The Relationship between Trauma and Substance Use among Incarcerated Youth

Purpose: Delinquent youth report elevated rates of substance use with approximately half of adolescents in juvenile detention meeting criteria for a substance use disorder (Teplin et al., 2002). Because substance-abusing youth exhibit significantly higher recidivism rates than their non-abusing counterparts, understanding correlates of substance use among incarcerated youth is essential to develop effective rehabilitation programs. Experiencing trauma has been significantly associated with substance abuse and dependence, leading researchers to propose that some youth may use substances to cope with past traumatic events. Further investigation is necessary, however, to distinguish the types of traumatic experiences most highly associated with substance-related problems among incarcerated youth and to identify the specific substances most likely to be used by traumatized delinquents.

Methods: This NIDA-funded study investigates the relationship between trauma experiences and substance use among youth (N= 723) incarcerated in the Missouri Division of Youth Services. Youth completed face-to-face interviews assessing trauma experiences, substance use history, substance-related problems, and psychiatric symptoms. Lifetime trauma experiences and substance use problems were measured using the Massachusetts Youth Screening Instrument (2nd version). Specific trauma-related experiences assessed included: seeing someone severely injured or killed; having been badly hurt or in danger of getting badly hurt; and having something very bad or terrifying happen. In addition, youth were asked how many days, in the year prior to incarceration, they used different substances. Multivariate regression and polychoric correlations were used to examine associations between trauma experiences, substance use problems and substance use frequency.

Results: Youth reported a high rate of trauma experiences. Each type of trauma was observed in approximately 65% of the sample, with the exception of seeing someone severely injured or killed (45%). Each type of trauma was significantly associated with increased levels of substance use problems, after controlling for demographic and psychosocial factors. Seeing someone severely injured or killed exhibited the strongest and most consistent association with past-year substance use. Multivariate regressions also showed that youth who experienced this type of trauma were 1.7 times more likely to report higher levels of marijuana use and 1.4 times more likely to report higher alcohol use than youth who did not experience this trauma.

Implications: The current research builds on existing trauma research by identifying types of traumatic experiences associated with youth substance use. Particularly noteworthy was the importance of witnessing violence or harm towards others as an especially strong correlate of substance use, even when compared to personally being in danger. This finding adds to a small but growing literature suggesting the detrimental effects of living in violent neighborhoods or homes with domestic violence. Overall, the high correlation between trauma and substance use suggests that where one condition occurs, the other is likely, and treatment of either condition (or ideally treating both concurrently) is likely to enhance treatment outcomes among incarcerated youth. Accordingly, youth in juvenile justice facilities should be screened for past trauma, including witnessing traumatic events. Youth who have experienced trauma should be targeted with substance use prevention and intervention programs that include components of trauma-focused treatment.