Clarity Through the Smoke: An Investigation into London Service Users' Experiences and Understanding of the Interaction of 'Psychosis' and Cocaine

This study followed a grounded theory methodology in investigating the relationship
between psychosis and cocaine dependency; which is a specific dual-diagnosis
population that has been under-researched. To the researcher's knowledge, this is
the first study to use qualitative methodology to explore the link between psychosis
and cocaine.
Eight participants were recruited from an inner-London substance misuse service. All
participants were primary cocaine users (or recently abstinent ex-users), the majority
of whom normally smoked crack-cocaine, and all additionally experienced psychosis.
Semi-structured interviews were completed, focusing on what participants believed
caused their mental health difficulties; what participants' views were on why they
began using cocaine; and how participants believed their drug use has affected their
mental health.
From analysis of participants' interviews a model was created that provides an
explanation for cocaine use in this group. This replicates psycho-social aspects of
previous models of dependency, but also offers new contributions to understanding
this specific group. One of the key findings from this study was that cocaine is not
reported to be a causal factor in developing psychosis, while for some, cannabis
was. Another finding was that people self-medicate with cocaine, both to improve
mood and to help manage voices. Another specific factor in the maintenance of
dependency was exploitation by drug dealers.
Participants' relationships with family members and professionals were explored. It
seems that misunderstanding of participants' substance misuse difficulties was a
significant reason for break downs in such relationships. The study therefore
recommends more training for mental health professionals in collaborative
approaches (such as motivational interviewing) and more involvement and support
for families; so as to better engage this complex group.

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