[Health care needs of cocaine users in Hungary: results of a qualitative study]

There have not been any substantive collection of data on cocaine users in Hungary although there were numerous indications that a cocaine problem may exist.

In the frame of the project entitled "Support Needs for Cocaine and Crack Users in Europe" the aim of the authors was to identify the qualitative characteristics of Hungarian cocaine users.

In addition to a quantitative study of 210 cocaine users, we selected nine subjects by random sampling and conducted problem-oriented depth interviews with them. Three of the subjects belonged in the party group (weekend use, social integration), three in the scene group (part of the marginal drug-using subculture) and three in the therapy group (undergoing treatment for drug use at the time of the study). The main thread of the interview covered the following main aspects: 1. Drug-using behaviour--reduction, termination or continuation of use; 2. Use of support services; 3. Experiences with addiction medicine services; 4. Support needs.

The interviews decide to give up cocaine use when they perceive the disproportionately high costs of cocaine use on the basis of simple cost-benefit calculation. Apart from the existential costs, the main costs include sleep disorder, psychological and psychiatric symptoms and problems (depression, sensitivity, paranoid state, panic, anxiety, sexual disorders, etc.), symptoms reminiscent of serious cardiac disorders (chest pain) and interpersonal problems. They were able to reach professional help by chance, through friends. Cocaine users do not favour state health services, they are mistrustful of the handling of data. For this reason they prefer private doctors. They seek medical help not for detoxification but rather to prevent a relapse, generally for problems arising after withdrawal. Psychological help dominates in the assistance given. Heroin-dependent cocaine users seek help from the staff in the place where methadone treatment is given. Much depends in the management of abstinence on the degree of involvement in the subculture, emotional support, the attitude to work, the extent of disorders arising after withdrawal, and the quality of the personal relationship formed with the doctor. Most cocaine users require complex multi-disciplinary treatment.

Cocaine use can be characterised along the dimensions of work, self-image, conspiracy, openness, criminality, basic drug, the negative or positive reinforcing function of cocaine: Dr. Jekyll and Mr. Hyde type, Carmen type, Pinocchio type. The Dr. Jekyll and Mr. Hyde type is characterised by a double life, the Carmen type is the prototype of the sovereign female placing the emphasis on sexuality, the Pinocchio type is a trouble-making, criminal risk-seeker. While some of those within the Dr. Jekyll and Mr. Hyde type are open to help and others do not seek help, the Carmen type is open and the Pinocchio type closed to help unless their legal interests require the opposite.