Profiles of people in treatment for crack cocaine use in Belgium (2016-2021): a latent class modeling approach
Background: Although the prevalence of crack use is much lower than for other illicit substances, data from the Belgian Treatment Demand Indicator Register (TDI) indicate a steady increase in treatment episodes related to problem use over the past five years. However, little is known about people who use crack beyond the general assumption that they are socially marginalized and often use multiple substances. The present study addresses this gap by using latent class analysis (LCA) to identify groups (or classes) of people in treatment for crack use, what characterizes them, and whether there have been notable changes in their profiles in recent years.
Methods: The study sample consists of 1443 and 2069 people entering treatment who reported crack as a problematic substance leading to treatment in 2016 and 2021, respectively. LCA was applied to identify subgroups of people in treatment for crack based on reported use of other substances as well as some substance use behaviour characteristics. Subsequently, multinomial regression analysis models were used to examine factors explaining class membership of the 2021 sample using socio-demographic characteristics and treatment-related variables.
Results: The LCA performed on the 2021 data shows a three-class solution. The first class (76% of the sample) is characterized by people who use mainly crack alone. In the second class (15%), we find mainly people using crack in combination with opioid. In the third class (9%), we have people using a lot of different substances. The findings from the multinomial logistic regression analysis indicate that compared to the opioids group (class 2), people in the “mainly crack use” group (class 1) and the “multi-drug use” group (class 3) are more likely to be younger and for the first time in treatment for addiction. Except for housing status, social characteristics do not influence strongly class membership. The data from 2016 point out also a three latent class solution but structured differently: they can be differentiated by the level of severity of polysubstance use with a first and a third class similar to those from 2021 sample and the second group as middle point between “mainly crack use” group and a third with lot of problem substances.
Conclusions: The profile of patients evolves from 2016 to 2021. Opioid use has a higher discriminatory effect and is reported by fewer patients entering treatment in 2021. They are older and more likely to have previous treatment experience. This result is in line with the research on opioid use in Europe. In general, people report fewer additional substances in 2021. This supports the hypothesis that either the use of crack is replacing other substances, or that new people who use crack are less likely to use other products, perhaps because crack is more affordable.
