Background to the Research

• There is evidence of an increase in cocaine use in NI in recent years as seen through increases in police seizures of the drug, higher prevalence rates of use in self-report surveys and more people presenting to treatment services. This study explored the patterns of cocaine use and the lifestyles of users in NI with the aim of providing the Department of Health, Social Services and Public Safety and treatment service providers with a better understanding of cocaine use in NI.
  

Research Approach

• This primarily qualitative study was conducted in two phases. Phase I consisted of a 'Community Assessment Process' to gain an understanding of the experiences of drug treatment professionals to cocaine use in NI. Phase II involved 40 in-depth interviews with cocaine users.
  

Main Findings

• The study identified two types of cocaine user - recreational or socially integrated users and those referred for drug treatment who, as a group, was socially marginalized.
• The demographic profiles of each type of user differed in a number of important respects. Recreational users were typically young, educated and anchored to a largely conventional lifestyle and whose pattern of non-work activities involved partying and drug use. Treatment users, on the other hand, generally had low level educational qualifications and were typically unemployed and living on state benefits. A number of the treatment users were either living in a hostel at the time of interview or had experienced homelessness at some time in their life. None of the recreational users reported any experience of homelessness. These distinctions, as well as differences between the groups in terms of their drug use patterns, preferences and practices, strongly suggest that in unravelling the nature of cocaine use and cocaine problems there is a need to look beyond the drug itself.
• Many of the treatment professionals referred to the absence of a typical cocaine user profile. These professionals distinguished between recreational and treatment users. There was considerable uniformity within the study between the experiences and perceptions of service providers and cocaine users.
• Both recreational and treatment users were already drug-experienced when they used cocaine for the first time, with initiation to other drugs typically occurring several years before first use of cocaine. All cocaine users were polydrug users who had considerable experience with a range of illicit drugs. The majority in both groups had used cannabis, Ecstasy and amphetamine during their lifetime and many had used one or more of these drugs regularly at some time.
• Cocaine initiation typically occurs in familiar settings where the drug is invariably offered by familiar people. The dominant and favoured use settings were indoor, private spaces, showing that cocaine use generally takes place away from the public gaze and is likely to remain quite hidden.
• Recreational users in particular preferred to use cocaine in the company of others, either in their own home or in the home of a friend. House parties were the most talked about use contexts, although many recreational users had also snorted cocaine in public licensed premises (pubs and clubs).
• Recreational users were more animated than treatment users in their portrayal of cocaine benefits, and listed an array of appealing aspects of the drug which were strongly linked to self and social enhancement. Whilst treatment users talked about a number of these benefits - including increased self-confidence and feeling more energetic - their accounts focused to a greater extent on the chemical highs they experienced from use.
• Recreational and treatment users differed quite significantly in terms of their experiences and perceptions of risk and the negative consequences associated with cocaine use. Recreational users often reported no negative consequences or side effects arising from their use of the drug and many equated any downsides or unappealing effects with those associated with an alcohol hangover. Treatment users were relatively well-versed on the range of risks associated with cocaine use, including its impact on their physical and mental health and well-being. Their perspectives on cocaine risks may to some extent have been influenced by the experience of treatment, since the dangers of continued cocaine and other drug use are usually communicated within drug treatment regimes.
• Treatment users referred frequently to their 'addiction' to cocaine, a relatively rare reference point among recreational users who, in the main, claimed to 'control' their cocaine consumption. These differences in user perceptions of cocaine risks, particularly in relation to the risk (and perceived reality) of 'addiction', have implications for both prevention and treatment initiatives. For example, health messages stressing cocaine's addictive potential may be ineffective if a majority of recreational users experience and perceive no such risk. These users are likely to be more open to messages that match their experiences and to place greater value on advice about how to reduce the potential physical and/or psychological hazards associated with cocaine use.
• The experience of those referred for treatment was varied on this provision across the sample. These users, rightly or wrongly, often diminish the negative impact of cocaine on their lives and on their physical and psychological health, believing that the negative impact of drugs is more related to another substance(s). From a drug treatment perspective this situation presents challenges, particularly in relation to how services and interventions are organised and equipped to respond to polydrug users, including those who use cocaine. This was largely corroborated by professionals who identified gaps in service provision specific to cocaine-using clients as well as a perception that treatment providers lacked the requisite knowledge about how to adjust their services to meet the needs of problem drug users who use cocaine, a situation that is not unique to NI.

Conclusions

• The study confirms that cocaine is widely available and likely to become integrated into the drug repertoires of young polydrug users. However, the findings also highlight the hidden nature of cocaine use. Cocaine users who present to treatment are also likely to be polydrug users and, typically, will not identify cocaine as their primary drug of misuse.
• The perceived lack of experience in dealing with cocaine-(ab)using clients points to a need for education for drug treatment and health professionals on the management of cocaine problems. This and the general findings from the study suggest that a convincing case can be made for the development of preventive messages which aim to reinforce some of the basic 'standards' and practices employed by cocaine (and other recreational) drug users to reduce injury and harm. Practical and 'sensible' advice which corresponds with the experiences of drug users is likely to be embraced rather than rejected by drug users who already subscribe to rules and strategies aimed at maintaining safe drug use practices.