Therefore, assessing the risk factors related to the early age of drug use initiation could help to plan and implement preventive strategies. Longitudinal studies with psychoactive substances users have shown that the earlier the age of onset of alcohol and tobacco use the greater the likelihood of developing drug addiction, more severe drug use patterns and more problematic deviant behaviors. The age of onset of drug consumption is influenced by numerous combinations of protective and risk factors, within a system that integrates social environments, relationships, individual characteristics and behavioral patterns. Another survey with Brazilians adolescents in treatment found that the mean age at first use of crack-cocaine was 13.3 years. The II Brazilian National Alcohol and Drugs Survey (BNADS) found that the mean age of initiation for cocaine consumption in Brazil was 18.8 years. Likewise, a study with homeless people ( n = 203) from Montreal, Canada, found that the age of onset of cocaine use and its presentations, such as crack-cocaine, happened after 17 years of age. According to Substance Abuse and Mental Health Services Administration (SAMHSA), crack-cocaine first use generally occurs between the ages of 18 and 25 in the United States. The first experience with crack-cocaine usually occurs in the transition to adulthood, often following the exposure to alcohol, tobacco, marijuana and snorted cocaine. Exposure to violence and situations of abuse have also been associated with crack-cocaine use. In Brazil, crack-cocaine users are often part of vulnerable and marginalized groups in society and suffer from severe social and economic disadvantage. Evidence indicates elevated mortality rates among crack-cocaine users, well above international standards, homicide being the main cause of death. In addition, its use is also associated with sexual risk behaviors and high rates of Human Immunodeficiency Viruses (HIV) and hepatitis B and C viruses’ infections, exceeding those observed in the general population. The use of this drug is associated with psychiatric comorbidities, including depression, antisocial personality disorder and suicide attempts. Crack-cocaine users tend to develop severe pattern of dependence in a very short period of time. Treatment and preventive programs should take these factors into account when designing and implementing community interventions.Ĭrack-cocaine use, and other forms of smokable cocaine, is a serious public health problem that affects virtually all countries across the Americas and some nations in Central and Eastern Europe. ConclusionsĮarly onset of crack-cocaine use seems to be associated with exposure to family conflict, easy access to drugs and deviant behavior. In the multivariate model, perceptions related to ease of access of illicit drugs (marijuana: p = 0.028, 95% CI = − 3.81, − 0.22 crack-cocaine: p < 0.001, 95% CI = − 7.40, − 4.90), and deviant behavior (threatening someone with a gun: p = 0.028, 95% CI = − 2.57, − 0.14) remained independent predictors of early age of crack-cocaine initiation. Presence of family conflict ( p = 0.002), maltreatment ( p = 0.016), and deviant behavior prior to age 15 in a bivariate analysis predicted an earlier age of crack-cocaine initiation, whereas adolescents experiencing parental monitoring during adolescence started use later ( p < 0.001).

A structured interview assessed life-time exposure to risk and protective factors for drug use, such as parental monitoring in childhood, deviant behaviors and peer pressure. This cross-sectional study enrolled a consecutive sample of 577 patients admitted to 20 therapeutic communities located in Southern Brazil, between September 2012 and September 2013. Crack-cocaine users are usually embedded in a context of great social vulnerability, often associated with violence, poverty, family conflict and easy and early access to alcohol, tobacco and other drugs. Crack-cocaine dependence is a serious public health issue, related to several psychiatric and psychosocial problems.

Crack addiction interview