Direct and Indirect Effects of Cumulative Trauma, PTSD, and Substance Use Disorder on Probability of Arrest Among Lower Income African American and Latina Women

• Author: Kelly M. Sykes,Ron Nicholson,Naomi Dambreville,Alina Shevorykin,Adriana Espinosa,Lesia M. Ruglass
• DOI: 10.1177/2153368716656917
• Date: 01 April 2018
• Published date: 01 April 2018
• Subject Matter: Articles

Article
Race and Justice
2018, Vol. 8(2) 126-153
Direct and Indirect Effects
ª The Author(s) 2016
Reprints and permission:
of Cumulative Trauma,
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DOI: 10.1177/2153368716656917
PTSD, and Substance Use
journals.sagepub.com/home/raj
Disorder on Probability of
Arrest Among Lower
Income African American
and Latina Women
Lesia M. Ruglass1, Adriana Espinosa1,
Kelly M. Sykes2, Alina Shevorykin3,
Ron Nicholson1 and Naomi Dambreville1,4
Abstract
We conducted a secondary analysis of cross-sectional data to examine the association
of cumulative trauma, post-traumatic stress disorder (PTSD), and substance use
disorder (SUD) with the probability of arrest in a sample of socioeconomically dis-
advantaged African American and Latino mothers (N ¼ 158). Results revealed that
34% of the sample had a history of arrest. Logistic regression revealed that cumulative
trauma was significantly and positively associated with the likelihood of arrest.
Exposure to increasing numbers of traumas contributed to greater odds of arrest, as
much as 62% for each additional trauma exposure. Moreover, binary mediation
analyses revealed that PTSD and SUD exerted an intervening influence on the pathway
between cumulative trauma and the probability of arrest. Women with a lifetime
history of PTSD or SUD were 5–6 times more likely to be arrested than women
without either disorder. Lifetime PTSD and lifetime SUD were partial mediators of
the association between cumulative trauma exposure and arrest, accounting for 63%
1 Department of Psychology, The City College of New York, CUNY, New York, NY, USA
2 Independent Practice, New York, NY, USA
3 Department of Psychology, Pace University, Pleasantville, NY, USA
4 Department of Psychology, The Graduate Center, CUNY, New York, NY, USA
Corresponding Author:
Lesia M. Ruglass, Department of Psychology, The City College of New York, CUNY, 160 Convent Avenue,
NAC Building, Rm 7/120, New York, NY 10031, USA.
Email: ruglass.ccny@gmail.com

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Ruglass et al.
127
of the variance. These findings have important implications for intervention efforts
geared toward helping young racial/ethnic minority mothers, especially those with
PTSD and SUD, manage the distress and impairment that may contribute to criminal
justice involvement.
Keywords
cumulative trauma, PTSD, substance use disorder, arrest, criminal justice
involvement
Trauma exposure (in particular exposure to multiple and chronic traumas) is
associated with a range of deleterious psychological and behavioral sequelae that
increase the risk for criminal justice involvement. Trauma disrupts self-regulatory
capacities, leads to profound impairments in emotion regulation and interpersonal
functioning as well as contributes to psychopathological reactions such as post-
traumatic stress disorder (PTSD; Breslau, 2009) and substance use disorders
(SUDs; Keane, Lyons, Wolfe, & Gerardi, 1988; Khantzian, 1997; Mills, Teesson,
Ross, & Peters, 2006; Stewart, Pihl, Conrod, & Dongier, 1998) all of which are risk
factors for criminal justice involvement. This article first provides an overview of the
epidemiology of PTSD, SUD and criminal justice involvement as well as the
sociodemographic factors associated with criminal justice involvement. We then
explore theoretical frameworks that help us understand the link between traumatic
stress and criminal justice involvement. Next, we present results from a secondary
analysis of cross-sectional data examining associations between cumulative trauma
and the likelihood of arrest and the mediating processes intervening on that pathway.
Finally, we conclude by addressing the limitations and implications of our findings
within the larger clinical and legal contexts.
Epidemiology of PTSD, SUD, and Criminal Justice
Involvement
PTSD is a debilitating disorder that affects an estimated 6.8% of adults in the United
States (Kessler et al., 2005), with women twice as likely than men to develop PTSD
(Lynch, DeHart, Belknap, & Green, 2012; McLean, Asnaani, Litz, & Hofmann, 2011).
SUD affects 14.6% of adults in their lifetime (Kessler et al., 2005), with men typically at
greater risk than women (Lynch et al., 2012). PTSD and SUD often co-occur.
According to the 2010 National Epidemiologic Survey on Alcohol and Related Con-
ditions, nearly half (46.4%) of the individuals with PTSD also met criteria for an SUD
(McCauley, Killeen, Gros, Brady, & Back, 2012). Among individuals with SUDs, the
rates of PTSD range from 11% to 41% (van Dam, Ehring, Vedel, & Emmelkamp, 2010).
Both PTSD and SUD are strongly correlated with involvement in the criminal
justice system (Abram, Teplin, & McClelland, 2014; Donley et al., 2012; Saddichha,
Werker, Schuetz, & Krausz, 2014). PTSD has been shown to significantly increase the
likelihood of arrests, incarceration, and being charged with a violent offense

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128
Race and Justice 8(2)
(Donley et al., 2012). Likewise, SUDs, particularly when comorbid with other mental
illnesses, have been shown to be strongly associated with criminal justice involvement
or criminal recidivism (Balyakina et al., 2014; Eronen, Angermeyer, & Schulze, 1998;
Kopak & Smith-Ruiz, 2014). Studies have shown women to be disproportionately
affected by the combination of co-occurring PTSD, SUD, and criminal justice
involvement (Diamond, Wang, Holzer, & Thomas, 2001).
Sociodemographic Characteristics Associated With
Criminal Justice Involvement
Racial/ethnic minority women are at greater risk for criminal justice involvement.
Compared to White women, Black women are 2 times and Latina women are 1.2 times
more likely to be incarcerated (Sentencing Project, 2007, 2015). Many of these
incarcerated women are mothers with minor children, the majority of whom are under
4 years of age (Glaze & Maruschak, 2008). The demands of parenthood, particularly
among those with young children, are difficult to manage for women who are also
using substances and have experienced traumatic events. Young mothers (i.e., those
who had their first child early) face many barriers in their attempt to gain access to
resources for their families, which in turn place them at risk for criminal justice
involvement. Research shows that beginning in adolescence, racial/ethnic minority
girls and young women are at risk for physical and sexual abuse, teenage pregnancy,
interpersonal partner violence, poverty, and homelessness (Salomon, Bassuk,
& Huntington, 2002). These factors, either independently or in combination, can lead
to the use of substances as a means of coping with their environment and psycho-
logical stress (Salomon et al., 2002).
Substance use is a major risk factor for child welfare involvement (Walsh,
MacMillan, & Jamieson, 2003). Research shows that parents who use substances are
less responsive to and/or neglectful of their children’s needs, display limited affection,
spend less time with their children, prioritize drug seeking and drug using, and risk
their child’s physical and emotional well-being (Magura & Laudet, 1996). Substance
abusing mothers who feel high parental stress and lack internal and external resources,
such as emotional strength and support networks, may be more prone to developing
maladaptive parenting behaviors, such as abuse and neglect (Kelley, 1998). In a
sample of substance abusing mothers, Kettinger, Nair, and Schuler (2000) found that
women encountering numerous negative environmental risks (high risk) scored worse
on child abuse potential were more depressed, reported higher parental stress, and felt
less competent as parents than those in the low-risk group. The high-risk substance
abusing mothers were also younger in age at the time of the birth of their first child,
less educated, and had more children. Overall, these results indicate that sociocultural
factors, traumatization, substance abuse, and poor parental attitudes may lead to
ineffective and harmful parenting behaviors that could enhance the risk of criminal
justice involvement due to the increased likelihood of reports to and/or involvement
with child protective services (Hines, Lemon, Wyatt, & Merdinger, 2004; Hong,
Ryan, Hernandez, & Brown, 2014).

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Theories Explaining Link Between Stress, Trauma,
and Criminal Justice Involvement
There are several theories that explain the link between stressful life events, trauma, and
criminal justice involvement including general strain theory (Agnew, 2006, 2012) and
traumatic stress theory (Chemtob, Roitblat, Hamada, Carlson, & Twentyman, 1988).
According to general strain theory (Agnew, 2006, 2012), exposure to strains or stressors
may contribute to an enhanced likelihood of engagement in criminal behaviors through
negative emotional responses to the stressors. For example, emotional states such as
depression, fear, anxiety, or anger may exert pressure on the individual to engage in
criminal (e.g., violent acts) or maladaptive behaviors (e.g., substance use) as a way to
relieve distressing emotional states or right an unjust experience. Traumas such as
childhood physical or sexual abuse and adulthood victimization are considered types of
strains most likely to induce criminal behaviors because they are high in magnitude and
perceived as unjust (Hay & Evans, 2006). Socioeconomic disadvantage, discrimination,
and parenting stress may also be perceived as strains for young impoverished racial/ethnic
minority mothers that may lead to engagement in deleterious behaviors such as substance
use and crime, placing them on the trajectory to criminal justice involvement.
According to the general strain theory, anger,...