 Cocaine addicts left out?Cocaine is more popular than ever. The former elite drug is currently increasingly used by the lower and younger social classes. While the number of heroin addicts is slowly becoming ‘extinct', the number of cocaine users is growing. The outgoing public exchanges the party drug XTC for white snow, i.e. cocaine and takes on a ‘jet set image'. Cocaine is a drug for everyone but can every cocaine addict get the right form of addiction care?"No", R. van Meerten of Cocaïne-Consultancy, or CoCo in short, says. According to him, there is insufficient care for cocaine addicts. Cocaine addicts are often required to follow a care programme that is similar to programmes for heroin addicts or alcoholics. "Therefore, it is important for the addiction care sector to adapt its care programmes. If this does not happen, a whole group of addicts is threatened to be left out." For that reason, Van Meerten started with CoCo in order to educate professional care workers in how to take care of cocaine addicts. Although the approach towards this project has been sceptical for years, figures from the National Alcohol and Drugs Information System (LADIS) seem to support Van Meerten's specific attention for cocaine addicts. The fact is that the number of requests for care concerning cocaine-related problems has increased with twelve per cent in 1998. In 1992, these requests amounted to only four per cent of the total number of requests for care. This proves that cocaine continues to be one of the fastest increasing substances of abuse. The cocaine supply on the Dutch market is larger than ever, the Rotterdam police inspector J. de Vlieger says in the newspaper NRC Handelsblad. According to him, this is shown by the excellent quality of the drugs that are offered at relatively low prices. "You used to pay 318 euros per gram and you were lucky if it contained sixty per cent of pure coke. Nowadays, you can get a gram of coke with a purity of ninety per cent for 45 euros," De Vlieger says. Low prices lead to an increased number of users and also to more addicts. Van Meerten: "For years now, the market is being flooded by the supply of coke. Nobody cared, however. Maybe this indifference was justified because only a small number of cocaine addicts sought help. Until now. Nevertheless, it is extremely difficult to get cocaine addicts to seek help in the professional care sector." An increased number of cocaine addicts At the Christian centre for addiction care and psychosocial care De Hoop, the number of applications of specific coke users has increased in 1998. D. de Boer, head of the outpatient clinic: "The percentage of people that primarily use cocaine is rising. Apart from this group, there is also a large group of polydrug users where cocaine plays an increasingly more important part. Currently, 21 Antilleans are participating in our programme who all are dealing with crack addiction (crack is a processed form of cocaine that can be smoked, editor)." Four hundred cocaine addicts come to the Jellinek clinic every year. They come from all social classes, from junks to hard workers with a family, most often 25 to 30 years old. Manager C. Salvador of the Jellinek clinic is concerned about the increasing normalisation of the cocaine use. "Especially because more and more people smoke cocaine, which enhances the effects of the drug." Crack In the Netherlands, crack is mostly used in the poor districts, in which many minorities live. Some groups, including Antilleans, have been familiar with crack for a much longer time. At the Antilles, crack is relatively easy to obtain at very low prices. Nevertheless, for a long time people thought that crack was not used in the Netherlands. "People were very naive as regards to crack. Here, you are not considered to be a junkie until you start using heroin. On the contrary, there was a huge fear for crack in the United States. A large group of users could not distinguish between crack (a smokable processed form of cocaine base) and cocaine (which is usually snorted) when they started using crack. For a short period of time, people thought that crack was more pure than cocaine. The users just did not know. For certain groups in society with a social disadvantage, cocaine is a means to gain social status. Moreover, people can earn a lot of money in a short period by dealing in cocaine," Van Meerten says. Turning point At first, everything is fun. Coke provides energy; you feel like doing everything. Crack gives the greatest reward ever. It influences the brain's dopamine system negatively. Dopamine is the stimulating system that makes you feel wonderful. Without dopamine, you would no longer feel like eating and drinking and have sexual feelings. Coke use leads to a decreased appetite, increased drinking, relational problems and debts. Support can only be offered if there has been a turning point. I would almost say that fortunately there is no replacing substance for cocaine, such as methadone for heroin. This will prevent the addiction from being maintained even longer. Only negative experiences will prompt users to ask for help. If they have reached a turning point, something snaps on the inside. You are only concerned with making yourself feel good. This feeling lasts for a mere twenty seconds, after which the user wants to experience that same feeling again immediately. This will evolve into a compulsory need for re-experiencing this feeling. If a cocaine user looks for help, he wants to get rid of this compulsory need. The addiction care sector, therefore, should focus on this aspect whereas now it is mostly concerned with how to deal with (traumatic) experiences in the past. People should focus more on the effects of the substance. The fact is that the effects of cocaine greatly differ from the effects of heroin. Therefore, there should also be a different treatment for cocaine and heroin addicts. If you do not offer this, this would be as absurd as treating alcoholics the same way as heroin addicts," Van Meerten states. Changes General director of De Hoop T. Stortenbeker agrees with this. "The way in which drug use in the Dutch drug scene changed prompted us to adapt our care programme. Actually, you should always be ding this if you want to continue to offer good care. At the beginning of the 1990s, De Hoop had already started making changes. For example, the set up of our work experience projects was changed. These projects are not only started to give former addicts the opportunity to learn a profession. They also match the feelings and motives of many addicts: they want to score immediately and they want to score big time. A slow care programme would not correspond with this. On the contrary, (cocaine) users want to work. Compared to the 1970s and 1980s, this is a huge difference. Nowadays, the professional care worker has to be tuned to the addict, be informed about the ways in which you can use drugs and the effects of, in this case, cocaine. He should be able to offer individual counselling to the addict. Setting short-term and feasible goals is very important in this respect," Stortenbeker says. Old-fashioned De Hoop may have adapted its treatment but in general, the addiction care is very old-fashioned and not well developed, Van Meerten beliefs. Because the number of cocaine users seeking help will increase, he deems it important that clinics also focus on scientific research when they adapt their care programmes. "The addiction care sector rarely turns to scientific studies in setting up treatment methods. The people working in the addiction care sector are all social workers. Things are different in the mental health sector. For example, extensive protocols are set up for the treatment of depression. However, this does not happen in the addiction care sector. There is one model and addicts should accept that model. If they do not succeed, they are out," Van Meerten criticises the addiction care. "The model has become more important than care. This goes on and on. In the United States, the addiction care sector focuses much more on scientific research. Clearly, scientific studies do not always provide the answer. However, they can be used in the addiction care sector and could provide a way to adequately detect and support requests for help." According to Stortenbeker, the Netherlands more often chooses a ‘system' of treatment than looking for new treatment methods. This offers a disadvantage for the treatment of (cocaine) addicts. The general director of De Hoop beliefs that the Dutch Ministry of Health, Welfare and Sports is mainly responsible for this systematic approach. "The total addiction care policy consists of many variations to the same theme. Actually, the same applies to addiction care policies all over the world. There are not many innovations. Added to this, the Ministry is very slow to follow if people do want to innovate. Detoxification under anaesthetic, for example, is a scientifically based good method to help opiate addicts. In the Netherlands, however, the set up of this treatment method has been very slow while other countries have used this treatment method for years. Nobody is helped with such a bureaucratic delay. This way, new treatment methods are being frustrated. Added to this, financial funding is often being discontinued and new treatment possibilities prematurely terminated. You do not have the change to be innovative. If you want to do something with a heart filled with compassion, you have to beg." Stortenbeker: "The government constantly asks for results. Politics is concerned with the question: ‘What do you offer and what does it produce?' You must be able to measure it financially. This is reasonable. However, society's opinion about what is acceptable or unacceptable cannot always be applied to the addiction care. When it comes to addicts, you cannot always talk about a ‘desired' result. Nowadays, much more steps are needed to achieve a ‘good' result, if there were a standard for this. The government says that the client should be at the centre of the care programme. When it is about results, however, then professional care is suddenly at the centre. If the client continues to be at the centre of the care programme, you can anticipate changes involving the person asking for help. For example, this applies to the increased number of cocaine users. It offers opportunities for a flexible and innovative treatment." ‘Made to measure' care In order to continue to be able to anticipate the changes as regards to requests for care, De Hoop has adapted its treatment programme again this Summer. De Hoop's care no longer consists of a programme with the duration of one and a half year but of modules. Every addict can start treatment at the level that matches their needs best. A treatment trajectory is set up with the client, which is based on the addictive substance, the addict's backgrounds and the modules or programme elements that match the addict-related problems of that person best. In short: ‘made to measure' care. With the individual counselling and the programme's modular set-up, Stortenbeker does not expect problems should the number of cocaine users seeking help increase. "It enables us to anticipate the addict's specific request for help even better. Alcoholics, medicine, soft drugs, heroin or cocaine addicts can be offered the treatment that corresponds to their problems the most. Moreover, the treatment can be set up in such a way that professional care workers are best able to anticipate the client's detoxification symptoms." Published in De Hoop Magazine, no. 5, 1999 |
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