Women represent a fast-growing segment of the criminal justice system. The number of women incarcerated increased by 202% nationwide from 1980 to 1989, compared to a 112% increase for men during the same period (1). Among the reasons for this escalation is the widespread increase in crack cocaine use among women. A 1991 survey of New York State inmates found that 51% of female inmates used crack cocaine prior to entry, 28% used heroin, and 4% used other drugs not including marijuana (2). A study conducted by the Bureau of Justice Statistics compared inmates who had used crack cocaine a month before their arrest with inmates who had used other drugs (3). Crack cocaine users were more likely than users of other drugs to be female, black non-Hispanic, and unemployed; they were also three times more likely to have committed their current offense in order to obtain money for drugs, and more likely to have had a previous criminal history. Beyond these demographic differences, little is known about psychosocial characteristics that may discriminate crack cocaine users from other drug users among incarcerated women.

The widespread practice of exchanging sex for money or crack cocaine, now documented by many studies (4-7), has evolved into a particularly degrading and dangerous form of prostitution. Fullilove’s ethnographic research documented multiple psychological traumas (e.g., homelessness, loss of child custody, domestic abuse, and sexual and physical abuse) that both predate and occur concomitantly with the exchange of sex for money or drugs among crack-using women (8). Wallace found that two-thirds of a sample of 66 crack-using patients in detoxification were children of alcoholics, and many also suffered from physical and sexual abuse as children (9). Another study of 146 indigent women who had a current or past history of using crack cocaine found that sexual abuse was associated with severity of drug use and with other traumatic experiences (10). Although methodologically limited (i.e., lack of comparison group and failure to adjust for potentially confounding variables), these studies suggest that psychological trauma may be a useful construct in understanding how crack-using women may differ from other drug-addicted women. Psychological trauma refers to a set of responses to extraordinary, emotionally overwhelming events that are beyond the individual’s ability to control (11-13). These events may be ongoing and chronic, such as physical abuse, or they may be discrete and clearly bounded, such as loss of child custody (11-13).

The association among psychological trauma, substance abuse, and the symptomatology of posttraumatic stress disorder (PTSD) has been hypothesized as a complex interaction between external factors (severity, duration, and frequency of trauma experienced) and inter/intrapersonal factors (coping strategies, availability of social support, personality factors, prior stress, early deprivation) (14-16). Previous studies that have documented deficiencies in social support and social competence among crack cocaine users, particularly among women, suggest that crack cocaine users may be more prone to exhibit PTSD following a traumatic experience (17,18). The intent of this study was to depict childhood and adult psychological trauma variables (childhood sexual abuse history, childhood physical abuse history, history of parental alcohol abuse, domestic abuse, loss of custody of children, exchanging sex for money or drugs) associated with regular crack use (three or more times per week). Based on previous research findings (8-10), we hypothesized that after adjusting for social support, coping, demographic/ criminal history variables, women who report childhood and adult psychological traumas are more likely than other women to be classified as regular crack users. To test this hypothesis, we used two separate logistic equations: one in which adult trauma variables were entered first, followed by social support and coping variables, and demographic/criminal history indicators; and another in which past trauma variables were entered first, followed by social support and coping variables, and demographic indicators.

METHODS

Sample Recruitment and Selection

At Rikers Island, the major jail facility in New York City, female drug users were recruited to participate in the study. Eligible participants were aged 18-55, convicted and serving a sentence between 3 months and I year, scheduled for release within 10 weeks, and reported using drugs-other than marijuana or alcohol-three or more times a week within the 3 months prior to arrest. The latter data were corroborated by review of prison medical or intake records indicating use of drugs other than alcohol or marijuana prior to arrest. Among 194 women recruited, 170 met eligibility criteria and 159 agreed to participate in the 90-minute interview process. Data on drug use were missing for one woman; consequently, analyses were performed on 158 subjects.