The Impact of Trauma Exposure on Substance Use Among Women in the Criminal Legal System: Do Neighborhoods Matter?

Background and Purpose: Women entangled in the criminal legal system experience higher rates of substance use compared to system-involved men and women in the general public. This heightened prevalence contributes to adverse mental and physical health outcomes, increases the likelihood of reoffending, and raises the risk of fatal overdose and mortality. Additionally, system-involved women have elevated rates of exposure to traumatic events like physical and sexual abuse and disproportionately reside in neighborhoods marked by poverty, crime, and disorder. While both trauma and unsafe neighborhood environments are established risk factors for addiction, evidence suggests they may interact to shape patterns of substance use. However, research on this intersection has largely overlooked the unique challenges faced by women in the criminal legal system, focusing instead on the general population. To address this gap, our study examines the following research question: Does trauma exposure among system-involved women interact with perceptions of neighborhood safety to influence substance use?

Methods: This secondary analysis utilized data from the Probation/Parole Officer Interactions with Women Offenders Project, a longitudinal prospective study of women under community supervision (e.g., probation or parole; N = 402). As part of this study, participants completed surveys assessing neighborhood safety, current substance use, and a history of sexual or physical abuse using the Women’s Risk Need Assessment, a validated measure designed to assess recidivism risk factors among system-involved women. Negative binomial analyses were conducted to explore whether perceptions of neighborhood safety moderated the relationship between a history of sexual or physical abuse, assessed at baseline, and substance use, evaluated six months later.

Results: Our analysis revealed a notable prevalence of trauma among study participants, with 56% of women reporting a history of sexual abuse and 65% reporting a history of physical abuse. A significant interaction emerged between perceptions of neighborhood safety and sexual abuse (IRR = 1.13, 95% CI: 1.02, 1.26, p = .027), indicating that the relationship between a history of sexual abuse and substance use was stronger for women residing in neighborhoods they perceived as unsafe. However, no significant interaction was observed for a history of physical abuse (IRR = 1.10, 95% CI: 0.97, 1.24, p = .140), suggesting variations in how different trauma experiences interact with perceptions of neighborhood safety to impact substance use.

Conclusions and Implications: Study findings suggest that the impact of sexual abuse on substance use intensifies when women involved in the criminal legal system perceive their neighborhoods as unsafe. These results underscore the importance of interventions addressing substance use among this population to consider not only their trauma history but also their perceived safety in their neighborhoods. Trauma-informed services targeting women in the criminal legal system should prioritize facilitating access to safe and supportive neighborhoods, a key social determinant of health, as part of their comprehensive approach to addressing substance use.