Developmental Trajectories of Cocaine/Crack Use Among Juvenile Offenders: PTSD as a Risk Factor

• Author: Thomas W. Wojciechowski
• DOI: 10.1177/0022042617729352
• Published date: 01 January 2018
• Date: 01 January 2018
• Subject Matter: Articles

https://doi.org/10.1177/0022042617729352

Journal of Drug Issues

2018, Vol. 48(1) 50 –66

© The Author(s) 2017

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DOI: 10.1177/0022042617729352

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Article

Developmental Trajectories of

Cocaine/Crack Use Among Juvenile

Offenders: PTSD as a Risk Factor

Thomas W. Wojciechowski1

Abstract

Cocaine and crack are illicit drugs linked to numerous health issues. Despite the public health

issues which these drugs present, there has yet to be an examination of the heterogeneity which

exists in the developmental course of use of these drugs among a group at-risk for substance

abuse: juvenile offenders. Furthermore, the role that posttraumatic stress disorder plays for

predicting developmental patterns of use of these drugs has yet to be investigated either. The

present research analyzed data from a sample of 1,354 juvenile offenders using group-based

trajectory modeling and multinomial logistic regression to examine these phenomena. Results

indicated that a five-group trajectory model best fit the data. Meeting criteria for a lifetime

diagnosis of posttraumatic stress disorder at baseline predicted assignment to the Accelerating

and Moderate Chronic groups. These results indicate that juvenile offenders are at-risk for

participation in cocaine/crack use and patterns of use which extend into adulthood.

Keywords

cocaine, crack, PTSD, group-based trajectory modeling, juvenile offenders

Introduction

Cocaine and crack are two substances derived from the coca plant with high addiction potential.

The use and abuse of cocaine/crack present a major public health problem in the United States.

Use of cocaine and similar substances has been linked to increased risk of heart disease/compli-

cations, stroke, sleep problems, and chronic fatigue (Dolsen & Harvey, 2017; Lange & Hillis,

2001; Treadwell & Robinson, 2007; Washton & Gold, 1984). Despite these major public health

concerns, cocaine/crack use represents a serious form of substance use in which the vast majority

of individuals will never partake (Sordo et al., 2014). It is for these reasons that it is important to

identify populations at particular risk for engagement in serious substance use behaviors to best

target prevention and intervention efforts. One subpopulation of adolescents who are at increased

risk for engagement in substance use and abuse are juvenile offenders (Leukefeld et al., 2015).

Juvenile offenders represent a population of individuals who are disparately affected by mental

health issues—a major risk factor for engagement in substance use and abuse (Lehman & Dixon,

2016; Underwood & Washington, 2016). Posttraumatic stress disorder (PTSD) is one of these

Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric

1University of Florida, Gainesville, USA

Corresponding Author:

Thomas W. Wojciechowski, Department of Sociology and Criminology & Law, University of Florida, 330 Newell Dr.,

Gainesville, FL 32611-7011, USA.

Email: wojci1tw@ufl.edu

729352JODXXX10.1177/0022042617729352Journal of Drug IssuesWojciechowski

research-article2017

Wojciechowski 51

Association [APA], 2013) classified mental disorders which has been demonstrated to increase

risk for engagement in general substance use and cocaine use disorder (Lee, Brook, Finch, &

Brook, 2016; Saunders Lambert-Harris, McGovern, Meier, & Xie, 2015; Stewart & Israeli,

2002). Despite the relationships between PTSD and substance use and the relevance of better

understanding the course of cocaine/crack use, there is little existing research examining cocaine/

crack use from a developmental perspective and no research which examines PTSD as a risk fac-

tor predicting differences in this development.

Specific Aims

The present study seeks to accomplish several goals. The first of these goals is to provide greater

understanding of the development of cocaine/crack use across adolescence and early adulthood.

Research indicates that substance use occurs at high frequency during this period of the life

course and that problematic substance use habits are often formed during this time (Chassin,

Hussong, & Beltran, 2009; Johnston, 2010). Little research has studied the development of

cocaine/crack use (Hamil-Luker, Land, & Blau, 2004; Roussell & Omori, 2016). This is surpris-

ing considering the relevant public health problem which cocaine/crack use presents. This

research will add to the existing literature on this topic and provide increased understanding of

this phenomenon by elucidating developmental trajectories which highlight commonalities with

past research or provide description of previously unknown differential developmental heteroge-

neity. The other main aim of this research is to examine the role of PTSD for predicting differen-

tial development. PTSD has been linked to engagement in a number of substance use and abuse

behaviors (APA, 2013; Lee et al., 2016; Stewart & Israeli, 2002). Because of this, it is expected

that lifetime PTSD prevalence at baseline will predict development characterized by elevated

engagement in cocaine/crack use relative to other developmental patterns. This examination will

provide greater understanding of the risk for the development of problematic engagement in

cocaine/crack use during adolescence and early adulthood based on PTSD diagnosis among juve-

nile offenders. In doing so, this subpopulation of adolescents may be identified as being an

important target of prevention and intervention programming to best mitigate the public health

concerns associated with cocaine/crack use.

Cocaine/Crack Use Among Juvenile Offenders

Cocaine and crack are powerful stimulants which produce an intense euphoric effect and lead to

the high abuse potential of the drugs (Dackis & O’Brien, 2001). While the two drugs are derived

from the same plant, they differ in their form, cost, and modes of administration. Cocaine is typi-

cally consumed intranasally or intravenously, while crack is typically smoked in rock form

(Gossop, Griffiths, Powis, & Strang, 1994). Despite these differences, the two drugs are highly

similar in their chemical makeup and long- and short-term effects (Hatsukami & Fischman,

1996). Juvenile offenders are a subpopulation of adolescents demonstrated to be at-risk for

engagement in multiple types of substance use (Leukefeld et al., 2015). Past research focused on

juvenile offenders demonstrates the high risk for cocaine use across the life course for this popu-

lation. Dembo, Wareham, and Schmeidler (2007) provided evidence that cocaine use by juvenile

offenders tended to remain stable across adolescence and early adulthood. This is demonstrative

of the high potential for continued use of the drug following initiation in use. This continued use

across time places individuals at-risk for numerous health complications. While this past research

has provided some understanding of the development of cocaine/crack use across time, our com-

prehension of this development is still in its infancy as little research has applied group-based

trajectory modeling (GBTM) as an analytic tool for studying this phenomenon (Hamil-Luker

et al., 2004; Roussell & Omori, 2016). This research found several similar trajectory groups