The menace of the war on crack in Britain

Richard Hammersley

Behavioural Sciences Group University of Glasgow

Much concern has been expressed over the likelihood of a British crack epidemic. The American situation may be alarming, but there are several reasons to doubt that this situation will be duplicated in the UK Rather than the crack epidemic being due to the drug's extreme addictiveness, the crack epidemic occurred because conditions in America were right for it: There were high baseline rates of drug use in general, cocaine use in particular, and violence prior to crack. The USA is also near the major drug producers, so smuggling is easy. None of these conditions apply to the UK. Nor is there evidence that cocaine or crack use is increasing epidemically in the UK. The possibility of increased crack use should not divert society's attention from the UK's existing, widespread problems of drug, alcohol and tobacco misuse.

Over the last two years, warnings have been issued concerning the likelihood of crack becoming a problem drug in the UK (Brown 1989, McKillop 1989, Sunday Times 1989) . These warnings usually assert that crack is

"instantly addictive" and, in consequence, creates many addicts who are associated with high levels of violent crime. Although in the past the British approach to drug misuse has used a combination of legal, social and medical interventions, crack is supposedly so bad that it must be excluded from the country at any cost. A major part of that cost is likely to be increased customs, police and, at the extreme, military action. As this article will describe, such action is over-reaction, for the reality is that crack is just another drug, which should be dealt with in the context of Britain's existing drug misuse problem

Instant addiction? Central to the supposed special danger of crack is the concept of "instant" addiction. "Addiction" is, of course, a Humpty-Dumpty word which means whatever the speaker decides it should mean. But, if crack addiction is like addiction to other drugs, then the concept of instant addiction makes no sense: One cannot "instantly" change, after one smoke, from being a conventional, problem-free citizen to someone with a major substance dependency. Perhaps, less melodramatically, "instant addiction" really means that crack is often immediately so enjoyable that those who are already predisposed to use drugs frequently tend to take to crack very quickly. This would be in contrast to people's first experiences with many other drugs, which are often only partly, if at all, enjoyable (Gossop, 1982).

If crack being "instantly addictive" meant more than this, then whoever tried it would be addicted. It is then odd that, despite the endemic baseline availability of cocaine in the USA (see below), crack users seem to be concentrated in the same areas of urban deprivation which previously produced heroin abusers

Polydrug dependency

It makes more sense to accept that crack is highly enjoyable, the euphoria is short-lived and there are unpleasant rebound effects which can be delayed by smoking more. In consequence, many people, whose social and personal circumstances mean that they have little to lose by taking drugs and few scruples about committing crimes to pay for them, are eager to repeatedly take crack (or any other powerfully psychoactive drug) for "a mental vacation" Cluckson 1989). Other users, with more to lose, probably regard illegality, rebound effects and the expense of repeated use as reasons not to use more crack. This is certainly true of cocaine in general (Cohen, 1989). There is no evidence that crack is fundamentally more (or less) addictive than any other drug with abuse potential. It is also important to recognise that most illicit drug misusers will substitute one drug for another. depending upon availability (Hammersley et al, 1989). Drug "addiction" is not merely a matter of needing a drug with a specific pharmacological action in the way that a diabetic needs insulin. Because drug use is a learned behaviour, even individuals who may be biologically vulnerable to a specific drug may end up learning to misuse other drugs as well (Lerner & Raczynski 1988, Levinson et al 1983).

There are plenty of deprived urban areas in this country with traditions of drug misuse, where crack might be used if it became available. There is already some use, at least in London and Liverpool (Power & Wells, 1989). Thanks to widespread media exposure, most drug users have probably heard of crack and some are probably attracted to it because it has been publicised as euphoric, dangerous and exotic (Kleber,

wonder if crack is going to become an American-style problem in the UK.

Drug prevalence before crack

In the USA, crack became available to a society where cocaine use was endemic. For example, 17% of high school seniors had used cocaine in 1985 Johnson et al 1986). When crack appeared it was sold in a more affordable form than cocaine had been - just as heroin began to be sold in £5.00 bags during the British epidemics of the '80s - and both prevalence and incidence of use increased (Kleber 1988). Cocaine use occurs but is not widespread in the UK. Less than 2% of London 11 to 16 year olds had ever used cocaine in 1986 (Swadi 1988). Only 1% of a group of 150 new Glasgow drug users aged 15-20 had used cocaine in 1988-1989 (in contrast 73% of this group had used temazepam, 39% buprenorphine, 23% opiates and 9% heroin), while amongst a drug dependent group cocaine use only averaged 5 days per year (Hammersley et al 1990). British users of crack would not be changing to a cheaper form of a regularly-used drug, but adopting a rare drug which, to coin an oxymoron, few are in the habit of using occasionally. This pattern has been found in Amsterdam (Cohen 1989) and also in ongoing research led by Jason Ditton on Scottish cocaine users. The absence of an extensive cocaine tradition might slow the spread of crack.

Drug use and violent crime

In the USA, heroin, cocaine and crack use have been associated with murder and violent predatory crime (Collins et al 1985). In the UK, dependent cocaine use is rare, while heroin use is associated with shoplifting, burglary and theft from cars, but not with violence (Hammersley et al 1989, Parker & Newcombe 1987). Much of the crack-related violence in the USA seems to be part of inter-gang conflicts and intra-gang discipline, as urban street gangs battle for control of crack dealing; a product of illicit economics rather than addiction. This violent gang structure was already in place in the USA before crack, but such a formal and encompassing gang system does not currently occur in the UK. Also, firearms are much less widely available in the UK. For these reasons, the American neighbourhoods where crack is now rife were already extremely violent, even when compared to the worst in Britain. These American neighbourhoods have become more violent, but perhaps the UK is different from the USA in respect of violence and even if crack becomes widespread, it would not necessarily lead to widespread violent crime*.

In painting this relatively rosy picture of British society, one must not forget the existence in Northern Ireland of heavily armed paramilitary gangs, with varying degrees of political commitment. Fortunately for the prevention of drug misuse, the majority of these gangs appear to be fundamentally opposed to drug use

Ease of smuggling

Another reason for the crack and general drug problem in the USA is the multiplicity and ease of smuggling routes from Latin America. Much of America's cocaine and cannabis arrives via light aircraft and small boat (Drucker, 1989). The relative rarity of any form of cocaine in Britain suggests that cocaine manufacturers and distributors have not so far established widespread routes into Britain. It seems likely that crack will become more widely available, but unless direct routes from cocaine producers to the UK are established, it will not necessarily become an epidemic. By analogy, despite many years of determined cannabis smuggling into both countries, only 12% of Swadi's 1986 London teenage sample had ever tried cannabis (1986), whereas the equivalent proportion in the USA was over 50% in 1985 Johnson et al 1986).

Of course we should not underestimate the ingenuity of drug smugglers; both the UK and the USA have experienced heroin epidemics despite their distances from heroin producing areas. Still, comparing heroin use prevalence with other drugs, even during these "epidemics", only about 1% of either the British (Swadi 1988) or American Johnson et al 1986) population under 20 had ever tried heroin. The extent of the current crack problem in the USA is partly because the prevalence of crack/cocaine use is much higher - 20% in 1985 dohnson et al 1986). This in turn may be due to the relative ease with which crack can be imported into the USA. Britain is more distant from major cocaine producing regions and this may reduce cocaine availability and hence moderate consumption despite the best efforts of drug smugglers.

Will more crack use create more drug users?

Cocaine seizures in the UK have increased recently (Power & Wells, 1989), but this may in part be due to increased customs and police attention to cocaine. Even if more cocaine, or crack is being imported, there remains a big step between some increase in British crack use and the kind of problem faced in parts of some American cities. Evidence that crack is already being used is not automatically evidence that there is about to be a crack epidemic. British drug users will experiment with most psychoactive drugs which are available. Given the publicity crack has received, it would be amazing if use had not increased to an extent.

A final question is whether such an increase would be due to existing drug users switching to crack or cocaine, or whether crack users would add to the overall number of drug users. The latter possibility gives more cause for alarm, but if the American experience is repeated here then this alarm is not justified. The prevalence of cocaine use in the USA doubled among 17-18 year olds between 1975 and 1985, but the percentage of youth who had ever used any illicit drug but cannabis did not increase at all during the same time period Johnson et al 1986). In other words, at the population level cocaine use did not swell the number of drug users. Even if cocaine use in the UK were to increase proportionally across the next decade, at very worst 4% of British youth would have ever taken cocaine by 1996. Extrapolating again from American data, less than 2% would be current users and the percentage of dependent cocaine or crack users would be smaller still. It is sensible to suppose that these users would mostly be people who, in the absence of crack, would be misusing other drugs which are already associated with crime and other social problems in the UK, for habitual users o any particular drug tend to be relatively frequent users of all available drugs (Hammersley et al 1989).

Dogs also have teeth

In the past, society'» response to drugs problems has often been "too little, too late," but it is expensive to err in the other direction. At least in Scotland (Hammersley et al 1990, Morrison 1989 Sakol et al 1989) medically-available drugs such as buprenorphine and temazepam (which have only recently been placed on the controlled list) are being widely misused, while cocaine of any form seems to be rare and expensive. Anti-heroin measures making heroin scarce through law enforcement and prescribing alternative psychoactive drugs to help users "come off" heroin - have probably helped to switch users to buprenorphine and temazepam. It now remains to be seen the new moves against the latter drugs

lead users to switch to another substance. It would be ironic if, on top of the free advertising campaign which has been provided for crack in this country in the name of providing a warning, antidrugs policy were now to create a vacuum in the illicit drugs market which crack could fill.

Power and Wells (1989) remind us of the boy who cried "Wolf', warning that, however many false alarms there have been, "The wolf has teeth". But, in facing down the lone crack-wolf, we risk ignoring the relatively domesticated, but collectively more vicious, dog pack. In a country where there are already major drug, alcohol and tobacco misuse problems, diverting funding to ward off a possible drugs problem - however scary seems like throwing bread out of the window to keep the elephants away. As in that old joke (But there are no elephants!), the continued absence of a crack problem would be seen as evidence of the success of such a policy. Meanwhile, funds would probably have been diverted from the real drug and alcohol problems which already exist in this country. Let us remember that the British heroin users left over from the heroin epidemic of the early 1980s have not gone away just because crack and ecstasy are now receiving all the media attention. Nor have the millions of people withalcohol-related problems, or the twenty million of so Britons who still smoke tobacco, or the people who have difficulty discontinuing benzodiazapine use. Like the poor, drug misusers have always been with us. The roots of their problems are psychosocial and cannot be conveniently explained away by their addiction to a specific substance. Amelioration of those problems will not be achieved by a high profile assault on crack.

It should be possible to deal with any future British crack problems within the existing framework of drug management, treatment and controls. For, to sum up, although crack use may increase in this country, that seems unlikely to add to the number of problem drug users and potential problem users who already exist. The main menace of crack is that the intense rhetoric used against it may make matters worse, at least by clouding the real issues and leading to ineffective, expensive policy decisions, and, at worst, by turning users, dealers and traffickers into outlaws with little to lose by escalating the awar on drug". Continuation of normal anti-drug measures, rather than elaborate special operations, are required to bbeat the menace of crack" (McKillop 1989).

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