Motivations for cocaine use: relation with drug use patterns, risks and how this informs prevention

Background: After cannabis, cocaine is the most commonly used illicit drug in Europe (EMCDDA, 2023). It is particularly linked to specific settings, such as, club culture (Edland-Gryt, 2021) and specific work contexts (Mcentee et al., 2022). However, little is known about the specific motives for cocaine use and whether or how this is linked to specific patterns of use. As such, this study aims to gain insight into the motives and determinants of cocaine use. Lessons learned for prevention are discussed.

Methods: This study employs a mixed-method strategy combining a bivariate analysis of secondary data on cocaine use from the Druglijn (n=1857), qualitative semi-structured interviews with people who use cocaine (n=11), and focus groups with professionals who work with people who use cocaine (4 focus groups, n=38). The study was conducted in Flanders (Belgium) in 2023.

Results: Respondents mention diverse motives as to why they use cocaine, which can be categorized into five groups: social motives (to increase positive peer experiences), enhancement motives (to increase positive emotions), coping motives (to relieve negative moods), conformity motives (to avoid social rejection), and sobering motives (to counteract the intoxication of alcohol). When analyzing how these motives link to patterns in the use of cocaine, we discovered significant differences (p<0.001) in patterns of and risks in cocaine use. For example, social motives are associated with a lower likelihood of using large amounts of cocaine (1.5g or more) at a time (OR=0.548, p<0.001), a lower likelihood of frequently (several times a week or daily) using cocaine (OR=0.351, p<0.001) and lower odds of psychological consequences such as worrying about their use (OR= 0.303, p<0.001). Other motives, such as coping motives, are associated with higher odds of psychological consequences such as feeling down after using (OR= 1.791, p<0.001) or worrying about their use (OR= 1.957, p<0.001). We explore these associations more thoroughly in the interviews. Respondents confirm how (risk in) cocaine use can vary between positive and negative motives. Also, they contextualize the importance of motives by highlighting the importance of siuational factors (e.g., availability) and historical factors (e.g., previous experiences) on use, and stress how motives differ depending on setting and context. 

Conclusions: This study revealed a relationship between motives for and patterns in cocaine use. This could allow prevention interventions to target specific motives, enabling more tailored interventions (Kreuter & Wray, 2003). Nevertheless, it remains important to also consider context and the setting in which cocaine is used. Above all, the great diversity in motives, patterns of use and profiles of people who use cocaine shows that there is no one size fits all approach to prevention.