RESEARCH ARTICLES

Curiosity, pleasure, transgression: pillars of the motivation to consume crack

Edna Gurgel Casanova^I; Gertrudes Teixeira Lopes^II; Lorena de P. G. Carvalho^III; Amanda Gassi Muzzi ^IV; Suelen Andrade Bernardo de Freitas^V; Ana Paula Lopes Pinheiro Ribeiro^VI

^I Nurse. PhD in Nursing, Assistant Professor in the Nursing Graduate Program at the State University of Rio de Janeiro, Work Education Tutor Program / Psychosocial Care Network. Rio de Janeiro, Brazil, Email: ednagurgel@yahoo.com.br
^IV Assistant Professor in the School of Nursing at the Rio de Janeiro State University. Post Doctorate from the University of São Paulo. Coordinator of Studies and Research Group on Alcohol and Other Drugs. Rio de Janeiro, Brazil, Email: gertrudeslopes@gmail.com
^III Nurse. Graduate student in Psychoanalytic Theory at the School of Administration Science, Education and Literature. Missionary of the Presbyterian Church of Brazil. Rio de Janeiro, Brazil, Email: lorenamissoes@gmail.com
^IV Nursing Student at the University of Rio Grande Prof. José de Souza Herdy. Duque de Caxias, Rio de Janeiro, Brazil. Email: amanda.gassemuzzi@terra.com.br
^V Getulio Vargas State Hospital nurse. Rio de Janeiro, Brazil, Email: suellen.snb@hotmail.com
^VI Graduated in communication. Specialist in Advertising and Marketing from the Getúlio Vargas Foundation. Resident nurse at the Pedro Ernesto University Hospital / State University of Rio de Janeiro. Member of the Studies and Research Group on Alcohol and Other Drugs CNPq. Rio de Janeiro, Brazil, Email: anapaulaplp@uol.com.br

DOI: http://dx.doi.org/10.12957/reuerj.2015.18411

ABSTRACT

This qualitative, descriptive study described the motivations that led users to try crack, and analyzed the psychosocial effects of the behavior pursued to maintain consumption. The interviewees were ten crack addicts, nine male and one female, at an alcohol and drug psychosocial care center (Centro de Atenção Psicossocial Álcool e Drogas, CAPS AD) in Duque de Caxias municipality, in the Baixada Fluminense, Rio de Janeiro State, in 2011. The results showed that curiosity and pleasure were decisive in their starting to use crack. User behavior was characterized by transgressions reported in various forms of violence and the sale of the body as a source of income to support drug use. It was concluded that crack abuse can be a device for transforming a life marked by failure, discrimination and lack of prospects into a constant search for pleasure.

Keywords: Drug; crack abuse; curiosity and pleasure; transgression.

INTRODUCTION

Hypermodernity characterized by fluidity, flexibility and indifference to major structural principles of modernity, has produced a change in the subject's relationship to the present time. On this issue we often find in the postmodern subject compulsive behavior of product consumption. Thus, we can understand drugs as a commodity and the addiction as a form of reaction, in which the escape from reality, sometimes happens by means of compulsory purchasing of the drug product¹.

On the other hand, the pleasure provided by the use of psychoactive substances, as well as the possibility to live new experiences should also be considered when seeking to understand the phenomenon of chemical dependency. Several polemics accompany the drug theme, primarily correlated with sale and consumption, with social inequality, legality or illegality and its criminalization².

Presently, there is an over valuation of the satisfaction of the individual wishes, making them actual slaves. Among the various psychoactive substances they produce immediate pleasure effects, which prevents the subject to learn how to deal with disappointments that are natural in life².

However, the drugs have always been present throughout the history of mankind and was part of the experiences of societies in their different cultures. Thus, at the end of the last century, a special drug, crack, caused an impact on society and became a major concern through its devastating effects.

Crack came to Brazil in the 90s, and its use has increased in an exaggerated proportion. Some evidence points its beginning in Sao Paulo. Before long, the drug consumption has reached other States of the Federation, and is now considered a public health problem^3-5.

This drug, despite being marketed for a short time in Rio de Janeiro, it has already reached unimaginable statistics. Its occurrence can also be explained by the rapid duration of substance's effects causing the user to return to using it more often, and in a short time, predisposing them to developing a dependence, in short time.

Initially, the substance consumption reaches the range of users attracted by the low price compared to cocaine, and others looking for more intense effects. In addition, some supporters of injectable cocaine use abandoned this route of administration for fear of contamination with the Human Immunodeficiency Virus (HIV), choosing crack as an alternative.

In addition to factors previously cited as motivation for crack usage was the search for the sense of pleasure was also mentioned as a justification. This initial feeling is progressively replaced by a compulsive behavior. This continued use reduces the crack user to think constantly in consumption at the expense of sleep, food, affection and sense of responsibility⁴.

As for the socio-cultural profile observed among crack users, the most recurrent corresponds to the individual male, young, and young adults with low education, unemployed, from low-income families⁶.

In addition to the situations described above, the rapid growth of the consumption of crack, its severe physical, psychological and social effects, especially increasing the vulnerability of socially excluded groups and disadvantaged portions of the population, support the choice of this study's theme.

The narrative that we present is based on the assumption that the chemical dependency of the crack should be understood as a chronic condition, treatable and determined by many aspects of human existence, including biological, psychological and sociocultural dimensions in both the source of the problems, as well as the proposals of its approach⁷.

Given the above and the consequences that it raises, cut out as a research object of the motivational aspects for the initiation and crack abuse among addicts treated at a Psychosocial Care Center for Alcohol and Drugs (CAPS AD).

Thus, facing the complexity of the problem requires the user to society in general and the government in their different fields, the following goals were set: to describe the motivations that led users to try the crack and analyze the psychosocial repercussions behavior assumed for maintaining consumption.

LITERATURE REVIEW

Historically, crack emerged in the United States in the 80s among people living in poor and marginalized neighborhoods in the cities of Los Angeles, New York and Miami. The substance produced great euphoria and a short duration, causing intense cravings and heightened tolerance. Per these characteristics, it was considered overwhelming and became the target of government attention and society in general³.

When inhaled, the crack arrives quickly to the brain and its effects are felt almost immediately, in 10 to 15 seconds; however, they last an average of five minutes, which explains its great addictive power⁸.

Another contributing factor to its dependence is the feeling of intense pleasure noted by people who use of substance. As the crack is rapidly eliminated from the body, producing a sudden interruption of the wellness sensation it leads to an immense displeasure and a strong desire to reuse it⁷.

Among the consequences of drug addiction, we can highlight depression, fatigue, and fissure, which is the compulsion to use it, which in the case of crack is overwhelming⁸.

As for the crack consumption pattern, compulsive behavior is the most recurrent, with episodes of fissure and loss of control of drug use its primary characteristics, which increases the likelihood of frequent use and, as a result of dependency, to a lesser evolution time.⁹

Given the magnitude of the problem, the search for concrete solutions and the Brazilian Government's concern with the high use of crack was established, among other initiatives, the Confrontation to Crack and other drugs, by means of Decree No. 7179, May 20, 2010. Such legislation aims to develop an integrated set of prevention, treatment and social reintegration of users of crack and other drugs, as well as confront trafficking in partnership with States, federal district, municipalities and civil society¹⁰.

In this perspective, as part of the actions of the plan, was held in 2012, a survey by the national anti-drug Secretariat (SENAD), in partnership with the Oswaldo Cruz Foundation, with people living in 26 capitals and the federal district. It is estimated that 1,035,000 people regularly used illicit drugs in the last 6 months preceding the survey, except marijuana. Among these individuals, 370,000 were users of crack and/or similar, being 14% minors − representing approximately 50 thousand children and adolescents¹¹. A study developed in order to map the crack user experience on treatment in the city of Recife / PE, it highlighted that among the factors that most influenced the consumption of crack was first peer pressure, followed by curious to know the sensation caused by the drug, reinforced by the user's social environment and also for the sense of belonging to a certain group¹².

METHODOLOGY

The choice of the methodological approach, the nature of which is based on the descriptive qualitative research took as a principle the search subjectivity of users, reflected in their motivations and reasons to find pleasure through the consumption of crack, as well as the psychosocial consequences of its abuse.

The investigation was a CAPS-AD, located in the municipality of Duque de Caxias, in the Baixada Fluminense, in the State of Rio de Janeiro.

The project was submitted to the Research Ethics Committee of the University of Rio Grande Prof. José de Souza, Lauren being approved under Protocol 0018.0.317.000-10.

The study subjects were ten users, dependent on crack, nine male and one female, chosen from the following inclusion criteria: be effectively registered in AD CAPS for at least 6 months and presenting a compulsive pattern as their usage modality. The reports were identified with the letter E (interviewed) and assigned sequential numbers for each user.

When starting the interviews, subjects received clarifications about the research and the ethical principles involving research with human beings, in accordance with resolution No. 196/96 of the National Health Council, signing, then an informed consent¹³.

The data were processed according to the precepts of the content analysis¹⁴. With a careful look at recorded units, we arrived at three analytical categories: The curiosity and pleasure in the initiation of crack use; Use of transgression for the purchase of drugs; The body as a bargaining chip for maintenance of crack use.

RESULTS AND DISCUSSION

In an attempt to clarify the meaning assigned by users to crack consumption, the analytical categories mentioned above are presented.

Curiosity and the pleasure in the initiation of crack use

This category gives visibility to the influence of the crack users since the first trial, either in the context of family intimacy (brothers and cousins), being in a sociable environment of outside the family (friends, colleagues and acquaintances).

The influence of family and friends, and curiosity about the effects obtained from the use of this substance were constituted decisive factors that led to the first trial¹²

On the other hand, the decision to use (or not) drugs arises from the interaction of several different complex factors and less noticeable, as the fragility of the situation, the family bond, the limits, the fear, the expectations and the fascination for the challenges¹⁵.

All of the respondents admitted that the presence of a person using the drug instigated the trial, as summarized in the three testimonial fragments:

Because I have a cousin who's a user. (N2)

Questions of colleagues, tried it and I was told to use it and by my curiosity I tried and I liked it at the time. (N1)

I was at the Manguinhos station (Rio de Janeiro) and a colleague was at the station waiting for the train to come to Saracuruna and he was smoking the joint with the crack. Then I tried it [...]. (N3)

As you can understand, the relatives and colleagues appear as the first consumer influencers. For these respondents, crack was originally consumed as a curiosity and became a source of pleasure. In this respect, satisfaction and pleasure are sensations that cannot be put in abstract terms: must besubjectively experienced-lived. Thus, the satisfaction of achieving pleasure through the drug is only temporary, but concrete and subjective ¹⁶.

The need to consume more often the crack is associated with the desire to feel more pleasure or can be related to attempt to avoid the withdrawal symptoms. Thus, research conducted with crack users pointed out that the figure of speech brought by users before the crack makes us realize how much pleasure the substance gives each of them and how hard it is to give up that pleasure, which is so intense and immediate. We can think about crack as paradigmatic of the pleasure experience^12:58.

However, the challenge of controlling the use of the substance, often without success, it's a fact that accompanies the start of the trial of crack. People are aware that continued use can lead to compulsion, but believe always that they can control the consumption¹².

A guy offered it to me and I tried it out of curiosity. I just lost my desire to go to school, I stopped studying. (N9)

The previous narrative shows that the modern world calls for the pleasure and the decline of the duties. Thus, the search for new sensations or the idea to be consuming something new mobilizes people, reinforced by the news given in the commercial appeals are attractive and seductive, as well as the need to be part of a group ofconsumers¹⁷. That's what has the potential to mobilize groups, especially those in social vulnerability. In this perspective, young users and young adults use crack more often associated with destructive processes in relation to their social life¹⁸.

The use of the transgression to acquisition of the drug

One of the situations that characterize the behavior of drug users is the transgression that can show different forms, from those of smaller personal injury up to the use of physical and psychological violence.

Domestic and urban violence, petty theft, shoplifting and involvement with the crime are situations that often cause vulnerabilities even more the drug user, in addition to the inequality of opportunity, a short supply of quality education and professionalization exacerbate the stigma, discrimination and social exclusion¹¹.

Then they show up some transgressions for the crack, as illustrated by the speeches

I stole things from inside the house to sell and buy the stone, my mom's stuff, money and cell phone. (N6)

As has been discussed by experts, the first transgressions by most users / drug addicts - and particularly the crack - are held within their own home and with people I admire and respect, for example, the mother. Such practice initially happens with relatives, but with the progression of substance use, will expand to reach the world of crime, finding the transgression a way to settle an identity¹⁹.

Thus, the correlation between drug-violence has a consequence of drug abuse, identifying the user as a violence that causes fear for society, for family and for people who live in their environment²⁰.

Corroborating the relationship between violence and crack, studies show the sale of belongings of family members, assaults, petty theft, drug trafficking and kidnappings^21,22.

I would go to the streets and apply 171 to the others, saying that it was for a bus fare or else I sold candy and cleaned windows. (N4)

I took a cell phone from a girl who lived in the community. (N10)

For these users, what counts is the promotion of pleasure, independent of the risks often are exposed to obtain money or drugs.

The initiation into the world of crime, regardless of their motivations and the category of the transgression, no evidence consciously feelings of guilt, but rather manifests itself as a source of pride and of self-esteem¹⁹.

I included the others in the street to get high ... I started stealing, I started doing evil, stealing cars in order to get high. (E8)

I've cut a girl's face because of crack. (E7)

As shown by the statements above,configuration variations of transgressions tend to impact the incidence of violence in its dynamics and, in particular, in its intensity ^23:74.

The body as a bargaining chip to maintain using crack

The sale of the body has become an established practice for the acquisition of the crack among men and especially women. The continued consumption requires increasingly significant amounts of financial resources. Therefore, selling their body for women is the best way to raise money to buy the drug ²⁴.

I've already sold my body to buy drugs, when I had no money. (N9)

Study concluded that women sell their body as a way to get income for the consumption of crack and do not recognize themselves as sex workers for practicing sex in Exchange for drugs or money to buy the substance²⁵.

A study realized in a CAPS AD in the municipality of Duque de Caxias, in the State of Rio de Janeiro, identified that, among 113 women drug users, 69.9% had no paid occupation and 12.4% were involved in prostitution²⁶.

I went to the hotel with a man, tied the man to the bed and I stole everything from him, even his clothes. Everything is worth money! (N5)

In addition it may be noted that this practice has promoted the increase in sexually transmitted diseases among women users. Unlike sex workers, the sale of the body to obtain crack or money to buy it is related to fissure for acquiring the drug, which features a promiscuous sex, despair, degradation and high risk of infection with sexually transmitted diseases. The sex workers, in turn, use care and protection measures in relation to safe sex²⁴. Thus, the practice of unprotected sex makes women crack users an important risk group in relation to sexually transmitted diseases (STDS) and acquired immunodeficiency syndrome (AIDS).

Furthermore, lately, the higher prevalence and incidence of STDS occur among women who undergo the practice of sex for drugs without proper precautions for disease prevention²⁷.

This commercial transaction of sexual services for the purchase of drugs, paying dominates the negotiation, often requiring the dispensing of condoms and the practice arrangements of unusual sexes, as well as payment for the service with negligible amounts, leading the user to seek greater number of programs and hence exposing them to a greater number of partners to achieve the amount required for the drug. These evil ingredients together greatly increase the risk of STD / AIDS, violence and degradation^28,29.

As you can see, the use of crack is multifactorial and needs to be understood from the perspective of psychosocial aspects, subjects' vulnerability and aggression.

CONCLUSION

Crack abuse can become a device capable of transforming a life marked by lack of resources, discrimination and lack of prospects in a constant search for pleasure, focused on the present, in which users try to fill the existence, with a concrete and feasible objective: to obtain more and more crack.

Regarding the first category, emerging the statements, the results showed that initiation to crack use had as its starting point the curiosity to try the drug, driven by socializing with family and friends. In this regard, it must be understood that, in contemporary times, there is a fluidity of the family, with colleagues and neighbors, predisposing to a weakness in traditional areas of references.

As to the second category, the transgression, in their various forms and amplitudes, was referred to by users as a way to get the crack. The fear of being without the drug, withdrawal and psychic effects arising from the use predispose to violence, which can be materialized in physical and verbal assaults, theft, robbery and the sale of belongings of family members.

Considering the third category, selling body for money-making or the drug itself was also a practical pointed out in this research. That risk behavior presents itself as another kind of violence that is exposed or that the crack users are exposed. It is possible that these perform unprotected sexual practices, increasing the possibility of contamination and spread of STD/AIDS.

We need to better understand the users of crack through the strengthening of inter-sectoral network, at all levels of health care, inclusive, in the perspective of harm reduction in that the uniqueness of the subject.

The study, despite its greatness and magnitude in terms of knowledge produced from the testimonies of ten respondents about the motivations and reasons for initiation, use and abuse of crack, does not allow for the generalization of the results. However, it can produce, by proxy, the understanding of the phenomenon in similar studies. With this limitation, we suggest that other studies are implemented to deepen the knowledge in this area.

REFERENCES

1. Dufour CR. A arte de reduzir cabeças: sobre a nova servidão na sociedade ultraliberal. Rio de Janeiro: Companhia de Freud; 2005.

2.Acselrad GA. Educação para autonomia: construindo um discurso democrático sobre drogas. IN: Acselrad GA. Avessos do prazer: drogas, aids e direitos humanos. 2ª ed. Rio de Janeiro: FIOCRUZ; 2005. p. 183-212.

3.Procópio A. O Brasil no mundo das drogas. Petrópolis (RJ): Vozes; 1999.

4.Nappo AS, Gauduróz JC, Raymundo M, Carlini EA. Changes in cocaine use as viewed by key informants: a qualitative study carried out in 1994 and 1999 in São Paulo. J Psychoactive Drugs. 2001; 33:241-53.

5.Centro Brasileiro de Informação sobre drogas Psicotrópicas: I Levantamento domiciliar sobre o uso de drogas psicotrópicas no Brasil: estudo envolvendo as 107 maiores cidades do país. São Paulo: Universidade Federal de São Paulo; 2002.

6.Ribeiro M, Dualibi LB, Perrenoud LO, Sola V. Perfil do usuário e história natural do consumo. In: Ribeiro M, Laranjeira R, organizadores. O tratamento do usuário de crack. 2ª ed. Porto Alegre (RS): Artmed; 2012. p. 39-49.

7.Cruz MS, Vargens RW, Ramôa MI. Crack: uma abordagem multidisciplinar. In: Prevenção ao uso indevido de drogas: capacitação para conselheiros e lideranças comunitárias. 4ª ed. Brasília (DF): Secretaria Nacional de Políticas sobre Drogas – SENAD; 2011. p. 193-206.

8.Pacievitch T. InfoEscola [site da internet]. Crack. [citado em 13 abr de 2014] Disponível em: http://www.infoescola.com/drogas/crack.

9.Perrenoud LO, Ribeiro M. Histórico do consumo do crack no Brasil e no mundo. In: Ribeiro M, Laranjeira R, organizadores. O tratamento do usuário de crack. 2ª edição. Porto Alegre (RS): Artmed; 2012. p. 33-38.

10.Senado Federal(Br). Decreto nº 7.179/ 2010, de 20 de maio de 2010. Brasília(DF): Senado Federal; 2010.

11.Ministério da Saúde (Br). Secretaria Nacional de Políticas sobre Drogas. Ministério da Justiça. FIOCRUZ. Perfil dos usuários de crack e/ou similares no Brasil. Brasília (DF): SENAD: 2013.

12.Almeida RB, Caldas MT, Albuquerque RKR, Campos AR. Crack, a pedra lançada no SUS: desafios para uma atenção necessária. Saúde em Debate. Revista do Centro Brasileiro de Estudos de Saúde. 2013;37 (esp): 49-60.

13.Ministério da Saúde (Br). Conselho Nacional de Saúde. Diretrizes e normas regulamentadoras sobre pesquisa envolvendo seres humanos. Resolução nº 196/96. Brasília (DF): CNS;1996.

14.Bardin L. Análise de conteúdo. Lisboa(Pt): Edições 70; 2011

15.Fracasso L, Torres S. Situação de rua e consumo de crack. In: Ribeiro M, Laranjeira R, organizadores. O tratamento do usuário de crack. 2ª ed. Porto Alegre (RS): Artmed; 2012. p. 585-597.

16.Bauman Z. Modernidade líquida . Rio de Janeiro: Jorge Zahar editor; 2001.

17.Jorge MSB, Quinderé PHD, Yassui S, Albuquerque RA. Ritual de consumo do crack: aspectos socioantropológicos e repercussões para a saúde dos usuários. Ciênc. saúde colet. 2013; 18: 2909-18.

18.Ministério da Saúde (Br). Abordagens terapêuticas aos usuários de cocaína/crack no Sistema Único de Saúde. Brasilia (DF): 2010.

19.Baptista GC. Adolescência e drogas: a escuta dos dependentes. São Paulo: Vetor; 2006.

20.Rodrigues AS, Oliveira JF, Paiva MS, Oliveira DS, Marinho MN. Representações sociais de discentes técnicos de enfermagem sobre drogas. Esc Anna Nery, 2015; 19: 226-232.

21.Carvalho HB, Seibel SD. Crack cocaine use and its relationship with violence and HIV. Clinics. 2009; 64: 857-66.

22.Bungay V. ,Johnson NJL, Varcoe C, Boyd S. Women's health and use of crack cocaine in context: structural and everyday violence. International Journal of Drug Policy. 2010; 21: 321-9.

23.Sapori LF, Sena LL. Crack e violência urbana. In: Ribeiro M, Laranjeira R, organizadores. O tratamento do usuário de crack. 2ª ed. Porto Alegre (RS): Artmed; 2012. p. 74-91.

24.Nappo SA, Sanchez ZVDM, Ribeiro LA. Troca do sexo por crack. In: Ribeiro M, Laranjeira R, organizadores. O tratamento do usuário de crack. 2ª ed. Porto Alegre (RS): Artmed; 2012. p. 566-76.

25.Zaluar A, Vallim DC, Sampaio C. Uma análise do perfil sociocultural dos usuários de crack no município do Rio de Janeiro: relatos de uma etnografia. In: Anais do II Encontro Nacional sobre a Sócio-Antropologia do Uso de Psicoativos; 2012 jul 01-02; São Paulo, Brasil. São Paulo: Associação Brasileira de Estudos Sociais do Uso de Psicoativos; 2012.

26.Silva EBO, Pereira ALF. Perfil de mulheres usuárias de cocaína e crack atendidas em um centro de atenção psicossocial. Rev enferm UERJ. 2015; 23: 203-9.

27.Zanotto DF, Buchele F. Revisão sistemática sobre crack: aspectos relacionados ao uso e abuso. Saúde em Debate. Revista do Centro Brasileiro de Estudos de Saúde. 2013; 37 (esp): 12-20.

28.Nappo AS, Sanches ZM, Oliveira LG. Crack, Aids and women in São Paulo, Brasil. Subst use Misuse. 2011; 46: 476-85.

29.Lejuez CW, Bornovalova MA, Daughters SB, Curtin JJ. Differences in impulsitivity and sexual risck behavior among inner-city crack/cocaine users and heroin users. Drug Alcohol Depend. 2005; 77: 169-75.