From the first drug to crack: the sequence of drugs taken in a group of users in the city of São Paulo.

To identify a progression in drug use and influencing factors among crack users, a qualitative methodology was used for a more in-depth investigation, taking into consideration the view that the interviewee has of the problem. A long duration and a semi-structured interview was used; a purposeful sampling was outlined and a criterion sampling was achieved. Thirty-one crack users or ex-users were interviewed in order to reach theoretical saturation. Two distinct phases of drug use were detected. The first, with licit drugs, where alcohol and tobacco were the most frequent, the relatives and friends were the ones who encouraged use, and the need for self-assurance was the reason most often reported. The early start and the "heavy use" of one or both drugs were determinant for the beginning of a progression towards illicit drugs. Marijuana was the first drug of the second phase. A stronger attitude for the search of a drug as a source of pleasure replaced the reason previously stated. The study reveals that the progression in drug use seems to be associated more with external decisions (e.g., peer pressure, dealing influence, etc.) than to the preference of the user. Two different progressions were identified: among the younger (<30): tobacco and/or alcohol, marijuana, snorted cocaine, and crack, and among the older (>30): tobacco and/or alcohol, marijuana, intravenous medication, snorted cocaine, intravenous cocaine, and crack. This pilot study's findings are limited in generalizability to its sample. Further research is needed.