. 

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The Regulation and Control of Drugs, Part 2

Continues to look at the development of laws regulating recreational drug use, in particular in America, which has influenced world drug policy so strongly. (881 words)

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Historical Perspectives: Cocaine

Traces the history of cocaine, linking the Incas, Freud, Thomas Edison, Sherlock Holmes and Coca Cola. (880 words)

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Cocaine: The experience of using and quitting

41lk1WqLs4L._BO2,204,203,200_PIsitb-sticker-arrow-click,TopRight,35,-76_SX342_SY445_CR,0,0,342,445_SH20_OU02_What does scientific research tell us about people overcoming substance use problems? I have previously described the study with US veterans who stopped using heroin after they returned from Vietnam, showing that the common belief that heroin is highly addictive cannot be generalised to all situations.

A variety of other scientific studies have been conducted with people who have recovered from addiction to other substances and we look at another of these studies in this chapter.   

Dan Waldorf and colleagues conducted the most comprehensive ethnographic study of heavy cocaine users in the mid-1980s in northern California. 

They interviewed 267 current and former heavy users of cocaine, a sample that did not include people in treatment programmes or in prison. Most of the respondents were “solidly working- or middle-class, fairly well-educated, and steadily employed.”

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Crack in America

reagan-wife-1Yesterday, I ran a blog written by Bill White showing the questionable ‘science’ that surrounded the so-called issue of crack babies. There was tremendous media hype about crack and crack babies at the time. Why?

I wrote on this issue in the educational series I wrote for Drink and Drugs News nearly a decade ago. Here’s what I wrote in a longer article entitled ‘Regulation and control of drugs: Part 2’.

‘In their book Crack in America, Craig Reinarman and Harry Levine point out the politics that surrounded crack in the US during the 1980s and 90s. Crack first appeared in late 1984 and 1985, primarily in impoverished African-American and Latino inner city neighbourhoods in New York, Los Angeles and Miami.

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‘Moral panics, the limits of science & personal responsibility’ by Bill White

Time-Crack kidsAnother classic from Bill White, illustrating how junk science can dominate the sensationalist media and create moral panic, which of course can be used for political gain.

‘From the mid-1980s to the mid-1990s, new patterns of crack cocaine use dominated cultural headlines in sensationalized media frenzies that sociologists refer to as moral panics. Other than cocaine-related violence, no aspect of this alarm garnered greater attention than the images of premature, cocaine-exposed infants trembling within incubators of neonatal intensive care units.  Those infants and children became widely caricatured as “crack babies” and “crack kids” and their images were exploited to forge new laws and policies that in turn fueled dramatic expansions of the U.S. criminal justice and child welfare systems.

Those most dramatically affected by the expansions were poor communities of color who witnessed unprecedented numbers of their young men imprisoned and their young women and children placed under the control of state child protection authorities.

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Addiction Recovery: Getting Clean At 22

IMG_2353I found this powerful Recovery Story on the Huffington Post website. It’s nice to see such a story of hope amongst the addiction-focused ‘stories’ that predominate in the popular media. There is also a short video interview to watch.

‘On March 4th, 2012, I was having trouble breathing. “Am I going to be okay?” I asked the nurse who was monitoring my heart rate. “I don’t know,” she said. “If you are, I hope you stop destroying your life.”

It was not the first time substance abuse had landed me in the emergency room. But, though I didn’t know it then, it would be the last.

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