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. Author manuscript; available in PMC: 2025 Sep 21.
Published in final edited form as: J Ethn Subst Abuse. 2024 Mar 21;25(1):145–163. doi: 10.1080/15332640.2024.2326948

Associations Between Traumatic Life Events and Substance Use Among Black Men who are Incarcerated

Jasmine K Jester 1, Brittany Miller-Roenigk 1, Paris Wheeler 2, Danelle Stevens-Watkins 1
PMCID: PMC11415548  NIHMSID: NIHMS1982056  PMID: 38511975

Abstract

The current study examined associations between traumatic life events, current and lifetime importance of mental health and substance use treatment, and crack cocaine use among 201 Black men who were incarcerated and nearing community re-entry. Results indicated age, sexual trauma and lifetime importance of drug treatment were significantly associated with an increased likelihood of crack cocaine use. Substance abuse treatment in correctional settings should consider culturally tailored assessment and treatment for history of unaddressed sexual trauma among Black men who are incarcerated and use crack cocaine.

Keywords: Black men, Trauma, Substance Use, Incarceration, Treatment, Sexual Assault

Introduction

Overdose deaths among Black Americans have increased by 44% from 2019 to 2020 and has been largely attributed to a recent increase in stimulant use often unknowingly co-occurring with fentanyl use (Kariisa et al., 2022). For example, in 2020, cocaine overdose deaths involving opioids were three times higher among Black Kentucky residents than among White Kentucky residents (Slavova et al., 2022). While Kentucky’s government has made efforts to reduce drug use through no-cost recovery programs (Associated Press, 2022), there are barriers to access for underserved populations. Notably, individuals who struggle with substance abuse are often punished instead of receiving access to rehabilitation services. For example, Black men are five to seven times more likely to be incarcerated for drug related offenses when compared to White men (Schleiden, 2020). The racial disparities in incarceration rates highlight the need for an increase in drug abuse services for Black Americans.

Glaring disparities of substance use rates and trauma among Black men who are incarcerated raise public health concerns. For example, 60% of Black men who are incarcerated have an active substance use disorder (Rowell-Cunsolo, et al., 2018). However, the National Center on Addiction and Substance Abuse reports only 11% of individuals who are incarcerated with a substance use disorder utilize substance use treatment (Chandler et al., 2009). Further, Kaba and colleagues (2015) found that Black men who are incarcerated were less likely to receive mental health treatment, but more likely to receive solitary confinement when compared to White men. Black men who are incarcerated experience inequitable access to mental health and substance use resources, making them at risk for adverse outcomes which can exacerbate their mental health and substance use concerns.

Trauma and substance use have been found to directly influence incarceration risk. For instance, individuals with co-occurring substance use disorders and mental health disorders are at a five times greater risk of incarceration (Mukku et al., 2012). Therefore, examining associations between substance use and trauma is critical to target points of intervention and assessment among individuals who are incarcerated. Black men overwhelmingly comprise the prison population (Carson, 2018), disproportionately report experiences of trauma (Roberts et al., 2011), and are considered a high-risk population for cocaine use (John & Wu, 2017). Further research is needed related to specific areas of treatment intervention to combat the present drug use epidemic. Thus, the purpose of the current study was to examine associations between traumatic life events, importance of mental health and substance use treatment, and substance use among Black men who are incarcerated.

Trauma Among Men Who Are Incarcerated

Previous research indicates substance use programs offered in prisons are not designed to effectively meet the overwhelming mental health needs of this population (Sered et al., 2021). Ineffective treatment in prisons can partially be attributed to a lack of awareness related to mental health disparities in prisons. Men who are incarcerated disproportionately report experiences of trauma with 62–98% of men who are incarcerated reporting experiencing at least one traumatic event in their lifetime prior to incarceration (Pettus-Davis, 2014). Among these traumatic experiences, physical trauma is one of the most commonly reported experiences (Morrison et al., 2019). Physical trauma is defined as a body wound resulting from sudden physical injury caused by impact, violence, or accident (McElvenny et al., 2021). Over half of the men who are incarcerated (56%) report experiences of physical trauma including violent trauma (Morrison et al., 2019). Additionally, although 10% of men who are incarcerated report experiences of sexual trauma (Wolff & Siegal, 2009), studies have largely focused on the relationship between sexual trauma and substance use among women (Ullman et al., 2013). Further, it is important to note that although instances of trauma are more frequently reported among individuals who are incarcerated across race, Black men’s access and utilization of treatment differs from their racial counterparts. For example, a recent study exploring mental health access among individuals who are incarcerated with severe mental illness found that compared to White Americans, Black Americans were 5% less likely to receive jail-based treatment. A lack of access and utilization of mental health services ultimately result in untreated mental health problems, which has been identified as a precursor to patterns of substance abuse among Black men (Sayers et al., 2017).

Trauma and Substance Use

Unaddressed trauma can perpetuate substance use disorder among individuals who are incarcerated (Blakey & Bowers, 2014), and is associated with higher rates of recidivism (Maschi et al., 2019). Additionally, use of specific substances, such as crack cocaine, has been associated with individuals who have a history of trauma. Khoury and colleagues (2010) found that individuals who have experienced childhood sexual, physical, and emotional trauma, were more likely to use crack cocaine compared to other substances such as alcohol and heroin. Further, cocaine use differs when considering the type of trauma a person experiences. For example, physical abuse has been found to be significantly associated with greater cocaine use among White men (Saddichha et al., 2015) and sexual abuse is significantly associated with a greater likelihood of crack cocaine use among women (Decker et al., 2016). Further, lifetime crack cocaine use is commonly associated with mental health disorders such as PTSD (Zhornitsky et al., 2020). Black men in particular also report more negative treatment experiences and treatment discontinuation (Kerrison, 2018). Thus, it is imperative Black men are considered in further trauma and cocaine related research to develop effective treatment intervention and prevention programs in prisons.

Crack Cocaine Use and Treatment

Crack cocaine has an extensive racialized history in Black America. Crack cocaine use garnered national attention in the 1980s as an affordable and highly addictive derivative of powder cocaine (Hendricks & Wilson, 2013). The popularity of crack cocaine grew across races, however, manifested disproportionate impacts, predominantly affecting Black men ages 16–34 ( Hendricks & Wilson, 2013). The Federal Anti-Drug Abuse Act was passed in 1986 to improve drug law enforcement and cooperation and to increase drug abuse prevention and treatment programs (Mimimums, 2012). However, despite Black men being identified as the demographic most in need of drug treatment, governmental efforts predominantly concentrated on the enactment of harsh prison sentencing laws. This included the implementation of mandatory minimum sentences, such as a five-year prison term for first-time simple possession of five grams of cocaine (Mimimums, 2012). The implementation of stringent laws exacerbated existing incarceration disparities within the Black community, given that 85% of individuals convicted for crack cocaine offenses were Black (Hartley & Miller, 2010). The enactment of more severe prison sentences for crack cocaine use, in comparison to other drugs, contributed to the perception that the government’s approach towards crack cocaine was motivated by racial bias, emphasizing criminalization over therapeutic intervention. Consequently, Black men were at an intersection of systemic oppression and incarceration with little attention given to drug treatment. While the crack epidemic was approximately four decades ago, an estimated 3.4% of Black Americans report experiencing an illicit substance use disorder, encompassing individuals using crack cocaine (Substance Abuse & Mental Health Services Administration, 2021). Additionally, an estimated 4.7% of Black men report past year experiences of illicit substance use disorder compared to Black women at 2.2% (SAMSHSA, 2021).

There is ample evidence highlighting treatment disparities and challenges associated with retaining Black Americans who use crack cocaine in treatment (Cooper et al., 2010; Siqueland et al., 2002). Research suggests individual and structural level gaps in how crack cocaine treatments address the underlying needs of Black Americans and thus result in less successful treatment outcomes. For example, most studies focus on developing treatment readiness and motivation at the individual level and addressing racism, cultural competency, access to treatment and social services at the structural level to increase positive treatment outcomes (Wechsberg, 2007). However, Wechsburg (2007) suggests positive treatment outcomes may increase if future research examines underlying psychological disturbances, such as trauma, to understand individuals who use crack cocaine dependence and interactions with the substance abuse treatment system. However, there is a lack of research that exclusively investigates Black men who are incarcerated and whether their experiences of trauma relate to their crack cocaine use and further impact their desire for mental health and substance use treatment. Examining such associations among Black men who are incarcerated is important, considering the criminal justice system is a prominent pathway into treatment for minorities (Saloner and Cook, 2013).

The Present Study

Potential positive associations between trauma and crack cocaine use indicate possible points of intervention and treatment for Black men who are incarcerated. Thus, the current study aimed to examine associations between traumatic life events, current and lifetime importance of mental health and substance use treatment, and lifetime crack cocaine use among a sample of Black men who were incarcerated and nearing community re-entry. It is hypothesized that (1) reported experiences of sexual trauma will be associated with a greater likelihood of ever using crack cocaine, (2) men who reported experiencing physical trauma would be more likely to have used crack cocaine in their lifetime, and (3) current and lifetime importance of mental health and substance use treatment will be associated with a greater likelihood of ever using crack cocaine.

Methods

Participants and Procedure

The present study was a secondary analysis of a larger study examining substance use and mental health among Black men who were incarcerated and nearing community re-entry. Participants were recruited from four minimum to medium security prisons in Kentucky. To participate in the study participants had to: [1] identify as African American or Black; [2] be at least 18 years old; [3] be willing to participate in the study; [4] be eligible for community reentry within 120 days of participating in the study; and [5] be returning to Jefferson or Fayette County, two urban counties in Kentucky. Participants were recruited through letters in the mail inviting them to participate in a health study and meet face-to-face with study staff. Informed consent was obtained from each participant and participants were compensated $25 upon completion of the study. The parent study was approved by the Department of Corrections Research Ethics Committee and the university’s Institutional Review Board.

Participants (n = 201) were between the ages of 19 and 69, with an average of 36.04 years old (SD = 11.07). The average years of education reported by participants was 11.48 (SD = 1.63) with 90 indicating completing high school or an equivalence. The current study examined ever experiencing (1) sexual trauma; (2) physical trauma; (3) no trauma; (4) ever used crack cocaine in their lifetime. Most participants reported experiencing physical trauma (77.4%), followed by sexual trauma (17%), and no trauma (2.9%). Importance of treatment for drug problems in participants lifetime was examined with most participants reporting ‘not at all’ (56.9%) and 43.1% reporting ‘important’. Importance of treatment for psychological and emotional problems now was also examined with most participants reporting ‘not at all’ (54.1%) and 45.9% reporting ‘important’. Participants also reported a history of ever using cocaine in their lifetime (29.5%); see Table 1. For descriptives of the prevalence of other traumatic experiences reported among the sample; see Table 2.

Table 1.

Descriptive profile of age, education, sexual trauma, physical trauma, no trauma, if treatment for drug problems has been important in lifetime, if treatment for psychological and emotional problems is important now, and lifetime crack cocaine misuse (N= 201).

Demographics M SD Range N(%)
Age (years) 36.04 11.07 19–69
Education (years) 11.48 1.63 6–16
Ever- sexual Trauma 17%
Ever- physical trauma 77.4%
No trauma 2.9%
Is treatment important for drug problems- in lifetime
Not at all important 56.9%
Important 43.1%
Is treatment important for psychological or emotional problems- now
Not at all important 54.1%
Important 45.9%
Ever used crack cocaine 29.5%
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Table 2.

Descriptive profile of items from a modified version of the Life Events Checklist (N= 208).

Traumatic Life Events N N (%)
Ever in serious transportation accident 117 56.3%
Ever witness a serious transportation accident 140 67.3%
Ever physically assaulted 161 77.8%
Ever witnessed a physical assault 184 88.9%
Ever assaulted with a weapon 101 48.6%
Ever witnessed someone being assaulted with a weapon 156 75.4%
Ever sexually assaulted 28 13.6%
Ever witnessed a sexual assault 24 11.6%
Ever had any other unwanted or uncomfortable sexual experience 27 13.1%
Ever experienced combat exposure 36 17.3%
Ever had a life-threatening illness or injury 59 28.4%
Ever witnessed a sudden violent death 94 45.4%
Ever witnessed a sudden accidental death 62 29.8%
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Measures

Demographics

Participants were asked their current age and the number of years of education they completed.

Independent Variables

Traumatic Life Events.

A modified version of the Life Events Checklist (MLEC)(Weathers et al., 2013) was administered to assess whether participants have ever experienced specific traumatic events in their lifetime. Items used in the current study include, (1) Have you ever been sexually assaulted? (2) Have you ever had any other unwanted sexual experiences? (3) Have you ever been physically assaulted? Response options were 1 = yes or 0 = no. Items (1) Have you ever been sexually assaulted? and (2) Have you ever had any other unwanted sexual experiences? were recoded and combined to create one sexual trauma variable. Another dichotomous variable for “no trauma” was recoded and created to capture participants with no reported experiences of sexual trauma or physical trauma among the sample. Response options were 1= reported at least one MLEC trauma or 0= reported none.

Mental health and Substance Use Treatment.

A modified version of the Addiction Severity Index, Fifth Edition (ASI-V; McLellan et al., 1992) was administered to assess current and lifetime importance of drug and mental health treatment. Items used in the current study include, (1) How important has treatment for drug problems been in your lifetime? (2) How important to you now is treatment for psychological or emotional problems? Response options were between 0 = not at all important and 3 = extremely important. Treatment variables were recoded to dichotomous variables with 0 = not at all important and 1= important.

Dependent Variables

Ever Used Crack Cocaine.

A modified version of the Addiction Severity Index, fifth edition (ASI-V; McLellan et al., 1992) was administered to assess drug use. Participants were asked, Have you ever used crack cocaine? and responded either 1 = yes or 0 = no.

Analytical Approach

Analyses were conducted using IBM SPSS Statistics (version 24) predictive analytics software. The overall sample size was (n = 208). Participants with missing data on the variables of interest were removed from analyses, resulting in a final analytic sample of n = 201 for the current secondary analysis. Descriptive statistics were used to analyze sociodemographic characteristics of the sample. Bivariate correlations (Pearson and Spearman) were conducted to examine relationships between study variables. Main study analysis used a binomial logistic regression to examine the association between traumatic life events, current and lifetime importance of drug and mental health treatment, and the likelihood of crack cocaine use. Control variables added to the model included age and years of education. Tests examining if the data met the assumption of collinearity indicated that multicollinearity was not a concern.

Results

Bivariate Analysis

As presented in Table 3, bivariate correlations were computed to determine basic relationships between lifetime crack cocaine use, traumatic events (ever experienced sexual trauma, ever physical trauma, no trauma), lifetime importance of drug treatment, current importance of mental health treatment, and control variables (age and years of education). Results of the bivariate correlations showed positive significant correlations between age, sexual trauma, lifetime importance of drug treatment, and current importance of mental health treatment with the outcome variable of crack cocaine use. Age was significant and positively correlated with crack cocaine use (r = 0.54, p <.001). Sexual trauma was significant and positively correlated with crack cocaine use (rs = 0.22, p = .001). Lifetime importance of drug treatment was significant and positively correlated with crack cocaine use (r = 0.37, p <.001) and current importance of mental health treatment was significant and positively correlated with crack cocaine use (r = 0.22, p = .001). Years of education (r = −0.08, p = 0.24), physical trauma (rs = 0.04, p = 0.57) and no trauma (rs = 0.49, p = 0.49) were not correlated with ever using crack cocaine.

Table 3.

Correlation between lifetime crack cocaine use, sexual trauma, physical trauma, no trauma, if treatment for drug problems has been important in lifetime, if treatment for psychological and emotional problems is important now (N= 201).

Variable Age Education (Years) Ever-sexual trauma a Ever- physical trauma a No trauma Is treatment important for drug problems- in lifetime a Is treatment important for psychological or emotional problems- nowa Ever used crack cocainea
Age . −.04 .07 −.06 −.08 .17* .18* .54**
Education (Years) −.04 . .05 −.01 −.02 .01 −.13 −.08
Ever- sexual trauma a .07 .05 . .18* .08 .16* .18** .22**
Ever- physical trauma a −.06 −.01 .18* . .32** .23** .13 .04
No trauma a −.08 −.02 .08 .32** . .09 .10 .05
Is treatment important for drug problems- in lifetime .18* −.13 .16** .23** .09 . .34** .37**
Is treatment important for psychological or emotional problems- now .18* −.13 .18** .13 .10 .34** . .22**
Ever used crack cocaine a .54** −.08 .22** .04 .05 .37** .22** .
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Note.

a

Spearman rho coefficients.

**

Correlation is significant at the .01 level (two-tailed).

Main Study Analysis

Binomial logistic regression analyses were conducted to determine the likelihood of an association between traumatic life events, lifetime and current importance of drug and mental health treatment, and crack cocaine use. In the regression model, relevant socio-demographic characteristics (age and years of education), traumatic life events (sexual trauma, physical trauma, and no trauma), and treatment variables (how important has treatment for drug problems has been in lifetime, how important treatment for psychological and emotional problems currently) were entered simultaneously in the model. The model correctly classified 86% of cases. Additionally, the model fit the data well, as determined by Hosmer and Lemeshow test, x2(8, 195) = 10.1, p = .26. Results of the main analysis showed there were significant differences between types of trauma and crack cocaine use. Participant’s experience of physical trauma or no trauma were not significantly associated with crack cocaine use (B = −0.14, SE = 0.58, p = 0.81; respectively B = 0.15, SE = 0.94, p = 0.50). Also, how important treatment was for participant’s mental health problems now was not significantly associated with crack cocaine use (B = 0.07, SE = 1.40, p = 0.50). However, sexual trauma was significantly associated with an over three times greater likelihood of crack cocaine use (B = 1.25, SE = .51, p = 0.01, OR= 3.50, 95% CI [1.28 – 9.55]). How important treatment was for drug problems in participant’s lifetime was significantly associated with crack cocaine use (B = 1.60, SE = .43, p = .000; OR= 4.95, 95% CI [2.13 – 11.55]). Age was also significantly associated with crack cocaine use, such that a one unit increase in age was associated with a 1.23 times greater likelihood in crack cocaine use (B = 0.12, SE = .02, p = .000, OR= 1.23, 95% CI [1.08 – 1.18] . However, education was not significantly associated with crack cocaine use (B = −0.10, SE = .09, p = .26); see Table 4.

Table 4.

Summary of binomial logistic regression model examining associations between trauma, importance of drug treatment in lifetime, and importance of treatment for psychological and emotional problems now, and crack cocaine misuse (N= 201).

Variable B SE Wald df Exp(B) 95% CI p
Age 0.12 .02 31.16 1 1.13 1.08 – 1.18 .000
Education (Years) −0.10 .09 1.25 1 0.90 .75 – 1.08 .26
Ever- sexual trauma 1.25 .51 5.98 1 3.50 1.28 – 9.55 .01
Ever- physical trauma −0.14 .58 0.06 1 0.87 .28 – 2.72 .81
No sexual trauma 0.94 1.40 0.45 1 2.56 0.16– 40.06 .50
Is treatment important for drug problems- in lifetime 1.60 0.43 13.73 1 5.0 2.13 – 11.55 .000
Is treatment important for psychological and emotional problems- now 0.07 .42 0.03 1 1.07 .48 – 2.43 .86
Nagelkerke’s R2 0.48
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Discussion

Findings from the present study demonstrate differences in associations between lifetime experiences of trauma, lifetime and current importance of mental health and substance use treatment, and crack cocaine use among Black men who are incarcerated. Notably, sexual trauma was found to be significantly associated with a three times greater likelihood of ever using crack cocaine. However, no statistically significant relationship was found between physical trauma or no trauma and crack cocaine use. Our findings contradict previous research suggesting physical trauma is a salient predictor of crack cocaine use among Black men (McDermott et al., 2010). Conversely, our findings are supported by current literature indicating individuals with histories of sexual abuse are more likely to engage in higher rates of substance abuse, particularly crack cocaine (Mandavia, 2016).

There is a well-established link between sexual trauma and crack cocaine use among Black women (Young & Boyd, 2000), including those who are incarcerated (Clark et al., 2012); however, sexual trauma is largely understudied among incarcerated Black men. This may be due to a longstanding misperception that men are not victims of sexual assault (Stemple & Meyer, 2014). However, findings from the current study challenge this misperception and further indicate Black men who have experienced sexual trauma are at an increased risk for crack cocaine use. Awareness of sexual assault among Black men is imperative as Black men may experience increased barriers to treatment for their sexual trauma. For example, Black men are less likely to report a history of sexual trauma (Stone, 2007). This may be due to the way Black men are socialized, which often teaches them to limit their emotional expression (Thorpe et al., 2021). Socialization messages teaching men to limit their emotional expression promote the silencing and suppression of sexual assault reporting among men (Hlavka, 2017). However, this disparity in sexual assault reporting and lack of treatment among Black men poses severe implications as evidenced in the current study.

McDermott et al., (2010) assert men who experience traumatic events may be more motivated to conform to masculine gender role norms placing them at a greater risk of experiencing severe PTSD symptoms. Existing literature indicates men may feel they have to respond to unwanted sexual contact by restricted emotionality or not reporting incidences of sexual assault for fear of others perceiving them as “unmanly” (Levant, 1997; Stockdale, 1998; Vaux, 1993). However, the effects of sexual assault are no less distressing among men compared to women, but men typically respond through denial or minimization of their sexual assault (Masho & Alvanzo, 2010). Additionally, Gratz and Roemer’s (2004) model of emotion regulation identifies one’s ability to implement “situationally appropriate” emotion regulation skills in flexible and adaptive ways is a core component to “manage both their internal experience and the external expression of emotions” (Gratz & Tull, 2010), However, when an individual is unable to regulate their emotions they may respond through substance use (Kober, 2014) in an attempt to avoid, terminate, or repair an uncomfortable emotional state (Roberton et al., 2012). Adverse responses of restricted emotionality and emotional dysregulation responses may be further evidenced in the findings of the current study showing a nonsignificant relationship between current importance of treatment for emotional and psychological problems. A possible interpretation of this finding is that Black men may be hesitant to address the impact their sexual trauma may have had on their emotional or psychological wellbeing. Further, Black men may be less likely to seek help related to their sexual trauma due to stigma surrounding sexual trauma among men. However, when men restrict their emotions related to their experiences of trauma, they may adopt maladaptive coping strategies such as substance use and aggressive behaviors to avoid or escape their emotions related to their trauma (Donahue et al., 2014; McDermott et al., 2010). Therefore, it is possible Black men who are incarcerated and have experienced sexual trauma without mental health treatment endorse increased restricted emotionality and engage in maladaptive emotion regulation strategies by using crack cocaine. However, turning to substance use can further perpetuate the severity of these symptoms (Messaman-Moore et al., 2013). Additionally, compared to other substances, crack cocaine use specifically can increase the risk of using other illicit substances, physical and mental health issues, and is associated with higher relapse rates (Gossop et al., 2006). Further, a lack of access to mental health and substance use treatment in prisons may predispose Black men who are incarcerated and nearing community re-entry to higher recidivism rates. Therefore, it is crucial for Black men to receive comprehensive treatment to address both substance use and trauma.

The present study found a significant association between lifetime importance of substance use treatment and crack cocaine use. However, current behavioral treatments offered in prisons may not be as effective in meeting the treatment needs of Black men (Kerrison, 2018). Black men are less likely to complete substance use treatment in prisons and partially attribute their discontinuation to culturally insensitive treatment modalities and an excessive emphasis on drug abstinence without the inclusion of other factors influencing drug use (i.e. socioeconomic issues and underlying mental health issues; Kerrison, 2018). For example, a qualitative study exploring how prison-based substance use treatment shaped participant’s treatment, sobriety, and recovery outcomes, found that compared to White participants, Black adults were more likely to discontinue or find treatment less helpful due to an emphasis on adopting a “broken self” narrative instead of acknowledging differences across race related to structural and cultural barriers experienced during substance use and recovery (Kerrison, 2018). Treatment must identify unique structural and cultural barriers and remain cognizant of the Black male experience while synchronously identifying and treating unaddressed trauma and substance use. Failing to do so could make Black men vulnerable to the continued cycle of addiction and maintain the disparity in successful treatment outcomes.

There exists a need for culturally tailored assessment and treatment for trauma among Black who are incarcerated and use crack cocaine to rehabilitate underlying factors impacting their ability to fully recover from substance use. Accordingly, clinicians should aim to establish a trusted and safe environment which could prompt disclosure of sexual trauma and provide Black men with positive experiences of therapy which is crucial to successful therapeutic outcomes (Donne et al., 2018). Effective treatment for Black men has been determined by the clinicians ability to form a trusted therapeutic alliance, acknowledgement of unique stressors faced by Black men, and dismantling cultural mistrust in mental healthcare (Hankerson et al., 2015).Thus, it is imperative for clinicians to be understanding and patient with Black men prioritizing establishing rapport, considering Black men are generally less likely to seek therapy (Hankerson et al., 2015) and may be less likely to disclose sexual trauma. Moreover, clinicians must reassess how they implement these culturally-tailored interventions. For instance, prisons primarily engage inmates in group therapy. Given the current literature on the effectiveness of group therapy with sexual assault victims is unclear (Heard & Walsh, 2021), stigmas associated with sexual assault (Kennedy & Prock, 2018), and literature supporting group therapy in prison settings as harmful for some inmates (Kerrison, 2018), group therapy may pose as a potential risk for further harm to Black men who have experienced sexual trauma. However, group therapy is often a standard practice in correctional settings, because of insufficient staff to provide ongoing individual therapy (Trestman et al.,2015). While efforts are made to address this structural barrier, correctional institutions can implement groups exclusively serving men who have experienced sexual trauma through culturally sensitive screening practices. Group therapy composed of sexual trauma victims has been found as a facilitator to self-disclosure and a beneficial strategy to destigmatize sexual trauma among men (Sivagurunathan et al., 2019) Additionally, sexual trauma groups should be specifically tailored to address stigma, sexual assault education (Donne et al., 2018), and maximize confidentiality as much as possible within correctional settings.

Strengths, Limitations and Future Research

The current study demonstrates several strengths. First, the present study contributes substantiating evidence to the literature on trauma and substance use among Black men who are incarcerated. Notably, findings indicate sexual trauma and lifetime importance of treatment for substance use significantly predicts crack cocaine use among Black men who are incarcerated, supporting claims to consider trauma in substance use treatment. Second, findings highlight history of sexual trauma should be assessed among Black men who are incarcerated and use crack cocaine to develop culturally-tailored and relevant treatment.

However, the present study is not without limitations. First, data from this study was collected from Black men in prisons across Kentucky; therefore, results may not be generalizable to Black men who are incarcerated across the U.S. Further, results may not be generalizable to Black men without a history of incarceration. Results from the current study provides evidence that additional research is needed exploring associations between sexual trauma and crack cocaine use. Future research is needed in other regions of the country to determine if associations between sexual trauma and crack cocaine use is similar in other studies among Black men who are incarcerated and Black men who do not have a history with the criminal justice system. Second, due to the descriptive and cross-sectional nature of the study we cannot imply a causal relationship between participant’s reported experiences of trauma, mental health and substance use treatment desires, and crack cocaine use. Lastly, participants were only asked to report if they have experienced sexual trauma or physical trauma in their lifetime. We did not examine the frequency or location of these traumatic events. Different associations have been found between when a traumatic event occurs. For example, trauma experienced in childhood has been associated with lifetime panic disorder, agoraphobia, and lifetime posttraumatic stress disorder (Zlotnick, 2008). Future research could examine differences in when traumatic experiences occurred (e.g., childhood versus adulthood or while incarcerated versus in the community) and substance use. Examining potential differences between when traumatic events occur can help clinicians identify crucial intervention points, complex trauma histories, and conceptualization of Black men who are incarcerated and have experienced trauma (Ford et al., 2012).

Associations between experiences of trauma and drug use among Black men remains understudied in current literature. While the current study provides findings to encourage clinicians to assess for the prevalence of sexual trauma among Black men who are incarcerated, there remains a dearth in literature addressing additional factors that could contribute to their drug use and trauma history. Few studies have sought to examine socio-cultural correlates of drug use such as racism. Instances of racism have been found to be significantly associated with drug use initiation and progression among individuals who use crack cocaine (Stevens-Watkins, et al., 2012). The crack cocaine epidemic created environments (e.g. prison, violent neighborhoods, socioeconomically disadvantaged communities) that made Black men vulnerable to experiencing instances of trauma. Future research could examine the relationship between racism, trauma, and drug use. Such research could hold significance, since crack cocaine use continues to disproportionately affect the Black community, and new findings suggest a similar disproportionate impact by the opioid epidemic (James & Jordan, 2018). Black Americans remain a vulnerable population to experiences of trauma at the intersection of racism and drug use, and future research should explore how addressing these issues on a structural level could treat Black men who struggle with drug use on an individual level.

Conclusions

This study examined the associations between traumatic life events, importance of mental health and substance use treatment and crack cocaine use among Black men who are incarcerated. Findings revealed significant differences between types of traumatic experiences, current and lifetime importance of mental health and substance use treatment and crack cocaine use. Notably, reported experiences of sexual trauma was significantly associated with a three times greater likelihood of ever using crack cocaine. Lifetime importance of substance use treatment was also significantly associated with ever using crack cocaine. A need exists for culturally-tailored assessment and treatment for unaddressed sexual trauma history among Black incarcerated men who use crack cocaine. Additionally, future research should continue to examine the relationship between trauma and drug use among Black men who are incarcerated.

Funding:

This research was supported by the National Institute on Drug Abuse (NIDA) K08DA032296 (PI: Stevens-Watkins). The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Footnotes

Declaration of Interests Statement: The authors report there are no competing interests to declare.

Data Availability Statement:

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.

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Data Availability Statement

Due to the nature of this research, participants of this study did not agree for their data to be shared publicly, so supporting data is not available.

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