A subtle poison

“No room for smack or crack in Brixton” warns the bright yellow
poster at the top of Brixton tube station’s escalators. A few
streets away from the bustling south London station is a scheme
dealing with the consequences of Lambeth Council’s response to
crack.

Homelessness charity St Mungo’s operates two hostels in Brixton,
providing two stages of support and accommodation to female sex
workers who use crack. The hostels are run in conjunction with the
Lambeth Crime Prevention Trust, the Stockwell Project and seven
other agencies. The hostels’ current residents became homeless when
Lambeth Council launched its CrackOUT initiative to reduce the
supply and use of crack in the borough last August. One of its aims
is to shut down the borough’s 80 “crack houses” where many users
live. So far, about 52 have been closed.

Crack is a serious problem not just for busy, metropolitan areas
like Brixton; it has gained a foothold in communities across the
UK. So how have the government and social care services responded
to the emerging crack problem, and what should be done to support
individuals using the drug?

The 2001-2 British Crime Survey estimates that between 39,000 and
85,000 people aged 16 to 59 used crack in the previous
year.¹ This is on a par with the number of heroin users
– between 32,000 and 73,000 for the same period. The BCS estimates
that 26,000 16 to 24-year-olds used crack over the same time.

One of crack’s traits is users’ mistaken belief that they are in
control of their habit, says Aidan Gray, national co-ordinator of
advice agency Conference on Crack and Cocaine. He says crack’s
impact is also compounded by poverty and exclusion.

Harriet Smith, director of Lambeth Crime Prevention Trust, says
crack takes away the normality of a person’s life. “It creates an
inclusive community among crack users and they won’t let other
people in. The need to get money to buy crack becomes their entire
focus.”

She adds that crack dealers often move in on vulnerable tenants and
use their homes as bases for the distribution and consumption of
the drug – crack houses. “This makes the person and other tenants
vulnerable and frightened.”

Mick Collins is manager of the Stockwell Project for users in south
London. Some of his clients have lost their homes to crack dealers.
“They think they can control the situation and let people use crack
in their home, but they can’t,” he says. “They lose control of
their home in just a few days.”

Crack can also “compromise the morality of some drug users”, he
adds, because the more they take, the further away they get from
everyday reality. To obtain money to buy crack, he says, some
individuals sell sex or become involved in violent crime.

Liz McDonnell, women’s services co-ordinator for St Mungo’s (see
Carol’s story below), says she and her colleagues work to break the
cycle of women selling sex to buy and use crack.

“It is about giving women an awareness that they don’t need to do
that. For a lot of women, that is their whole lives and they don’t
know anything different,” McDonnell says. “Most women want help.
Their lives are in a mess, they want some form of stability.”

So far, 32 clients have been referred to the charity’s two hostels.
When clients arrive at the first hostel, they receive an intensive
needs assessment and are allocated a key worker and a drug worker,
and are helped with benefits and health care.

When they become stable, they move on to the second hostel where
they are encouraged to live more independently. St Mungo’s also
runs classes for its clients ranging from sewing to computing, and
arranges day trips.

In response to the increasing use of crack throughout the UK, the
government published the report Tackling Crack: A National
Plan as part of the national drugs strategy in December 2002.
It promised guidance for drug action teams (DATs) on handling crack
problems by the beginning of this year; new specialist crack
treatment services by April 2003; and new schemes for vulnerable
people at risk of crack use in high crack areas by this
month.

These promises are being fulfilled – DATs have received the
guidance; in March, 11 drug services were announced as pilots for
the specialist crack treatment services; and 37 crack areas in
England will receive extra funding to provide services.

Meanwhile, under proposals detailed in the Antisocial Behaviour
Bill published in March, police are being given new powers to close
premises where Class A drugs are sold within 48 hours and to seal
them for up to six months.

But shutting down crack houses is not a solution in itself, says
Smith at the Lambeth Crime Prevention Trust. “It is about having
the resources to deal with the people coming out of the houses in
the long term.”

At the Stockwell Project, Collins believes approaches to tackling
crack are being incorrectly driven by the criminal justice agenda.
He says: “I’d like to see crack covered from a health agenda as
well. It is important we don’t miss that while we concentrate too
much on the legality of crack.”

The way services engage with drug users has been changed by crack,
argues Gray from the Conference on Crack and Cocaine. He says most
drugs services are geared up to work with injecting opiate users
who can be stabilised on the heroin substitute methadone while
coming off it. “But crack users have to be seen quickly because
they are in crisis when they approach a service.”

Collins says working with crack users has been “a huge learning
curve” for the sector. “Our tried and tested methods won’t work
with this group, and we have had to develop new crisis intervention
skills.”

Agencies experienced at dealing with heroin users are not always
capable of effectively dealing with clients taking crack, says Leo
Downer, a crack development, treatment and communities worker with
Lambeth drug action team. “They don’t know how to work with crack
users, so they don’t ask the relevant questions.”

So what should the social care sector be doing to support crack
users? St Mungo’s substance user services manager Sue Clark says
“greater communication and less judgemental attitudes” from social
workers dealing with the children whose mothers use crack is
needed. Although she agrees these workers have a duty to protect
the child, she says stronger links with children and families’
social workers would also help.

“These women don’t trust social workers because they feel they will
take their children away,” she says. “When this happens, it is
really hard for us to work with the women effectively.”

McDonnell says all professionals should listen to what their
crack-using clients tell them about themselves, and take on board
the issues they raise.

Providing clients – and their families – with the appropriate help
is key to avoiding relapse, Collins says. “Any intervention that
involves everybody in the user’s family is more likely to be
successful, because they are all getting support.”

Drug services must remodel their working practices to ensure their
clients know they deal with more than one drug, recommends Downer.
He wants agencies to stress that crack addiction is a treatable
condition, and that clients can make positive changes to their
lives quickly. He says: “It is about re-establishing links with
their family or gaining new associations where they can rediscover
how to interact with people who are not using crack.” He adds that
users forget simple pleasures, such as going to the cinema or out
for a meal.

Most importantly, Downer says, professionals need to remember they
are dealing with individuals and not crack users. “People using
crack are just like anyone else. They need to be approached as the
person first.” CC

¹ Home Office, “Prevalence of drug use: key
findings from the 2001/2002 British Crime Survey”, Home Office
Findings 182,

www.drugs.gov.uk/ReportsandPublications/NationalStrategy

‘You have to be ready to stop’ – Carol’s
story

Carol is 49 and a reforming sex worker and crack addict. She
lives in St Mungo’s project for crack-using female sex workers. She
moved in when the crack house she lived in was shut down. “The
project has helped me a hell of a lot. It’s given me somewhere to
live and shown me a part of life I’d forgotten.” 

Carol became a sex worker at 16 and has used crack for 15 years,
having started with marijuana and cocaine 10 years earlier. She
heard about the St Mungo’s initiative at a drugs drop-in clinic. It
was the first time she considered changing her behaviour. She says:
“I was sick of the life I was living. When you take crack you have
to be ready to stop because it’s all psychological.” She was
financing her £300-a-day crack habit through sex work but now
spends about £30 a week on the drug. “I have become immune to
it.”  

Originally from an Irish Catholic family in Yorkshire, Carol was
one of 12 children. When she was 15 she and her childhood
sweetheart had a son, whom her parents raised. She left home at 16
because her parents were “over-protective” and went to live with a
new boyfriend. Unbeknown to her, he was a pimp and soon she was
working for him. She says: “The first time was a huge shock. I felt
dirty and didn’t know you had to ask for the money first. I’ll
never forget that day.” At 21 Carol moved to London. She kept in
touch with her family and son until four years ago, never telling
them about her drug habit or sex work. 

Now, she feels positive about the future and wants to train to
be a drugs counsellor dealing with sex workers. “If I can get out
of it, so can they,” she says. “I want them to check me the way
they used to, because I am still the same Carol.”

What is crack?   

Cocaine comes from the coca plant and at the turn of the 20th
century was widely used in toothache cures, tonics and medicines.
Until 1916 it could be bought over the counter at Harrods. Nowadays
cocaine is a Class A drug, and about 40-50 tonnes of it are shipped
into the UK annually. Crack is crystallised rocks of cocaine
created when cocaine hydrochloride is concentrated by heating it in
a mixture with baking soda until the water evaporates. It takes its
name from the cracking sound made during this process. It costs
about £10 a rock and can be smoked or injected. The “high”
from crack lasts only a few minutes but it is much more intense
than that of cocaine. Although not physically addictive, crack is
psychologically addictive. Users often seek, in vain, to replicate
their first crack high.