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.

> pdf document

Factors Facilitating Recovery: Gaining a Positive Identity

People with serious substance use problems lose a lot of the roles or personal characteristics that help define their normal identity (e.g. loving son, athlete, generosity, intelligence) as their dependence on their substance(s) increases, relationships wither and isolation increases. Eventually, their identity as viewed by others may become ‘a useless, dirty addict’. They will also have personal views of what they have become and these views can lead to lowered self-esteem or even intense hatred of oneself.

On the basis of qualitative research with over 100 heroin addicts who had recovered from their addiction without professional treatment, Patrick Biernacki argued that: ‘To change their lives successfully, addicts must fashion new identities, perspectives and social world involvements wherein the addict identity is excluded or dramatically depreciated.’ [1]

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What Happens to Women in Recovery: Stephanie Brown

In the Resources section of the website, I have a series of my posts under the title Stephanie Brown on Recovery. These posts are based on Stephanie Brown’s wonderful 2004 book A Place Called Self: Women, Sobriety, and Radical Transformation. In her book, Stephanie talks about what happens to women in recovery, how they think, how they feel, their problems, the good things, etc. (The book is relevant to men as well!) Here is the main part of the first of my posts, entitled ‘What is Recovery’, according to Stephanie Brown (Part 1).

“‘Recovery has held so many surprises for me. Some good. Some bad. I didn’t know I could hurt so much. But I also didn’t know I could love so much and be so loved. I had no idea that recovery was also learning how to be in intimate relationships, learning how to have close, wonderful friends. Then there’s my marriage. My husband and I have developed a rich life together. And get this – I really like myself now. Learning about who I am and accepting me, that’s been the hardest part of recovery – and the best. I wouldn’t trade this path for anything in the world.’ Anne, Recoveree

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Factors Facilitating Recovery: Mutual Support

I continue with my series of blog posts relating to the factors that facilitate recovery from addiction, which I have detailed in the second last chapter of my eBook Our Recovery Stories: Journeys from Drug and Alcohol AddictionThese factors are also relevant to recovery from mental health problems.

“Acceptance is just one aspect of the fifth key factor underlying recovery, being supported by others. People in recovery stress the importance of having someone believe in them, particularly when they don’t believe in themselves. They also stress the importance of having a person in recovery as a mentor or role model as they travel their journey.

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Pathways from Heroin Addiction: Recovery Without Treatment, Part 4

The research conducted by Patrick Biernacki, with 101 former heroin addicts, showed some of the courses that people take in their lives when they give up using the drug without the aid of treatment. This is the last part of this series of blog posts.

When people resolve to stop using heroin, they face a variety of problems that go beyond the cravings for the drug and the temptation to use again. These additional problems are related to their attempts to fashion new identities and social involvements in worlds that are not associated with drug use.

As Biernacki pointed out, ‘The manner of termination and the course [or courses] that follow withdrawal from opiates are closely related to the degree that the addicts were involved in the world of addiction, to the exclusion of activities in other, more ordinary worlds, and to the extent that they had ruined conventional social relationships and spoiled the identities situated in them.’

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12 Principles of Indigenous Healing

When I first developed the educational healing resource Sharing Culture, I did a great deal of reading about the healing of trauma and historical trauma. I summarised what I considered to be 12 principles of healing, which are relevant to Aboriginal people here in Australia and other Indigenous peoples around the world.  I have decided to make an article on these principles the first  in our educational journey into Indigenous trauma and healing.

1. The Human Rights of Indigenous Peoples must be recognised and respected
Recognition of, and respect for, the Human Rights of Indigenous peoples is fundamental to improving their health and wellbeing. Society must ensure that Indigenous peoples have full and effective participation in decisions that directly or indirectly affect their lives.

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Factors that Facilitate Recovery

The importance of these factors has been demonstrated by listening to the narratives of recovering people about their journeys into and out of addiction (1,200 words).

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Journeys Into and Out of Heroin Addiction, Part 2

Focuses on living with addiction and covers such topics as relationships, changes in personality and lifestyle, hustling, crime and prison, impact on health, and treatment (5,900 words).

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Stopping Heroin Use Without Treatment

Research by Patrick Biernacki reveals important insights into how people recover from heroin addiction. It also illustrates the major challenges that people with a heroin addiction face on their journey to recovery (2,200 words). 

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Stephanie Brown on Recovery

A series of my blog posts based on Stephanie Brown’s wonderful book, A Place Called Self: Women, Sobriety, and Radical Transformation. In her book, Stephanie talks about what happens to women in recovery, how they think, how they feel, their problems, the good things, etc. (The book is relevant to men as well!)

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‘What is Recovery?: David Best

Here is a blog I wrote about David Best in May 2013. At that time, he had done a huge amount for the addiction recovery field and for the Recovery Movements in the UK and Australia, in terms of his research, writings, advocacy and a wide range of other recovery-based activities. Where he gets his energy from, I have no idea?

I thought it was worth showing what David thinks about the question, ‘What is Recovery’. I’ve followed his arguments and included quotes from his excellent book, Addiction Recovery: A Movement for Social Change and Personal Growth in the UK.

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‘What is Recovery?’: Julie Repper & Rachel Perkins

In my blogs, I will explore the nature of recovery and will sometimes focus on the ideas of someone else (or a group of people). I’ve previously looked at how David Best has talked about ‘What is Recovery?’ David described key principles underlying addiction recovery.

In this blog, first posted on this website in June 2103, I am going to look at what Julie Repper and Rachel Perkins have to say about ‘What is Recovery?, as described in their excellent book Social Inclusion and Recovery: A Model for Mental Health Practice. They include a number of quotes about recovery, some of which I will use here.

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Key Factors Facilitating Indigenous Healing

When I first developed the educational healing resource Sharing Culture back in 2014, I did a great deal of reading about the healing of trauma and historical trauma. I summarised what I considered to be 12 principles of healing, which are relevant to Aboriginal people here in Australia and other Indigenous peoples around the world.

1. The Human Rights of Indigenous Peoples must be recognised and respected
Recognition of, and respect for, the Human Rights of Indigenous peoples is fundamental to improving their health and wellbeing. Society must ensure that Indigenous peoples have full and effective participation in decisions that directly or indirectly affect their lives.

Read More ➔

‘Losing a Self: Lying to Yourself’ by Stephanie Brown

rsz_41a-shrpktl_bo2204203200_pisitb-sticker-arrow-clicktopright35-76_sx342_sy445_cr00342445_sh20_ou02_I’ve made reference to Stephanie Brown’s brilliant book A Place Called Self: Women, Sobriety, and Radical Transformation in past blogs. I’ve recommended this book to several women in early recovery and they have really like it. Here, Stephanie describes how one’s self (or identity) changes in a negative manner during the process of addiction. She focuses on lying to oneself.

‘… addiction develops over time, and it involves changes in the way you behave but also changes in the way you think: the way you think about drinking, the way you think about yourself, and the way you think about life.

You start to build your sense of self on a a false belief, the belief that you can control your drinking or other addictive behavior. This isn’t an easy thing to do. Since you really don’t have control, you’re going to have to lie to yourself in order to believe you are not addicted. You have to tell yourself more and more elaborate lies over time, as evidence to the contrary becomes more and more compelling, and you have to rationalize or explain it away. All your energy goes into pretending….

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‘Listening Across the Stages of Recovery’ by Bill White

Listening‘Addiction shrinks one’s world to a state of stark self-imprisonment.  As the person-drug relationship devours everything else of value, nothing remains that cannot and will not be sacrificed. And as the drug then devours the self, what remains are only manipulative masks interchanged so quickly that any sense of “true self” remains as only a faint memory.  This shell, now masquerading as a person, burns its way through the world leaving human wreckage in its wake – all wounded by addiction’s self-centeredness, dishonesty, disloyalty, depravity, and brutality.

Extreme narcissism, self-will run riot in the language of Alcoholics Anonymous, is the essence of addiction regardless of whether one sees this trait as a cause or consequence of addiction.  It is a paradoxical entrapment manifested in self-absorption (self-inflation and exploitation or self-deflation and serial victimization) and deteriorating capacities for self-care. These styles of self-deception exist within a person fighting to retain and assert his or her fading humanity.  These are the Janus faces of addiction – the Dr. Jekyll and Mr. Hyde of addiction fame.

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‘Experiencing Recovery – Part 8′ by William L. White: History of Recovery Support

Bill introduces about the various types of recovery support that have existed historically: natural support, limited generalist support within the community, peer recovery (mutual aid) and treatment. He then goes on to describe how things have been changing in recent years.

‘Experiencing Recovery – Part 5′ by William L. White: Recovery Identity & Cultural Affiliation

This part of Bill’s excellent talk focuses on identity, social stigma and recovery styles. He describes how some people hide behind anonymity because they are ashamed of themselves.

‘Recovery: What Do We Know and Where Might We Go?’ by David Best

Dr David Best of Monash University gives the Keynote Speech at the CSARS Conference at the University of Chester in 2014. Well worth watching, particularly as David is one of the world’s leading recovery researchers.

The talk ends after 65 minutes, after which there is a panel discussion.

‘A personal and social model of recovery’ by David Best

Unknown-1Here’s another excellent article from David Best which is essential reading for people trying to facilitate recovery.

‘There has been a subtle change to the role of recovery in UK addictions research, policy and practice in recent years, with a transition from the periphery to centre stage. But it can be argued that, for all the bluster, we still have a limited evidence base and we have not come far in developing an integrated or testable theoretical model.

Humphreys and Lembke (2013) have done a good job in summarising the ‘what works’ of recovery – focusing on three areas: peer-inclusive interventions, recovery housing and mutual-aid groups – so this article will not revisit that evidence.

What I will do is overview three key component parts of a theoretical model of recovery, then draw them together to derive conclusions about what we should do next to make policy and practice stronger in this area.

  1. Recovery capital – personal and social resources – the journey of growth
  2. Social identity and social contagion in recovery – the role of friends and connections
  3. Therapeutic landscapes of recovery – the role of location.

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Balunu Foundation Cultural Healing Program

I love the look of this healing programme in northern Australia.

‘The Balunu Foundation Cultural Healing program delivers cultural healing programs to many at risk youth. The healing retreat and program are located in Darwin, NT and youth have attended the program from all over Australia.

Although the program was established to help address the many challenges faced by Indigenous youth, it has had as great an impact with non-Indigenous youth who have attended the program.

Balunu adopts a holistic and culturally appropriate approach to strengthening the youth with a major focus on suicide prevention, substance abuse, emotional, mental and physical trauma, intergenerational trauma, family disruption, homelessness, crime and education.

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