Welcome to the latest FRANK Action Update. This is a special reference edition to complement our other publications.
The range of professionals in the FRANK network is very broad, so some issues of the Update may be more relevant to your work and your client group than others. But we hope that each Update will bring you useful information and inspiration as you get on with the vital job of raising awareness about drugs.

Crack cocaine is not everywhere, but in some areas it is a growing problem and the drug, its effects on the individual, and the ways in which it is tackled, are often misunderstood. Many people wrongly believe that crack cocaine can be neither tackled nor treated. This often discourages people from taking collective action or coming forward for individual help. Drug workers and other professionals have had to address crack cocaine as a relatively new drug issue and many are now beginning to get the knowledge, confidence and support they need to work effectively with crack cocaine users. This FRANK Action Update aims to help you understand some of the issues related to crack cocaine. Containing background information, facts and statistics, it helps to explode some of the damaging myths surrounding crack cocaine. It gives ideas for action and shows how certain projects have successfully tackled crack cocaine, while also signposting routes to further help and information. If you are already addressing a crack cocaine problem in your area, you will probably be familiar with most of the material in this pack. However, you may find some useful additions to your local action.

FRANK IN ACTION VITAL STATISTICS Feedback from the public and local networks about the FRANK campaign What is crack cocaine? Crack cocaine in the UK The crack cocaine market Physical & psychological effects Challenging a crack cocaine drug market Young people and crack cocaine prevention Common Myths MOVERS AND SHAKERS Snapshots of positive practice on tackling crack cocaine CHECKLISTS FOR ACTION Key needs and requirements in addressing crack cocaine locally IDEAS FOR ACTION Ideas and inspiration for local action USEFUL RESOURCES Useful contacts, publications, resources and websites FRANK FACTS FRANK TIPS MORE FRANK TELL FRANK Myth-busting summary Q&A Crack cocaine and the media Communication checklist Order your FRANK resources Tell us about your FRANK activities and plans 2 3 4 6 8 12 13 14 16 18 20 23

The core audience for this issue are drug workers and other professionals who may be experiencing an emerging or anticipated crack cocaine problem in their area. Update – Understanding Crack Cocaine FRANK Action
FRANK Action Update – Understanding Crack Cocaine 1

FRANK is proving an effective way of offering advice and information on drugs to young people and their parents and now has a range of services on its referral database to refer people into treatment, advice and counselling.
For news on how FRANK is progressing, and details of future plans, make sure you register at www.drugs.gov.uk/campaign

“I have been using heroin for some years and have now been clean for six weeks. I have called FRANK three or four times and have also spoken to a Scottish advisor in depth about my problems. I just wanted to call back to say thanks for being so sympathetic and offering such an excellent service. A lot of helplines seem really scripted but FRANK is great because you sound genuinely like you care and want to help. If any of my friends ever need help I will definitely recommend that they call FRANK.”
Call to the FRANK helpline from a member of the public

“I just wanted to congratulate you on producing a truly useful website for drug takers.Whilst I no longer take drugs, I've taken most of the drugs that you have described on your site and for a change people are actually getting unbiased facts about taking drugs. I'm sure that my stepson will be using your site just as soon as I encourage him to!”
email from parent about talktofrank.com

FRANK wants to thank Phoenix House and Turning Point for participating in the photography featured in this Update. Phoenix House is a leading provider of specialist treatment services for drug and alcohol users in the UK. Working within community settings and the prison service they provide people with services that reflect their needs. They address dependency problems, restoring dignity, self-worth and personal responsibility while introducing stability and new skills to rebuild lives. For more information telephone 020 7234 9756 or visit www.phoenixhouse.org.uk

“Thank you very much for your reply to my question! It was very useful and now when I need advice on drugs I know where to come!”
email from a young person to the FRANK helpline

Turning Point is the UK’s leading social care organisation working across the areas of drug and alcohol misuse, mental health and learning disabilities. As the largest voluntary sector provider of drug and alcohol treatment services - including services specifically aimed at stimulant users - they offer a range of treatment interventions including one to one support, counselling and structured day care or residential support for people in more chaotic situations. For more information visit www.turning-point.co.uk

Tell us what you’re doing – and what people are saying locally about FRANK – using the Tell FRANK form at the back of this Update, or by email to frank@homeoffice.gsi.gov.uk

2 FRANK Action Update – Understanding Crack Cocaine

It is thought that the manufacture of crack cocaine was first achieved in America in the late 1970s. Initially,‘freebase’ cocaine was popularised among the well-established bohemian society, but the low cost of a rock and the attraction of the rapid hit meant that usage quickly spread to street level. Whilst cocaine has been seen by some as a recreational drug for certain people with disposable cash,crack cocaine is often viewed as a drug closely linked to those on low incomes who are far more likely to live in urban areas of deprivation.

Cocaine is cultivated from the coca plant that is widely grown in Bolivia, Peru, Ecuador and Columbia. South America is thought to produce some 80% of the world’s cocaine. An estimated forty tonnes of cocaine reach the UK each year, most of it arriving in bulk-shipments via the Channel ports, with a much smaller quantity arriving via couriers, or ‘mules’, by air. It is thought that in South America local people have been chewing coca leaves for centuries – either as a herbal remedy or as part of traditional rituals. Cocaine production appears to be a more recent phenomenon. Cocaine was first isolated from the coca plant in 1855 and soon afterwards was being used in Europe as an antidepressant, a local anaesthetic and a ‘pick-me-up’. Over time, many prominent figures advocated the therapeutic use of cocaine, including Pope Leo XII, Sigmund Freud and Thomas Edison. Abuse of the drug, however, and wider recognition of its potential harms, led to it being banned in the USA in 1914, and in the UK in 1920. Coca leaves are made into cocaine paste using kerosene, limewater and sulphuric or hydrochloric acid. This paste is then turned into white powder in laboratories via further chemical processing.

Crack cocaine is a smokeable form of cocaine, made by ‘washing’ and then baking cocaine powder into ‘rocks’. When heated, these rocks ‘crack’ and give off vapour. Inhaling this vapour, or ‘smoking a rock’, enables the user to get a much larger dose than if they were snorting cocaine powder. The hit is harder and faster, shorter, more intense – and more difficult to control. Those who inject the drug run the additional risks associated with this practice.

Powder cocaine (cocaine hydrochloride) • Extracted from the leaves of the coca plant • Snorted,sniffed, rubbed onto gums, or injected Freebase cocaine • Made from powder cocaine, which is ‘washed’ with ether or ammonia. Contains fewer impurities than crack cocaine • Smoked (heated until vapour is released; vapour then inhaled) Crack cocaine • Made from powder cocaine, which is ‘washed’ and then baked, using sodium bicarbonate, into ‘rocks’or crystals which ‘crack’when heated • Smoked (heated until vapour is released; vapour then inhaled), or injected after being dissolved in water

FRANK Action Update – Understanding Crack Cocaine 3

Recognising the need for action, in December 2002 the Government published Tackling Crack Cocaine – A National Plan. This document sets out the range of Government actions to tackle the rise in crack cocaine availability and usage. Essential to this approach has been the identification of 37 High Crack Areas (HCAs): communities where crack cocaine drug markets have been established and are severely damaging individuals and the local community. Police, treatment and community action has been ongoing. Cocaine is being ‘taken out’ as traffickers attempt to cross the country’s borders; more crack cocaine markets are being targeted and disrupted; more treatment agencies are taking on and treating crack cocaine users, and more communities have been galvanised into taking action against the dealers.

Areas that meet a set of indicators of problem crack cocaine use have been classified as High Crack Areas (HCAs). These indicators comprise high figures for: • Number of people in treatment • Number of people arrested by police and testing positive for cocaine or crack cocaine • Percentage of people assessed by Arrest Referral Workers with cocaine or crack cocaine problems • Number of people arrested for cocaine or crack cocaine supply offences • Volume of seizures of crack cocaine • Volume of acquisitive crime • Risk indicators including the presence of a street sex market/markets and a presence on the Office of the Deputy Prime Minister’s (ODPM) deprivation indices

CJIP is part of the measures in the Updated Drug Strategy for reducing drug-related crime and aims to access drug-misusing offenders, moving them into treatment, away from drug use and crime. Of the 37 High Crack Areas, 31 are also CJIP sites. “Crack cocaine supply and related crime impacts on some of the most vulnerable and poor communities, hurting those who get in the way: those who are trapped by addiction into prostitution; those who are vulnerable through mental health and social exclusion.” Bob Ainsworth, former Home Office Minister commenting on the launch of Tackling Crack Cocaine - A National Plan

Supply route of cocaine to the UK

4 FRANK Action Update – Understanding Crack Cocaine


The geographical location of HCAs and CJIP areas


North East North West

• High CrackCJIP Areas and • High CrackCJIP Areas, non

Yorkshire and the Humber
Leeds Bradford Manchester Sheffield Stockport Nottingham Derby

Rochdale Salford Trafford Liverpool

Stoke-on-Trent Sandwell Birmingham Coventry

East Midlands East of England

West Midlands

Oxford Bristol



South West

South East



High Crack Areas Birmingham, Bradford, Brent, Brighton & Hove, Bristol, Camden, Coventry, Croydon, Derby, Hackney, Hammersmith & Fulham, Haringey, Islington, Kensington & Chelsea, Lambeth, Leeds, Lewisham, Liverpool, Manchester, Middlesborough, Newham, Nottingham, Oxford, Reading, Rochdale, Salford, Sandwell, Sheffield, Slough, Southwark, Stockport, Stokeon-Trent, Tower Hamlets, Trafford, Waltham Forest, Wandsworth, Westminster.



Waltham Forest

Redbridge Havering





Hackney Barking & Dagenham

to ng




Tower Hamlets



r ste in tm ton sing ith Ken ersm mm Ha



Greenwich Bexley Lewisham


Wandsworth Richmond Merton

Kingston Sutton Croydon


FRANK Action Update – Understanding Crack Cocaine 5

The vast majority of crack cocaine is manufactured in the UK from powder cocaine imported into the country. The powder cocaine is then ‘washed’ by the dealer, usually in premises near to the intended drug market. The crack cocaine produced is then either sold in open street markets or in closed local drug markets, with dealers sometimes making use of ‘crack houses’ where users can purchase and then binge upon the drug. Local drug markets that sell crack cocaine vary. Some meet the needs of poly-drug users, offering ‘crack and smack’ packages, while others are more geared towards the exclusive needs of crack cocaine users, selling crack cocaine only.



Crack cocaine users can find themselves increasingly cut off from mainstream services such as housing and health. As with other problematic drug use, social exclusion can therefore be a consequence as well as a cause. This often leads to crack cocaine use being conspicuous in a way that other drug use is not and gives rise to greater anxiety amongst the public and greater insistence that something be done. Key activities that can take place to challenge the problems that crack cocaine poses within a community: • Education and care of young people to inform them on the risks of crack cocaine misuse and offer realistic alternatives to crack cocaine culture • The provision of healthcare and treatment to address the mental health needs of crack cocaine users, help them control their cravings and stop using • The provision of interventions within the criminal justice system and by the police • The needs of sex workers and the management of sex markets to help sex workers exit the street and prevent young people entering the sex trade • The regeneration of deprived areas and communities • The specific targeting and focus of drug services by DATs and local partnerships in addressing local hotspots


A strong local crack cocaine drug market, particularly in areas where crack houses exist, has a major impact upon the local community. Due to the short life span of a single rock of crack cocaine and the desire to binge upon the drug, high levels of income are needed to sustain a crack cocaine habit. Subsequently, crack cocaine market areas experience high rates of crime in the form of street robbery, theft, prostitution and fraud. Such high rates and types of crime severely undermine the quality of life for those living in these communities. The large amounts of money to be made from crack cocaine dealing make it all the more attractive to those seeking to profit in this way. Defending their share of the market from other dealers can lead to ‘turf wars’ and a high incidence of violence and gun-crime.

6 FRANK Action Update – Understanding Crack Cocaine

Crack cocaine and local sex markets are known to be strongly associated. Sex workers claim that using crack cocaine helps them endure the work they do. Very often, however, the work they do becomes necessary to sustain their crack cocaine dependency. Those who seek to exploit sex workers have found that crack cocaine-dependent individuals are by far the easiest to manipulate and control. Habits are fuelled and encouraged, and for the sex worker it therefore becomes all the more difficult to break out of this damaging way of life. Look out for the new Home Office guidance ‘Solutions and Strategies: Drug Problems and Street Sex Markets (guidance for partnerships and providers)’ on how to tackle local sex markets. This will include information on the links between sex markets and crack cocaine. Download the report from www.drugs.gov.uk

• Rocks of crack cocaine can cost anything from £5 to £25. A recent survey conducted among London crack cocaine users found that on average, users spend £100 a day 2 • Recent research in London concluded that purity levels of crack cocaine were found to have fallen from 88% in the mid-1990s to 72% in 2002. The same study found cocaine was only 52% pure3 • In 2000, 5,451 people were cautioned or convicted for drug offences involving cocaine, and 1,216 for offences involving crack cocaine4 • The British Crime Survey 2002/03 estimates that 63,000 people used crack cocaine within the previous 12 months in 2002 5 • The same survey estimates that 28,000 people used crack cocaine within the last month5

Local agency Druglink and partner agencies, such as the Police, have identified an increase in the use of crack cocaine by sex workers in some areas, with many spending an average of £100 - £150 a day to support their habit. This is changing some of the conditions and habits for these women including a rise in unprotected sex and a deterioration in their health.6

FRANK Action Update – Understanding Crack Cocaine 7

In treatment terms, crack cocaine dependency is recognised as being predominantly psychological rather than physical. Dependency, however, cares not for such subtle distinctions: be it physical or psychological, the need to satisfy the craving perpetuates itself.

Whether smoked or injected, crack cocaine takes effect very quickly. Crack cocaine is a stimulant drug whose high is said to be intense, immensely pleasurable but relatively brief. After the intense high, however, comes the crash: anxiety, tension, mood swings, paranoia and depression. This ‘come down’ reinforces the craving for more crack cocaine as users seek a way out of this very low and uncomfortable state (this also plays a significant part in crack cocaine users’ use of other drugs, such as alcohol, cannabis and sleeping pills, to compensate for the crash). In this way, crack cocaine use can easily become compulsive, with the tendency to binge being more common.

Crack cocaine can be attractive to heroin users as it gives them a high that heroin no longer can. Dual use of both drugs adds a further dimension to what is an already complex situation for both users and those seeking to help them.

When crack cocaine is injected it can destroy veins and cause blood poisoning. A crack cocaine injector who binges on the drug can severely damage him or herself through repeated injecting. Sharing needles brings with it the risks of contracting and spreading HIV, hepatitis and other diseases. Pipe sharing may run the risk of blood-borne diseases such as hepatitis C being spread.

For many regular crack cocaine users, alcohol is a way of coping with the downside or enhancing the effects of the drug. The interaction between different substances and their impact on users requires all substance use to be considered and treated in context.

For more information about drugs and their effects, log on to www.talktofrank.com

8 FRANK Action Update – Understanding Crack Cocaine

Crack cocaine use has the potential to be very physically damaging. Crack cocaine users don't develop the same kind of strong physical withdrawals seen in heroin users, but may be very distressed for a period after stopping use. Ongoing and heavy use of crack cocaine can lead to a number of physical health problems. As with all Class A drug use, sometimes the lifestyle that accompanies the drug use can be more damaging than taking the drug itself.
Skin problems Impaired immune system

Stress on the heart Heart attacks and strokes

Liver damage Stress

• Fast heart rate and breathing • Sweating and shaking • Agitation, butterflies in the stomach – feelings of nausea • Altered mood - may be very low

• Inability to sleep • Loss of appetite • Stress • Skin problems • Impaired immune system • Hyperthermia • Hallucinations • Liver damage • Stress on the heart • Heart attacks and strokes

Crack cocaine and cocaine use can affect users’ sexual functions. Chronic use of crack cocaine and the lifestyle that goes with it can disrupt hormones, for example causing impotence in men and disrupted periods and infertility in women.

Crack cocaine differs from heroin in its pattern of effects and dependency. Primary crack cocaine users can fluctuate between displaying little or no outward signs of dependency, sometimes going several weeks without a purchase, to periods of desperate and chaotic craving. At the height of a binge, when their need is at its most acute, a crack cocaine user may be using the drug almost 24 hours a day for several days or even weeks.1

FRANK Action Update – Understanding Crack Cocaine 9

In the six months to March 2001, 24% of new or returning patients in treatment reported using crack cocaine with 7% considering it their primary drug of use.

Treatment programmes help to manage dependency on crack cocaine by using psychological approaches focusing on triggers, and dealing with lifestyle issues. This helps users understand their drug habit and provides tools to help them make changes to their behaviour. There is little evidence suggesting drugs are useful in treatment. Psychological approaches that help the user understand and change the way their thoughts and feelngs affect their ability to control their actions, such as cognitive behavioural therapy 8, have been shown to be effective. Complementary therapies, such as auricular acupuncture9, have been used by services to attract and improve involvement in psychologically based treatment. Some crack cocaine users in treatment report that such approaches help them deal with their cravings, and cope with stress, though here is no conclusive evidence yet on its effectiveness. Treatment has been shown to be more effective if it adopts a holistic approach. This means looking at issues such as housing needs, education and skills, debt management, diet and exercise in addition to addressing psychological dependency. Rapid intake and a proactive outreach approach also have a positive impact. Access to peer support, 24-hour helplines and drop-in services are also said to contribute to successful treatment.

In the past, crack cocaine users have been wary of treatment services, which, in their eyes, have seemed to cater primarily for heroin users. They have been reluctant to approach services where accessing appropriate treatment can involve weeks or even months of waiting. Further more, drug users from ethnic minorities often consider treatment services to be run by white people for white people. Without treatment uptake, the damaging effect of crack cocaine use could become all the more harmful and more difficult to overcome. These negatives are beginning to be addressed. In terms of ethnicity, drug treatment agencies are becoming more reflective of the communities they serve, waiting times are reducing and the available range of treatment increasing. Dedicated crack cocaine and stimulant treatment services have also been developed in areas where demand is greatest. Where poly-drug use is seen, treatment services are responding to the need to address crack cocaine and heroin together.

The National Treatment Agency has instigated a range of initiatives to help improve treatment of crack cocaine. See the ‘Commissioning Drug Treatment Systems’ at www.nta.nhs.uk and the Drug and Alcohol National Occupational Standards at www.danos.info

10 FRANK Action Update – Understanding Crack Cocaine

Crack cocaine use can affect any community. Police seizures and other research have illustrated that crack cocaine is available throughout the country. The size, nature and associated criminality of the local drug market, and the contribution of crack to this, largely determine the required actions to challenge the market itself and the harm it does to the community.



Deprivation, social economic decline and associated problems, plus the existence of an established drug market, are all factors likely to either create or sustain a strong element of crack cocaine within a local drug market. Minority ethnic communities are disproportionately represented in areas of deprivation. This, combined with social perspectives drawn from America, has created the false impression that ‘crack is black.’ In fact, the vast majority of crack cocaine users in this country are white, but the strong link between urban areas of deprivation and the existence of crack cocaine markets have helped sustain this false impression. What is true to say is that crack cocaine has impacted disproportionately upon minority ethnic communities. Where demand is high and drugs are available, the impact on the community is especially pronounced. Users purchase drugs locally then can go on to commit crimes such as theft and aggressive begging in order to buy more drugs. This has a knock on effect for the whole community.

Tackling crack cocaine in deprived communities then becomes part of the much wider challenge of tackling the social and economic decline of that community. Failing to tackle the drug market and the consequences of the drug market is likely to undermine the potential success of any effort to regenerate the community.

“By demonizing a substance, you not only demonize the user but also diminish the chance for effective and appropriate public health and public order responses.” Kazim Khan, Bristol Conference on Crack Cocaine

FRANK Action Update – Understanding Crack Cocaine 11

Crack cocaine in a community does not exist in isolation. It is likely to be linked to many other aspects of decline - all of which need to be taken into consideration if the needs of that community are to be successfully addressed.
This means partnership; partnership between Police, Local Authorities, Housing Associations, Community Groups, Faith Leaders, Drug Action Teams (DATs), Crime and Disorder Reduction Partnerships and Neighbourhood Renewal Agencies. Each agency involved needs to plan their action in a crack cocaine affected community with the full and active involvement of each of the other partner agencies. intended for the UK market, it has been set a target of increasing take-out rates from 21% to 26%. Recent figures for 2003/2004 show that progress is being made, with CIDA well on track to achieving this target. Evidence suggests clear associations of middle market drug dealers involved in the distribution of crack cocaine with smuggled tobacco, alcohol and guns. There is growing evidence to show that these distribution networks have clear associations with other serious and organised crime. The impact of crack cocaine dealing upon a community can be substantially mitigated by action to close open street markets and crack houses. New powers are now available to enable police and local authorities to work together to close crack houses in their communities. Users will be affected by the closure - action to address their treatment, housing and other needs can further support the enforcement. In particular, vulnerable tenants who have been forced to let their premises be used for the selling of class A drugs can be helped by this action and by implementing a planned programme of care to meet their needs. Many local authorities have worked with their local police force to put together a protocol for tackling the issue of crack houses. A good example is the one put together by Safer Southwark which recently won a good practice award from the Home Office (see page 17 of this Update for further details).

Since the launch of the National Crack Cocaine Plan, focused effort has gone into tackling crack cocaine markets in the UK. At every level of trafficking and selling, Police, Customs and Excise and other agencies have worked to disrupt the flow of crack cocaine. Disrupting Crack Cocaine Markets – A Practice Guide (DSD 2003) was published to complement the National Crack Cocaine Plan and to sustain the renewed focus on tackling crack cocaine drug markets. At international levels, inter-agency co-operation has strengthened efforts to restrict the free movement of cocaine across international borders. In the UK, the Cabinet Office Committee, Concerted Inter-Agency Drugs Action (CIDA) - which consists of the heads of MI6, MI5, the Customs and Excise investigation branch, the National Criminal Intelligence Service, the police National Crime Squad, and the Association of Chief Police Officers - takes primary responsibility to counteract cocaine being trafficked and imported into the UK. With reference to the proportion of cocaine

12 FRANK Action Update – Understanding Crack Cocaine

Sport can offer a practical and effective means of engaging with young people and can play a valuable part in drug prevention and education. Positive Futures is a national sports-based social inclusion programme for young people, aged 10-19, offering opportunities to engage in employment, education and training. 31 out of the 37 High Crack Areas have dedicated local Positive Futures schemes. Positive Futures brings together the support of a number of government departments and agencies, including the Home Office, Department of Health, Department of Culture, Media and Sport, Connexions (Department for Education and Skills), Sport England, Youth Justice Board and the Football Foundation. Based in the top 20% most deprived areas in the country (according to the Index of Multiple Deprivation), there are 107 Positive Futures projects throughout England and Wales. In each area, the programme is delivered through partnerships between local agencies, such as charities, sports clubs, Drug Action Teams, schools, police, youth and social services. Local programmes include: • Outreach and detached work to contact young people • Coaching skills across a range of sports linked to playing opportunities • Mentoring, volunteering and work experience • Drug awareness and education programmes • Curricular and extra curricular activity in schools and Pupil Referral Units • Pathways to further education, training and employment For more info, go to www.positivefutures.gov.uk

In October 2003, Cranstoun Drugs Services teamed up with Chelsea FC’s ‘football in the community’ programme to run a three-year coaching project for marginalized young people in the borough. Aimed at teenagers at risk of exclusion from school and from involvement in crime and drugs, the scheme delivers coaching and awareness-raising sessions three times a week at local schools and parks. Drugs and youth worker Desmond McDonald, who co-runs the Wandsworth scheme, says that, as an Arsenal fan, having to wear a Chelsea kit every day is one of the few down sides to his job. But this, as he admits, is a small price to pay for such high-profile involvement in three of the most deprived wards in Battersea: “We get more and more young people coming to us because we’re from Chelsea. And if a club as rich as Chelsea is prepared to plough something back into the community, it helps us get through.” During the sessions, informal discussions on drugs, crime and anti-racism are held during breaks in the football coaching. Football is the hook, but the overall goal is to steer young people away from the dangers of drugs and crime and towards more positive futures. Desmond feels it’s about getting their trust.“If they see us coming from Chelsea, coaching and playing football with them, they trust us a bit more. We’re trying to show all the kids that it doesn’t matter where they come from, they can avoid the pitfalls of drugs and crime if they want to.”

FRANK Action Update – Understanding Crack Cocaine 13

There are many damaging myths surrounding crack cocaine. These myths, often stemming from a lack of knowledge and poor communication, and often perpetuated by the media, can undermine effective delivery of treatment, frustrate community action, and get in the way of the facts. This has led to widespread misinformation and misunderstanding about crack cocaine in the UK.

The drug trade hits disadvantaged communities hardest and more often. Deprivation and multiple drug use, not race, are the best predictors of problematic crack cocaine use.

Crack cocaine dependency is treatable. Although there are no confirmed pharmacological interventions for crack cocaine dependence, psychological interventions such as cognitive behavioural therapy (in which crack cocaine users are helped to understand how the drug works, how to avoid triggers, cravings, and relapses) have been proven to be effective. As in all drug treatment, adopting a whole life approach rather than a narrow medical one is the key to success. “Treating crack cocaine dependence is neither difficult, nor does it necessarily require totally new skills.” National Treatment Agency

Crack cocaine is highly psychologically addictive, causing strong cravings, and it also causes a withdrawal syndrome (such as low mood and agitation) particularly with prolongd or heavy use. Unlike those dependent on heroin (who experience prominent physical withdrawal symptoms), periods of abstinence are normal for crack cocaine users. It is at such times that crack cocaine users may seek treatment.

Effective treatments for drug users are widely available. It is true that many services need to adjust in order to meet the needs of crack cocaine users better. However, with current training schemes and the utilisation of drug workers’ existing therapeutic skills, services are continually improving. See page 10 for more information on developing treatment.

Crack cocaine is more usually linked with poverty however its use is not confined to deprived areas and occurs across the social spectrum. As with all drugs, maintaining a habit is a costly exercise.

14 FRANK Action Update – Understanding Crack Cocaine

In fact, crack cocaine has been used in Britain since the early 1980’s. In many ways taking crack cocaine is simply another way of taking cocaine – albeit at a much higher dose level. What is new is the trend of crack cocaine being used by established opiate users, and powder cocaine users moving on to crack cocaine.

The term ‘crack house’ is used very loosely. It can mean a building housing one or more crack dealer and sex worker, or a house used for parties where crack cocaine may be used. However, crack houses are not the only places where crack cocaine is sold. Crack cocaine is also sold on the street, on the ‘open market’, or delivered to people’s homes, on the ‘closed market’.

Originally, specialist agencies such as COCA found that their work took them to large cities such as Liverpool, Manchester, London and Nottingham. Now, they operate in towns and communities all over the country. Crack cocaine use may be more concentrated in large, deprived urban areas, but it is certainly not restricted to them.

In the late 1980s/early 1990s, it was widely reported that babies born to crack cocaine using mothers would refuse to suckle and feed, and would invariably experience longterm brain damage. It has since been shown that the scare-stories surrounding ‘crack baby syndrome’ were overblown, and more to do with public and professional reactions to crack cocaine being used during pregnancy, than with factual evidence. However, crack cocaine and cocaine use during pregnancy is particularly inadvisable, and may cause miscarriage, low birth weight, premature birth or disturbed behaviour in newborn babies.

Crack cocaine does not, in itself, cause users to become violent. Unlike alcohol, crack cocaine does not provoke violence through consumption alone. But the desperation and craving that comes with crack cocaine can lead to violent behaviour, in the form of aggressive begging or recourse to crime in order to fund a habit. Crack cocaine dealing, particularly on open-market ‘turf’, can also lead to violence, including intimidation of bystanders or local residents. However, overall, alcohol is statistically much more associated with violence and violent crimes, while experienced crack cocaine workers report that heroin users are generally more likely to become violent in treatment centres. A small number of crack cocaine users can become psychotic and this can be associated with aggression.

For information on treatment, see ‘Commissioning Drug Treatment Systems’ from the National Treatment Agency at www.nta.nhs.uk For further information on crack cocaine, its effects and social impacts contact COCA (Conference on Cocaine and Crack Cocaine) at www.coca.org.uk And don’t forget to log on to www.drugs.gov.uk for the latest news and policy information.

FRANK Action Update – Understanding Crack Cocaine 15

In this section, we profile some of the excellent local drugs awareness initiatives on crack cocaine.

Birmingham HIAH delivers drug outreach and treatment services for young people across the city. The overriding goal of the agency’s work is to breakdown barriers to information, help and support, and to close the gaps between service tiers to provide seamless movement into treatment. Working alongside Birmingham DAT, HIAH has proactively tried to reach marginalized members of the community. Local youth services have been refurbished and provided with onsite facilities. The aim is to ensure that young people can be reached within their localities and to provide counselling and treatment – for crack cocaine, interventions could include acupuncture and other complementary therapies. The service has also been working with local schools to ensure that pupils can gain access to support and treatment at the earliest onset of their drug-use. Further plans include additional services with crèche schemes for young mothers, who are often reluctant to come forward for help, and development of other support programmes. HIAH also run innovative awareness-raising courses. The Complete Drug Course (CDC) offers drug education training, and acts as a strong enticement into treatment, with many participants often being drug users themselves. The ID and Difference course, meanwhile, addresses issues of identity, aspiration and influence, encouraging participants to consider who they are, how they think and act, looking particularly to make inroads into black and minority ethnic communities. Each course is discussion-group based, with accompanying course packs and education materials. For further info, contact: Grantley Haynes Tel: 0121 616 6162

Lifeline Kirklees is one of eleven new drug treatment services piloting crack cocaine treatment. Recognising a growing need to treat clients with crack cocaine misuse problems, the agency is expanding its existing services in line with the National Treatment Agency’s treatment manual. The crack cocaine service is being piloted through its newly commissioned open access Triage service,‘Way Ahead’ and an outreach service for black and minority ethnic communities,‘Making Things Equal’. Way Ahead now provides an appointmentfree drop-in service, where clients can receive advice quickly. This rapid access is particularly valuable for crack cocaine users, who often only seek help when they hit a crisis. Way Ahead, which has received funding to recruit a Stimulant Development Worker, provides support and advice through one-to-one and group counselling, and a programme of activities and complementary therapies. The Making Things Equal project works with local residents and community leaders to educate black and minority ethnic communities about drug misuse and drug treatment. The project has helped to target hidden populations of crack cocaine users and encourage them into treatment. Staff have also taken part in an NTA-run training programme designed to improve staff skills and knowledge.

For further info, contact: Maggie Hanson (Team Leader, Way Ahead & Making Things Equal) maggie.hanson@lifelinekirklees.org.uk

16 FRANK Action Update – Understanding Crack Cocaine

Not solely dedicated to crack cocaine but to the effects of all drugs, WAM work with children and young people across Nottinghamshire who may be affected by the substance use of others. Offering play therapy to 5-13 year olds, and one-to-one support for young people up to the age of 19, WAM provides crucial interventions for those who suffer neglect, harm or emotional disturbance because of the substance use of family members or friends. WAM have a team of skilled Support Workers and a Play Therapist, and offer children and young people confidential support via telephone, text and email. WAM also work in partnership with their sister service,‘Hetty’s’, to deliver interactive sessions with young people serving custodial sentences and attending drug treatment programmes. Sessions are designed to improve understanding and communication between young people and their families/carers, to reduce homelessness. In addition to providing countywide peer and school support, WAM have produced a short film ‘What About Me?’ examining the impact of illegal drug use on family life. The video of the film is used throughout the county to raise awareness among young people, and as a training tool for partnership agencies and community groups. Distribution of the film to young people is carefully monitored, and has support packages of time and materials built into every delivery. WAM work in partnership with, and enhance, existing local services (Social Services, drug services, Health & Education services) that may already have contact with families, or who may need to be involved as part of a ‘Care Plan’ for the family unit. For further info, contact: Nicola Crisp Tel: 01623 635326

The Southwark Crack House Protocol is a joint agreement between Southwark police, Southwark council, registered social landlords and voluntary groups. The protocol aims to provide local residents with respite from the criminal activity and anti-social behaviour associated with crack houses, and to reduce the impact of drug misuse and dealing. The initiative comprises a range of interventions and, while the specific objective is the closure of crack houses, seeks to balance enforcement with support to vulnerable users. Eviction, prosecution and repossession of premises (and actions to prevent them becoming illegally reoccupied), go hand in hand with help or diversion for vulnerable tenants. The protocol ensures that drug treatment workers are available in police custody suites to see people brought in following drug raids. The co-ordinated response of the participating agencies is essential to the project’s success. The raiding and closing of crack houses, for instance, requires action by both police and landlords. This cross-agency approach offers an anti-crack cocaine programme that is both fair and effective. Neighbours and other local tenants are already seeing a marked decrease in crack cocaine related crime as the number of raids and crack-house closures increase. The Southwark Crack House protocol is part of the Safer Southwark Partnership, which was commended at the Local Government Chronicle Awards in March 2004. The Crack House protocol was also hailed a success at the Home Office Tackling Drugs Supply Awards in 2004, coming top in the category of “best practice in tackling crack cocaine markets”. For further info, go to: www.safersouthwark.org.uk

FRANK Action Update – Understanding Crack Cocaine 17

Given the misconceptions and myths surrounding crack cocaine and its treatment, services need to be designed in a way that immediately appeals to crack cocaine users. If you are thinking of setting up or commissioning services in your area, here are some things you should consider:

• Immediate access: crack cocaine users often seek help in a crisis; easy and immediate access to support, advice and referral via drop-in centres, peer support networks and 24-hour telephone helplines are solutions recommended by users and found effective in practice • Many users could be in employment or education: attending services during the day may not be an option. Services that are available in the evenings and at weekends would be able to fill this gap • Services also need to appeal to all communities, and should not appear to favour one group of people over another • Outreach has proven invaluable to those services offering a dedicated crack cocaine treatment service, particularly amongst BME groups and among those working in the sex industry

The quality of the drug worker-user relationship is highly influential. Staff drawn from relevant parts of the community can support effective working with users. All staff need to ensure they are aware of, and comfortable working with, issues relating to street culture. Good drug workers should show: • empathy • knowledge of crack cocaine • honesty • a non-judgemental approach to users • an appreciation of how crack cocaine fits into the lifestyle of the individual user

• Early treatment experience makes a big difference to users’ later commitment to treatment • Anecdotal evidence suggests that the availability of complementary treatments such as auricular acupuncture helps to attract and then retain users • Relapse prevention is essential. Lifestyle issues are key contributing factors to the tendency of users to relapse and should be considered in a holistic context

• Users may not want anyone to know about their visit. Anonymous, discreet venues are preferable • Accessible and suitable services could capitalise on the gradual disenchantment with a crack cocaine-focused lifestyle experienced by users

18 FRANK Action Update – Understanding Crack Cocaine

Before you can deliver crack cocaine related information and messages in your area, and before you can begin to advertise treatment and services, you need to identify your audience.

Needs assessments may be a useful way of identifying specific audiences in need of information. Because most existing information has been gathered through treatment services and the criminal justice system, there may be significant hidden crack cocaine problems and hidden crack cocaine using populations in your area. Here are some ideas to get you started on identifying needs in your area.

In order to be proactive in assessing levels of use and problematic use, local or regional surveys could be commissioned to provide initial snapshots. Questions that you may like to ask respondents include: • If they have used crack cocaine • If they know one or more people who have used crack cocaine • If they have now stopped or are continuing to use crack cocaine • If they use cocaine powder or formerly did so

In the pursuit of networks that may reach deeper into communities and hidden user populations, standard practice should bring drug workers into contact with the following groups: • Crack cocaine and cocaine users and/ or user representation groups • Families and friends of crack cocaine and cocaine users • Local communities affected by crack cocaine and cocaine use • GPs • Generic mental health services • Criminal justice agencies/services • Services for homeless people • Services working in the sex industry • Social services. Work closely with these networks to enlist their help in identifying potential groups and individuals who could benefit from crack cocaine treatment and services.

The NTA suggests a research technique ‘snowballing’. This is where known users are engaged to contact hidden users and give information and encouragement to seek treatment.

Some minority communities (minority ethnic groups, women, gay and lesbian communities, homeless people, disabled people, people with mental health problems) may be reluctant to access services. Conducting a comprehensive needs assessment with these communities is a useful way of ensuring that there are no hidden crack cocaine using populations. See FRANK Action Update Understanding Diversity for information on communicating with diverse communities.

FRANK Action Update – Understanding Crack Cocaine 19

A local partnership is a process by which an agency works together with other agencies or organisations to achieve better outcomes for the local community. Such partnerships operate according to the needs of local stakeholders, and involve bringing together, or making better use of, local resources.
In some instances, local agencies are obliged to adopt a partnership approach to community problems. The Crime and Disorder Act 1998 (section 5), for example, places a statutory duty on local authorities, police, health authorities and probation committees to work together to tackle problems of crime and disorder. However, when dealing with complex issues such as drugs, collaboration between statutory bodies and the voluntary and community sectors is not only mandatory, it is also highly desirable. Benefits of local partnerships: • Provide platforms for the sharing of experience and expertise • Assist economies of scale and scope – enabling agencies and organisations to make more effective use of collective resources and skills • Open up opportunities for mutual learning • Help focus on outcomes for service users, rather than providers • Enable better co-ordination on complex issues, meaning less confusion for all • Bring more meaningful participation from all stakeholders • Provide fast dispersion of innovative ideas and ease of communication

When setting up local partnerships, there are certain things you need to consider. Working together requires initial commitment to: • A shared agenda • A respect for the needs of all partners involved • Effective leadership at all levels • Plan for the contributions and benefits of all the partners You will also need to: • Identify specific goals/targets of partnership working • Regularly assess partnership performance • Regularly review the relationship between partnership activities and community needs/priorities Finally, throughout your ‘partnership journey’, remember to keep focused on: • Priority target groups of users and other stakeholders • ‘Core’ activities: not everything will need to be ‘joined-up’ • Improving and fine-tuning all activities you intend to keep • Phasing out all activities that are low priority • Putting the customer/client first • Tackling issues at the right level • Understanding and accepting differences, on basis of mutual trust • Building on each other’s strengths • Communicating what you’re doing clearly and regularly to all those involved Before setting up a new partnership, contact your DAT to check any that already exist.

20 FRANK Action Update – Understanding Crack Cocaine

With its effects being so damaging to people and communities, there is a strong case for including crack cocaine in basic drugs education in all areas. Indeed, it is essential in identified High Crack Areas. Education around the dangers and risks could help prevent young people becoming involved with the drug. Contact local schools: make sure that headteachers are aware of local patterns of drug use, particularly if specific drugs are a problem in your community; teachers need to be able to make use of this information and build it into their planning and delivery of school-based drug education programmes. The important thing is to help schools and teachers develop their own expertise and drug education programmes that reflect the needs of the local community. Develop information materials highlighting the effects and dangers of using crack cocaine and display them in areas where young people hang out. Community Centres may be willing to help. Communicating the dangers of dabbling in crack cocaine at visible street level (such as on, leaflets, beer mats, posters) can help to get across effective preventative messages. The word ‘crack cocaine’ needs to be prominent, and the FRANK phone number large enough to be read at a distance. efforts on busting those myths can help people become more aware. Organise a discussion group or education session for people at their place of work. Focusing solely on crack cocaine use may be seen as alarmist, so you may find it more appropriate to incorporate education on crack cocaine within a general overview of drugs and their effects. Make use of the myth busting factsheet in this Update to create understanding. Contact the Human Resources departments at local firms to see if they would be interested. Arrange a general health awareness day and invite professionals to have stalls or give talks on health issues. You can then incorporate drugs information (including crack cocaine) in a more general way and be on hand to give advice to anyone who would like further information.

One of the key elements of communicating issues around crack cocaine is to create understanding of its physiological properties and this is particularly important for professionals who may come into contact with users other than by way of drug services. Organise discussion groups targeting groups of professionals (Police, shop workers, emergency services staff) to help them understand the best way to handle crack cocaine users. Focus on links between the user's craving, anxiety and withdrawal effects, and the feelings of compulsion to use; to help professionals understand how to avoid, or manage, conflict in some user. Face to face meetings or attendance at meetings can also be useful as they allow opportunities for raising awareness and stimulating discussion.

Given the myths that surround the drug, people living in a community affected by crack cocaine may be particularly concerned and have little understanding of what it is and its effects. Concentrating your communications

FRANK Action Update – Understanding Crack Cocaine 21

Decision-makers and opinion formers need to understand better the nature of crack cocaine and its use, as well as being made aware of the misleading nature of crack cocaine myths, and the dangers of basing policy on them. Ways to reach decision-makers and opinion formers may include: • Briefings through the established stakeholder relationships and DAT networks • Visits to a treatment centre dealing with stimulants or crack cocaine • Hearing from users, ex-users or treatment workers about the problems of and solutions to crack cocaine use • Hearing from key agencies involved in closing crack houses, open markets and dealing with environmental crime • Hearing from a third-party advocate about the benefits that effective action brings A well-organised visit is probably the best way to reach such people. Remember, they will be pressed for time and unlikely to read through all the documentation so be clear about the message you wish to get across. Different methods that have previously been used to attract users to services include: • Discreetly advertised and run services – large banners above a project, or services based in official buildings, can deter users • Posters – can be displayed in a variety of locations. Again, phone numbers should be large enough to read at a distance • Project information leaflets – developed advice and information services will demonstrate an understanding of crack cocaine and instil users’ trust • Radio – local or community radio stations are usually open to advertising services and can help reach a large number of people • Outreach – specialist outreach and peripatetic teams can help to engage with users and increase their awareness The Government Office for London has established a directory of drug services that deal with crack cocaine (details available from www.cracklondon.org.uk). Many areas have treatment directories; check if crack cocaine treatment is highlighted in these. Or, why not set up a directory of services for your own region?

One of the myths surrounding crack cocaine is that there is no treatment available to users. If you have set up services in your area, make sure that it is well publicised. Check to see if local services that you know of are listed on www.talktofrank.com and that their details are up to date. You could use the local media, listings and directories, as well as advertising via street posters and take-home media, such as bus tickets, leaflets and flyers.

Networking and word of mouth can also be effective ways to promote local treatment services. Ex-users can be a way into the using community, but care has to be taken that ex-users, through contact with current users, do not relapse and re-enter the cycle of craving and dependency.

See the ‘Crack cocaine and the media’ fact sheet in this Update for tips on communicating with the press. For more advice and ideas on communicating about drugs, see the selection of FRANK Action Updates at www.drugs.gov.uk/campaign or order using the More FRANK form at the back of this pack.

22 FRANK Action Update – Understanding Crack Cocaine

ADDACTION UK charity working solely in the field of drug and alcohol treatment. Manages a range of projects across the country. 020 7251 5860 www.addaction.org.uk ADFAM Charity supporting families affected by drugs and alcohol. Range of resources including publications and videos, a family newsletter, email group and online messageboard. Tel 020 7928 8898 www.adfam.org.uk BBC ONLINE Information and news on health issues, from the BBC www.bbc.co.uk/health COCA (Conference on Cocaine and Crack) Forum for drug workers offering support and information. Helps services and workers develop appropriate interventions and professional working practices. www.coca.org.uk CRANSTOUN DRUGS SERVICES A not-for-profit charity providing a range of high quality, cost efficient and effective models of treatment and rehabilitation in the community, in prisons and in residential centres. www.cranstoun.org DEPARTMENT OF HEALTH Publications Order Line: 08701 555 455 www.doh.gov.uk DRUGSCOPE UK Centre of expertise on drugs. Conduct research and seek to improve knowledge on drugs-related issues and have an extensive library of drug information. Tel 020 7928 1211 www.drugscope.org.uk NATIONAL TREATMENT AGENCY (NTA) Special Health Authority set up to improve the availability, capacity and effectiveness of treatment for drug misuse in England. Also has research and publications and is evaluating pilot sites for crack services. www.nta.nhs.uk PHOENIX HOUSE National charity providing specialist treatment services for drug and alcohol users across the United Kingdom. www.phoenixhouse.org.uk TREATMENT WORKS Website developed by some of the biggest independent providers of drug and alcohol treatment in the UK working together to improve awareness of and access to the right support. www.treatmentworks.co.uk TURNING POINT Social care charity with services across England & Wales working in the areas of drug and alcohol misuse, mental health and learning disability. www.turning-point.co.uk

FRANK Action Update – Understanding Crack Cocaine 23

Tackling crack cocaine – a national plan ref (DSD 14) Home Office Home Office Order Line 0870 241 4680 Download from www.drugs.gov.uk/nationalstrategy Updated Drug Strategy 2002 ref (DSD9) Home Office Home Office Order Line 0870 241 4680 Download from www.drugs.gov.uk/nationalstrategy Commissioning Drug Treatment Systems: resource pack for commissioners Available from the National Treatment Agency website publications section www.nta.nhs.uk On the rocks: a follow-up study of crack users in London. .J, Harcapos A., Dennis, D., Turnbull P Hough M. London: Criminal Policy Research Unit South Bank University, 2003 (ISBN 0 946786 364) Report of an independent study funded by the Community Fund and the National Treatment Agency looking at drug service use amongst crack cocaine users in the UK. The full report can be ordered from the CPRU, London South Bank University Tel: 020 7815 8458 www.sbu.ac.uk/cpru Drug & Alcohol Findings Published by Drugscope & Alcohol Concern Magazine devoted to UK relevant research on the effectiveness of interventions to treat, prevent or reduce drug and alcohol problems www.drugandalcoholfindings.org.uk Stimulating Drug Prevention in Local Communities Lynne Smith DPAS Available from Home Office drug publications www.drugs.gov.uk/ReportsandPublications Anti Social Behaviour, Notes of Guidence to Close Class A drug Premises Download from www.drugs.gov.uk/Reportsandpublications/ Communities/1074606449 Disrupting Crack Markets; A Practice Guide Download from www.drugs.gov.uk/Reportsandpublications

This listing is for information only. Inclusion does not imply endorsement of organisations or resources listed.

REFERENCES: 1. Tackling Crack Cocaine – A National Plan 2. On the Rocks, South Bank University 3. Drugscope 2002 4. Home Office Statistic 5. The British Crime Survey 2002/03 6. Swindon DAT (see www.drugs.gov.uk/WorkPages/Diversity/CaseStudies) 7. National Treatment Agency 2002 8. British Association for Behavioural and Cognitive Psychotherapies (BABCP) www.babcp.org.uk 9. The Society of Auricular Acupuncturists www.auricularacupuncture.org.uk

24 FRANK Action Update – Understanding Crack Cocaine