Cocaine Dependence and the African American Community

Abstract

Cocaine dependence is a condition which can affect Americans from all wakes of life however the condition has been a scourge in African American communities. Cocaine dependence has led to high incarceration rates which have disproportionately affect African Americans. The condition and its treatment options will be analyzed for cocaine dependence to determine ways in which the issue could be combatted specifically in the African American community. The research has found that there are few effective treatment options for cocaine dependence. This would mean that the condition continues to persist with few treatment options available.

Overview of the Disorder

Cocaine dependence is a condition where an individual has a controllable urge to use cocaine constantly. The condition is caused by regular use of the drug that results in a change in the brain chemistry of the individual. Cocaine can be highly addictive in comparison to other illegal substances. Wagner & Anthony (2001) fund that one in 16 users will become dependent on the drug after their initial uses of the substance. The continuous use of cocaine can cause personality changes in a person and can cause them to go to great extents to obtain the drug. “Cocaine addiction affects brain reward centers that have evolved to ensure survival. Cocaine euphoria is intensely pleasurable and results from mesolimbic dopamine (DA) neurotransmission” (Dackis & O’Brien, 2001, p. 111). This physiological and psychological need to obtain the drug results in debilitating impact on the person’s relationship and functioning within society. These symptoms are needed to be able to be diagnosed with the condition. Cocaine dependence is fairly prominent in African American communities where the drug is used in a baser form called crack cocaine. Due to the low cost of both production and sale of the drug it is most often found in low socio-economic communities. Despite the prevalence of the drug in these communities, Falck, Wang, and Carlson (2008) found that African American’s are diagnosed with cocaine dependence in lower numbers than Caucasians. The drug in this form has been found to be the most addicting and also has the harshest legal penalties associated with the drug. Many drug court cases involve cocaine. Due to the addictive nature of the drug it can be difficult to treat. This can be even more difficult to treat if individuals are not accurately diagnosed with cocaine dependence. The low socioeconomic status of those who use the drug often means that they do not have the resources or the means to be able to obtain treatment for the addictive and debilitating condition. 

Current Research

Research and media focus on cocaine dependence has been limited due to the barriers listed above in obtaining treatment for a condition that mainly affects those in low socioeconomic status.  Of the research that has been conducted African Americans have not been a part of the population that has been studied. Pena, Shervington, Rice, and Foulks (2000) found that the research on the condition has largely excluded minorities making it difficult to develop treatments that would work specifically with these populations. The research has been focused on understanding the changes that occur in the brain as a result of the drug use. Through analyzing the way in which the drug affects the brain researchers hope to develop effective treatments for the condition. As a result of this increased focus on the brain treatments have mainly been focused on attempts to develop medications rather than treatment modalities to treat the condition. Poling, Kosten, and Sofuoglu (2007) found that despite the increased focus on developing pharmacological methods to treat the condition an effective medicine has yet to be developed. This may indicate that the avenue to treat the condition is not through the use of medication but rather an alternative form of rehabilitation or therapy.

Trends

Cocaine use is prominent in the United States however despite the prevalence of the drug, the diagnosis and treatment of the condition are in low numbers. As mental health professionals become more aware of the diagnosis they are able to diagnose with increased accuracy. However Falck et al. (2008), found that despite over a quarter of cocaine users meeting the requirements for the diagnosis of cocaine dependence less than half of this number obtain treatment for the condition. Of the individuals who are diagnosed they are predominantly males. Despite the prevalence of the condition in the African American community diagnosis is rare as the community is largely distrustful of the medical community and would not be willing to seek treatment for the condition.

Evidence Based Treatment

Treatments for opiate dependence has been largely in the form of substance abuse treatment with a shift towards medication. Studies have been conducted to determine the efficacy of utilizing various forms of medication such as antidepressants in the treatment of the addiction. Lima, Soares, Reisser, and Farrell (2002), found that the randomized controlled trials that were completed on various medications determined that there was not an effective medication that could treat the condition. Lima recommended that a form of therapeutic treatment would be needed in conjunction for the medication to be effective. The effectiveness of medication is increased if the individual had co-morbid substance abuse and mental health diagnosis such as depression. If an individual is self-medicating with illegal substances the use of an antidepressant could potentially reduce the need for the drug use. A recovery based model for individuals who do not have comorbid mental health conditions may be more beneficial. In his studies, Flynn, Joe, Broome Simpson, and Brown (2003), found that treatment program which used a recovery approached had higher rates of success than other approaches. These individuals were more likely to be motivated in their recovery through the use of spirituality, positive influences of those in the recovery program with them and developing the understanding that recovery would be a process. For individuals who would require an external motivation drug court programs were found to be an effective in reducing rates of substance abuse. Henggeler et al. (2006), found that this was due to the increased surveillance of the program rather than the individual’s motivation to stop using. While this form of treatment is beneficial in the short run it may not prevent them from using in the long run. The limited availability of effective evidence based treatments demonstrates that increased research that needs to be conducted on cocaine dependence.

Implications for practice

The lack of effective treatments for cocaine dependence coupled with a lack of inclusion of African Americans in the research indicates that there is a gap, which can be addressed through social work practice. The impact of cocaine use in the African American community does not just impact individuals who are arrested for their substance abuse issues. Their families have to deal with one less breadwinner in the home. Children are placed in foster care due to their parents drug use. Whole communities lose contributing members of their society. In order to combat these issues proposals need to be developed on micro, mezzo and macro levels in order to address all of the areas that are affected by cocaine dependence. On a micro level an individual’s drug treatment will need to be focused upon. For individuals in the African American community a drug treatment center would need to be developed within the communities making them easier to access. Substance abuse counselors would need to be experienced with working with a diverse group of individuals in order to be able to address the multicultural needs of the community. Pena et al. (2000), found that the lack of African American participants in research studies leads to the development of treatment programs that do not address the needs of African American individuals. A program would then need to be developed in order to transition former addicts back to society through job training and rehabilitation. On a mezzo level families would need to be focused upon. Family therapy services would need to be provided to families to help them cope with the challenges of having an addict in their home. Falck et al. (2008), found high rates of comorbid disorders in African American communities. Dealing with a family member who has a substance abuse issue can lead them to develop mental health conditions such as depression. Families would need to be provided with the tools to ensure that they are functioning and children are not being removed from the home and placed into foster care. On a macro level social workers would need to work in conjunction with law enforcement to develop programs to get drug dealers off of the streets. Through a collaborative approach the epidemic of cocaine dependence in African American communities can be addressed and overcome.

Conclusion

The current approach to treating cocaine dependence in the African American community has been through incarceration. A preventive approach has not been utilized to address the substance abuse problems faced by millions of Americans. Through increased research on treatment options for the treatment of the condition a preventive approach could be developed. Minorities such as African American individuals also need to be included in these studies as they face the problem in their community yet they are provided with the least amount of resources to deal with the issue. As the previous approaches to address the issues have not been effective a paradigm shift is needed to decrease the incidences of cocaine dependence in not just the African American community but for all Americans. 

References

Dackis, C. A., & O'Brien, C. P. (2001). Cocaine dependence: A disease of the brain’s reward centers. Journal of Substance Abuse Treatment, 21(3), 111-117.

Falck, R. S., Wang, J., & Carlson, R. G. (2008). Among long-term crack smokers, who avoids and who succumbs to cocaine addiction? Drug and Alcohol Dependence, 98(1), 24-29.

Flynn, P. M., Joe, G. W., Broome, K. M., Simpson, D. D., & Brown, B. S. (2003). Looking back on cocaine dependence: Reasons for recovery. The American Journal on Addictions, 12(5), 398-411.

Henggeler, S. W., Halliday-Boykins, C. A., Cunningham, P. B., Randall, J., Shapiro, S. B., & Chapman, J. E. (2006). Juvenile drug court: Enhancing outcomes by integrating evidence-based treatments. Journal of Consulting and Clinical Psychology, 74(1), 42.

Lima, M. S. D., Soares, B. G. D. O., Reisser, A. A. P., & Farrell, M. (2002). Pharmacological treatment of cocaine dependence: a systematic review. Addiction, 97(8), 931-949.

Peña, J. M., Bland, I. J., Shervington, D., Rice, J. C., & Foulks, E. F. (2000). Racial identity and its assessment in a sample of African-American men in treatment for cocaine dependence. The American Journal of Drug and Alcohol Abuse, 26(1), 97-112.

Poling, J., Kosten, T. R., & Sofuoglu, M. (2007). Treatment outcome predictors for cocaine dependence. The American Journal of Drug and Alcohol Abuse, 33(2), 191-206.

Wagner, F. A., & Anthony, J. C. (2001). From first drug use to drug dependence: Developmental periods of risk for dependence upon marijuana, cocaine, and alcohol. Retrieved from 

http://www.biblioteca.cij.gob.mx/articulos/PatronDeUsoYDependencia/2002WagnerFrom-FirstDrugUseToDrugDependenceDevelopmentalPeriodsOfRiskForDependenceUponMarijuanaCocaineAndAlcohol.pdf