Diffusion of Crack: The Influence of Macro-Level Factors, Migration, and Existing Interdiction Efforts
Methods: The data for the present analyses come from an on-going international research collaboration between University of Southern California and the Instituto Nacional de Psiquiatría Ramon de la Fuente Muñiz. The sample consists of 150 male and female adult crack users recruited in designated delegaciónes. The team is using an adaptive sampling methodology that combines elements of field-intensive outreach, rapid assessment and targeted respondent-driven sampling. Data collection consisted of ethnographic interviews and ethnographic observations. The inclusion criteria for the sample are: 18 years of age or older; recruited in one of the selected delegaciónes; self-report crack use at least once during the past 30 days; and no participation in formal drug treatment 30 days prior to enrollment. A pre-screening method was adopted to help mask the eligibility criteria. In the pre-screening, questions were embedded about personal drug use with other questions about potential respondents' characteristics. The crack use criteria depended on subjects' self-reports. Based on the pre-screening information the outreach worker determined whether the subject met the inclusion criteria.
Results: Analyses revealed three general categories as emerging factors associated with the diffusion of crack use. Specifically, the diffusion of crack is attributed to macro-level structural factors, migration, and existing interdiction efforts. For instance, some respondents revealed that first time crack use experiences were prompted by friends who had spent time in the United States as undocumented immigrants. Accounts detail social gatherings in which small groups of users are exposed to crack use by these migrant men. Participants also perceive their use of crack as being attributed to the existing drug market. Respondents explained that in the past their use was limited to alcohol, marijuana, and inhalants. However, given that there had been a crack-down on the market, many of the drugs are now staying in their communities thus facilitating their initiation into new drugs such as crack.
Conclusions and Implications: Overall findings for this study have long term consequences given that existing research in Mexico has found high rates of underutilization of treatment services. Low rates of treatment seeking behavior have been attributed to factors such as the lack of recognition of addiction as a disease, social stigma and lack of integration of services. Moreover, Mexico’s public health system is not very extensive and geared more for insured workers or those in the public sector, while those patients who receive drug treatment do so in specialized centers. In conclusion, our data will contribute to designing peer-based prevention interventions that address social and contextual factors associated with the diffusion of crack use in México DF.