Survival Analysis of Time to Opioid Use and the Role of PTSD-Linked Stress Sensitivity for Predicting Onset Risk for Juvenile Offenders Following Adjudication

• Author: Thomas W. Wojciechowski
• Date: 01 January 2022
• DOI: 10.1177/00328855211069306
• Published date: 01 January 2022
• Subject Matter: Articles

Survival Analysis of Time

to Opioid Use and the

Role of PTSD-Linked

Stress Sensitivity for

Predicting Onset Risk for

Juvenile Offenders

Following Adjudication

Thomas W. Wojciechowski

1

Abstract

This study sought to understand how PTSD predicts opioid use onset rates

and how subsequent exposures to violence also inf‌luence this risk follow-

ing adjudication. Survival analysis was used to examine the moderating role

that baseline PTSD status plays for predicting rates of opioid use onset risk

following adjudication. Hazard models used to examine the role of time-

varying covariates for predicting opioid onset risk following adjudication.

PTSD was found to predict signif‌icantly greater odds of opioid use initia-

tion. Hazard of introducing opioid use was greater during observation peri-

ods in which participants witnessed violence. This effect was greater for

PTSD sufferers.

Keywords

opioid use, PTSE-linked stress sensitivity, onset risk, survival analysis, juvenile

offenders

1

Michigan State University, Lansing, MI, USA

Corresponding Author:

Thomas W. Wojciechowski, School of Criminal Justice, Michigan State University, 655

Auditorium Dr., East Lansing, MI 48824, USA.

Email: wojcie42@msu.edu

Article

The Prison Journal

2022, Vol. 102(1) 108–126

© 2022 SAGE Publications

Article reuse guidelines:

sagepub.com/journals-permissions

DOI: 10.1177/00328855211069306

journals.sagepub.com/home/tpj

Introduction

Opiates/opioids are a class of drugs derived from the poppy f‌lower which

come in the form of both prescription medications and narcotics like

heroin, Vicodin, codeine, opium, and morphine. Drugs in this class have a

high abuse potential, as evidenced by the current “opioid crisis”in the

United States, which estimates indicate is claiming 14.7 of every 100,000

deaths in recent years (Kolodny et al., 2015; Weiner et al., 2017). This

high abuse potential also presents a major public health problem in the

form of numerous health issues that are associated with chronic use

(Nabipour et al., 2014; Rosen et al., 2008). These factors, coupled with

issues associated with risk for overdose, demonstrate the need to prevent

onset of opiate use. One group which has been found to be at-risk for engage-

ment in opiate use is juvenile offenders (Dembo et al., 2007; Lebeau-Craven

et al., 2003). This population is often exposed to numerous risk factors which

elevate their odds for engaging in opiate use. While these include issues like

low self-control and other substance use (Carroll et al., 2006; Wojciechowski,

2017, 2019), perhaps two of the most important risk factors associated with

opiate use that should be considered are post-traumatic stress disorder

(PTSD) and exposure to violence (Birur et al., 2017; Hall et al., 2016).

Together, these risk factors may interact to produce even larger effects, indi-

cating PTSD-linked stress sensitivity. This PTSD-linked stress sensitivity

refers to the tendency of PTSD-sufferers to demonstrate increased reactivity

to stress due to damaged stress- processing systems of the body stemming

from trauma exposure (Stam, 2007; Wojciechowski, 2017) The present

study explores the role of these factors for predicting onset of opiate use

among juvenile offenders from adolescence to early adulthood following

adjudication for a serious offense.

Juvenile Offenders and Life Following Adjudication

Juvenile offenders comprise a subset of individuals who have been adjudi-

cated of some offense prior to the age of 18. These individuals are exposed

to a number of risk factors which place them at risk for substance use. One

of the major driving factors behind this risk is the high prevalence of

mental illness among this population (Underwood & Washington, 2016). In

terms of PTSD specif‌ically, research has found past year prevalence rates

between 11%–41% among juvenile offenders (Abram et al., 2004;

Robertson et al., 2004). Individuals in this study were incarcerated juvenile

offenders, indicating the adolescent status of these samples. This is generally

higher than the 9% lifetime prevalence rate found among the general

Wojciechowski 109