Coping And Drug Use Coping is the

capacity to surmount negative emotional states, including ANXIETY, DEPRESSION, anger, loneliness, and alienation. These aversive states are induced by internal psychological conflict or by external STRESS. Effectiveness in appraising and overcoming emotional distress that results from predisposing or triggering stressors determines, to a large extent, psychological well-being. In contrast, ineffectiveness in coping, as well as a subjective perception of ineffectiveness, exacerbates emotional distress, which comprises for some people an important factor in promoting ALCOHOL, TOBACCO, and other drug (ATOD) consumption.

The association between ATOD use and coping is complex. In some individuals there is a direct connection. In effect, PSYCHOACTIVE DRUGS are consumed to reduce tension and associated negative emotions. The consumption of drugs is motivated by their palliative effects. In most individuals, however, the connection between drug consumption and coping is more complicated. Numerous factors such as psychiatric illness, low self-esteem, deviant social values, maladaptive learned behaviors, inadequate social support, poor social skills, and personality disposition moderate and mediate the relationship between ATOD use and coping. No specific association has been established between coping style and VULNERABILITY to drug use or abuse. Thus, whereas it is generally recognized that a substantial proportion of the ATOD-using population is deficient in coping capacity, it is important to understand that many factors influence this association.

Coping and substance use and abuse become so intertwined over time that cause-effect relationships cannot always be discerned. Deficient coping capacity initially may, directly or indirectly, lead to ATOD consumption. Neurobehavioral, psycho-pathological, and social adjustment disturbances that occur along with chronic ATOD consumption may also diminish coping ability.

Substantial variation among individuals occurs with respect to both coping capacity and drug-use behavior across the life span. Drug consumption among youth is most frequently related to negative feelings such as depression and anxiety, social deviancy, and interpersonal problems—whereas substance use among the ELDERLY is more commonly associated with life crises, psychiatric disorder, bereavement, sleep disturbances, and unremitting pain.

Drug-abusing youth and adults, as a group, exhibit less ability to cope than the general population (Peele, 1985). It is essential to emphasize, however, that ATOD use and abuse may also be motivated by reasons other than the need to cope. In this context, ATOD consumption often stems from the desire for a euphoric effect or some other desirable state, a desire that may reflect accurate as well as inaccurate beliefs about the pharmacological effects of the chosen drug. For example, ATOD consumption may be motivated by perceived APHRODISIAC effects, energy or alertness enhancement, or social facilitation.

Among those whose ATOD consumption is motivated by deficient coping skills, it appears that augmenting competency improves the likelihood of successful treatment. In other words, treatments designed to enhance their coping skills are superior to treatments that emphasize their exploration of feelings (Getter et al., 1992). Furthermore, active coping strategies present 2 years after treatment are associated with a superior outcome at 10-year posttreatment follow-up (Finney & Moos, 1992).

The role of coping in ATOD use needs to be evaluated on a case-by-case basis. Assessment can be conducted using the Ways of Coping scale (Lazarus & Folkman, 1984) or the more comprehensive Constructive Thinking Inventory (Katz & Epstein, 1989). Severity of ATOD-use disorder can be efficiently quantified by employing the Drug Use Screening Inventory (Tarter, 1990). This brief self-

report evaluates the severity of the disorder in ten key domains: (1) substance use, (2) psychiatric disorder, (3) behavior patterns, (4) health status, (5) family system, (6) work adjustment, (7) social competence, (8) peer relationships, (9) school adjustment, and (10) leisure/recreation. A treatment protocol to enhance coping has also been developed for alcoholics (Kadden et al., 1992); this practical approach to intervention is also applicable for treating individuals with other types of drug abuse.

(SEE ALSO: Relapse; Treatment Types: Cognitive Therapy of Addictions)

BIBLIOGRAPHY

Finney, J. W., & Moos, R. H. (1992). The long-term course of treated alcoholism: II. Predictors and correlates of 10-year functioning and mortality. Journal of Studies on Alcohol, 53, 142-153. Getter, H., ET AL. (1992). Measuring treatment process in coping skills and interactional group therapies for alcoholism. International Journal of Group Psychotherapy, 42, 419-430. Kadden, R., ET AL. (1992). Cognitive behavioral coping skills therapy manual. Project MATCH Monograph Series, Vol. 3, DHHS Publication No. (ADM) 92-1895.

Katz, L., & Epstein, S. (1989). Constructive thinking and coping with laboratory induced stress. Journal of Personality and Social Psychology, 61, 789-800. Lazarus, R., & Folkman, S. (1984). Stress, appraisal and coping. New York: Springer. PEELE, S. (1985). The meaning of addiction. Lexington,

MA: Lexington Books. Tarter, R. (1990). Evaluation and treatment of adolescent substance abuse. A decision tree method. American Journal of Drug and Alcohol Abuse, 16, 1-46.

Ralph E. Tarter

CRACK Crack (sometimes called crack-cocaine) is an illicit drug, the smokable form of COCAINE, made by adding the bases ammonia or baking soda and water to cocaine hydrochloride. The white powder illicitly purchased as cocaine is in the hydrochloride form; it cannot be smoked, because it is destroyed at the temperatures required for smoking. Therefore, in order to be used by the smoked route, cocaine must be converted to the base state. A mixture is made and heated to remove the hydrochloride, resulting in a pellet-sized cakelike solid substance that can be smoked. This form of cocaine is inexpensive, available for purchase ''on the street,'' and is called ''crack,'' because of the cracks formed in the solid as it dries.

Although crack can be smoked in tobacco cigarettes or marijuana cigarettes, it is generally smoked in a special crack pipe. In its simplest form, this is a glass tube with a hole at the top of one end and a hole at the other end through which the smoke is inhaled. The crack pellet is placed on fine wire mesh screens that cover the hole distal to the smoker and a flame is applied directly to the pellet. Soda bottles, small liquor bottles, etc. are all used to manufacture crack pipes. They have in common the use of fine mesh screens so that the crack is not lost as it melts. Temperatures of approximately 200°F (93°C) are most efficient in providing the largest amount of cocaine to the user. Higher temperatures destroy more of the cocaine.

Smoking cocaine began with the use of FREEBASE cocaine, prepared by its users from the cocaine hydrochloride illicitly purchased by them. Soon after this form of cocaine had achieved its popularity, single doses of cocaine already prepared for smoking (i.e., crack), became available through the illicit drug market. Unlike the process for forming freebase cocaine, the crack manufacturing process does not rid the cocaine of its adulterants. Smoking cocaine rapidly became a popular route of administration once crack became readily available, since it was so convenient to use. Blood levels peak rapidly when cocaine is smoked, because of efficient respiratory absorption, and the smoked route of cocaine administration yields effects (peak, duration of effect, half-life) comparable to the intravenous route of administration. This means that the smoker of cocaine can achieve rapid onset of effect, including a cocaine ''rush'' and substantial cocaine blood levels, and can do this repeatedly using a more socially acceptable route of administration—one that requires none of the PARAPHERNALIA associated with hardcore illicit drug use (e.g., syringes, needles, etc.).

The more rapid the onset of the drug effect, the more likely it is that the drug will be abused. Thus, although the effects of smoking crack are no different than the effects of cocaine by any other route, the ease with which the drug can be taken, com-

Smoking crack, the rock form of cocaine, produces effects comparable to intravenous injection; the effects, felt almost immediately, are very intense, and quickly subside. (Drug Enforcement Administration)

bined with its toxicity make this an extremely dangerous substance.

From a financial perspective, crack is more desirable for both the buyer and the seller. A gram of cocaine hydrochloride costs approximately 50 to 60 dollars. This gram can be turned into 10 to 25 crack pellets, each selling for 2 to 20 dollars. Thus, a gram of cocaine can generate a substantial profit for the seller, and, as well, is available in singledose units to anyone with only a few dollars to spend.

(SEE ALSO: Coca Paste; Freebasing; Pharmacokinetics; Street Value)

BIBLIOGRAPHY

INCIARDI, J. A. (1991). Crack-cocaine in Miami. In S. Schober & C. Schade (Eds.), The epidemiology of cocaine use and abuse. NIDA Research Monograph No. 110. Rockville, MD: National Institute on Drug Abuse.

SlEGEL, R. (1982). Cocaine smoking. Journal of Psychoactive Drugs, 14, 271-359.

Marian W. Fischman

CRAVING The term craving is generally de-lined as a state of desire, longing, or urge for a drug that is responsible for ongoing drug-use behavior in drug-dependent individuals. Craving is also viewed by many drug-abuse researchers and clinicians as the main cause of relapse among drug users attempting to remain abstinent. During periods of abstinence, drug-dependent individuals often complain of intense craving for their drug. Several systems for diagnosing drug abuse include persistent desire or craving for a drug as a major symptom of drug-dependence disorders.

The belief that an addict s inability to control drug use is caused by craving and irresistible desire was a prominent feature of descriptions of addictive disorders provided by many nineteenth-century writers. Craving continued to be important in many models of addiction developed in the twentieth century. The use of craving as a key mechanism in theories of addiction peaked in the 1950s, supported largely by E. M. Jellinek's writings on the causes of alcoholism.

Jellineck contended that sober alcoholics who consumed a small amount of alcohol would experience overwhelming craving that would compel them to continue drinking. The proposal that craving and loss of control over drinking were equivalent concepts was adopted by many clinicians and addiction researchers. Equally popular was the position, also supported by Jellinek, that craving was a direct sign of drug withdrawal. WITHDRAWAL-based craving was often described as physical craving, distinguishing it from craving that led to relapse during long periods of abstinence after withdrawal had subsided. Craving that occurred after an addict no longer was experiencing withdrawal was typically viewed as the result of psychological factors. The craving concept was sufficiently controversial that a committee of alcoholism experts brought together by the World Health Organization in 1954 (WHO Expert Committees on Mental Health and on Alcohol, 1955) recommended that the term craving not be used to describe various aspects of drinking behavior seen in alcoholics.

The use of craving as a key process in theories of addiction decreased during the 1960s and early 1970s as a result of several factors. During this period, many studies showed that alcoholics did not necessarily engage in loss of control drinking when they drank small doses of alcohol. The failure to confirm Jellinek's conceptualization of alcoholic drinking cast doubt on the idea that craving was synonymous with loss of control over drug intake. Furthermore, withdrawal models of craving could not account for the common observation that many addicts experienced craving and relapsed long after their withdrawal had disappeared. Finally, addiction research was increasingly dominated by behavioral approaches that focused on the influence of environmental variables in the control of drug taking and avoided the use of subjective concepts, such as craving, to explain addictive behavior.

Even though many researchers questioned the value of using craving to explain addictive behavior, it persisted as an important clinical issue, as many addicts complained that craving was a major barrier to their attempts to stop using drugs. Craving continued to be cited as a major symptom of drug dependence in formal diagnostic systems of behavioral disorders, and the notion that craving was responsible for compulsive drug use remained at the core of several popular conceptualizations of drug addiction. Scientific interest on the role of craving in addictive disorders reemerged in the middle 1970s as a result of two developments. First, behavioral theories of addiction were increasingly influenced by social-cognitive models of behavior that were more sympathetic to the possibility that hypothetical entities such as craving might be useful in explaining addictive processes. Second, animal research on the contribution of learning processes to drug tolerance and drug withdrawal provided support for the hypothesis that learned withdrawal effects might produce craving and relapse in abstinent addicts.

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