Examining the Influence of Marijuana Use, Crack-Cocaine Use, and Childhood Victimization on Current Symptoms of Psychosis for Incarcerated Women

Background: The literature is mixed on whether using marijuana and crack-cocaine increases the risk of experiencing psychosis (e.g., Arseneault et al., 2004). Authors suggest that individuals who use these drugs frequently are more likely to experience symptoms of psychosis, with the highest risk group also having a family history of schizophrenia. However, incarcerated women and girls suggest that they use drugs to cope with experiences of childhood victimization (CV; DeHart, 2008; Fuentes, 2014). The purpose of this paper is to examine the relationships between CV, drug use, and psychosis for incarcerated women. We hypothesize positive relationships between marijuana use, crack-cocaine use, and current psychosis, with CV significantly moderating the relationship.

Method:  A random sample of 230 incarcerated women was obtained from two state prisons. Participants completed the Childhood Trauma Questionnaire, the Mini International Neuropsychiatric Interview, and the Substance Abuse Module-Revised. Psychosis was defined as audio/visual hallucinations and/or delusions not directly related to drug use. Binary logistic regression models assessed the relationship between frequency of marijuana and crack-cocaine use in the year prior to incarceration on current (past 30 days) psychosis. For each regression model we examined the following: case-to-predictor variable ratio, multicollinearity, model fit, and relationships between predictor variables and the dependent variable. Psychosis was a dichotomous variable in all models. 

Results:  Eighty-five women experienced at least one symptom of psychosis in their lifetime (37.4%), with 44 reporting symptoms in the previous 30 days (19.4%). Sixty percent (n=139) used marijuana in the year prior to incarceration, with almost 48.2% of users (n=67) reporting daily use. Seventy-three (37.1%) used crack-cocaine in the year prior to incarceration, with 46.6% of users (n=34) reporting daily use. Frequency of marijuana use in the year prior to incarceration did not significantly predict current psychosis (p=.853). Frequency of crack-cocaine use in the year prior to incarceration significantly predicted current psychosis (OR = 1.285, 95% CI = 1.053-1.569, p=.014). A one-unit increase in frequency of crack-cocaine use was associated with being 28.5% more likely to report current psychosis. However, when frequency of CV was added to the model, only the CV variable remained significant (OR=1.725; 95% CI: 1.216-2.445; p=.002). A one-unit increase in frequency of CV was associated with being 72.5% more likely to report current psychosis.

Conclusions and Implications:  Although the relationship between frequency of marijuana us in the year prior to incarceration and current psychosis was non-significant, frequency of crack-cocaine use in the year prior to incarceration was a significant predictor of current psychosis for women in the sample. However, adding CV to the model moderated the importance of crack-cocaine use in the incidence of current psychosis for affected women, making the drug use variable non-significant. This analysis supports findings which suggest that marijuana and crack-cocaine use may function as a method of coping with previous victimization for incarcerated women. Research is needed to better understand the interaction between CV and drug use for this population as a vehicle to improve the design and implementation of trauma-informed substance misuse interventions delivered within the prison milieu.