Impacts of age of onset of substance use disorders on risk of adult incarceration among disadvantaged urban youth: A propensity score matching approach
Introduction
Over the past two decades, the costs of criminal incarceration of persons involved in substance related crimes have increased substantially in the U.S. Inflation adjusted annual state prison costs more than doubled between 1986 and 2001, from $49 per resident in 1986 to $104 per resident in 2001 (Stephan, 2004). This increase in costs has been driven largely by increases in the number of persons incarcerated for substance offenses, crimes relating to the possession and distribution of illicit substances. Substance offenders now comprise the fastest increasing category of offenders in the U.S. state prison system (Harrison and Beck, 2005). Between 1980 and 2002, the number of persons in U.S. state prisons for substance offenses increased from 19,000 to 265,000. The rapid increase in public expenditures devoted to incarceration of persons who may have persistent substance use disorders implies there is an increasing economic opportunity to finance interventions aimed at preventing later incarceration of such persons. Information about the onset of substance use disorders and its relationship to later incarceration may consequently be useful to policymakers as they consider how best to allocate scarce public resources.
The onset of substance use disorders could be related to increased risk for criminal arrest, conviction, and eventual incarceration, especially for offenses related to the possession or distribution of illegal substances. However, evidence on the association of onset and course of substance use disorders with the risk of involvement with criminal justice systems (i.e., contact with law enforcement, judicial, and corrections systems that is related to one's own alleged or established violations of law) is scarce. Many research studies provide evidence that substance use and involvement in crime frequently co-occur in adolescence and early adulthood (Nurco, 1998, Hays and Ellickson, 1996, White and Gorman, 2000, McBride et al., 2003, Gordon et al., 2004). Recent studies of longitudinal data from a non-U.S. cohort provide evidence that heavy use of alcohol and marijuana in adolescence is positively related to later criminal justice system involvement (Fergusson and Horwood, 2000, Fergusson et al., 2002a, Fergusson et al., 2002b). Although these relationships suggest that onset of disorders might influence later risk of incarceration in the U.S., empirical evidence from at least some studies (Dobkin et al., 1995, Fergusson and Horwood, 1997, White and Gorman, 2000) suggests that correlations between substance use and adult criminal outcomes could be spurious, insofar as delinquent behaviors and serious behavioral problems usually precede initiation of substance use and later involvement in crime.
The present study explores the association of timing of onset of substance use disorders with the risk of criminal incarceration in early adulthood among a cohort of young men (ages 18–24) who are predominantly from lower income, urban, African American households. Using propensity score matching techniques (Dehejia and Wahba, 2002, Rosenbaum and Rubin, 1983a), analyses controlled for numerous observable characteristics that are related to initiation of substance use and incarceration risk. Young men who met Diagnostic and Statistical Manual Version 4 (DSM-IV) criteria for a substance abuse or dependence disorder were propensity score matched to a comparison group of young men who did not meet these criteria but had a similar propensity for having a substance use disorder. We hypothesize that young men with substance use disorders are at increased risk for criminal incarceration for substance related offenses in early adulthood. Epidemiological evidence that early initiation of heavy use of marijuana and alcohol is associated with higher rates of criminal justice system contacts (Fergusson and Horwood, 1997, Fergusson et al., 2002a, Fergusson et al., 2002b, Fergusson et al., 2003, Ellickson et al., 2003, Ellickson et al., 2004) and with greater involvement in drug distribution (Inciardi and Pottieger, 1998) led us to also hypothesize that an early age of onset of a disorder (onset by age 16) indicates greater incarceration risk, higher incarceration costs, and greater risk of criminal arrest and prosecution.
Conceptually, onset of substance abuse or dependence (a substance use disorder) has been hypothesized to increase an individual's vulnerability to impairments in executive function (e.g., decisionmaking and forethought) and impulse control, and consequently to increase an individual's propensity to participate in criminal acts (Anthony and Forman, 2003). Data from research studies of the correlates of substance use disorders are consistent with this concept (Fagan, 1990). Specifically, the onset of a substance use disorder is associated with a higher propensity for more severe forms of substance use, including polydrug use (American Psychiatric Association, 2000, Ellickson et al., 2004, Newcomb et al., 2001) and use of “hard drugs” (e.g., cocaine and heroin) (Chaiken and Chaiken, 1990, Ellickson et al., 2004, Morral et al., 2002). Severe forms of substance use, in turn, are associated with impulse control problems (Cunningham, 2004), and may motivate participation in drug selling and other crimes in order to obtain drugs or money to purchase drugs (Fagan, 1990, Nurco, 1998).
Compared with individuals whose disorders begin later, individuals with disorders appearing during the early and middle phases of adolescence, up to the ages of 16 or 17 years old, could have a higher risk of incarceration by early adulthood (Anthony and Forman, 2003, Fergusson and Horwood, 1997, Fergusson et al., 2002a, Fergusson et al., 2002b, Fergusson et al., 2003, Ellickson et al., 2003, Ellickson et al., 2004). An early onset indicates greater liability to more severe forms of substance use and to chronic relapse (Ellickson et al., 2003, Kandel et al., 1992, Reiss et al., 2005, Riala et al., 2004, Tolan, 1987). Early onset also indicates impaired executive function and impulse control problems (Chambers et al., 2003, Cunningham, 2004, Tomas et al., 1990), which may predispose individuals to participation in crime. Although these cognitive and behavioral problems could predate initiation of substance use, it has also been proposed that heavy use of addictive substances during the sensitive developmental phase of early adolescence may impair maturation of neurological systems that influence executive function and impulse control (Chambers et al., 2003, Hyman, 2005). Finally, early initiation indicates greater involvement in drug selling and distribution early in adulthood, which could increase the risk of incarceration (Inciardi and Pottieger, 1998).
Despite several decades of research, there is no consensus among researchers as to whether there is a unique contribution of substance use to participation in criminal activity and, therefore, to risk of incarceration in adulthood. Substance use tends to co-occur with several other behavioral risk factors for criminal activity, especially deviant or delinquent behaviors, affiliation with delinquent peers, and academic problems (Derzon and Lipsey, 1999, Ellickson et al., 2003, Ellickson et al., 2004, Elliott et al., 1989, Fergusson et al., 2002a, Fergusson et al., 2002b, Gordon et al., 2004, Hays and Ellickson, 1996, McBride et al., 2003, Tomas et al., 1990, White and Gorman, 2000). Moreover, initiation of substance use during adolescence is often preceded by behavioral problems and adverse family circumstances earlier in childhood (Dobkin et al., 1995, Fergusson and Horwood, 1997, Nurco et al., 1998, White and Gorman, 2000, Fergusson et al., 2005), complicating the interpretation of empirical correlation between initiation of substance use and later criminal activity or incarceration outcomes. As a result, empirical separation of a marginal impact of substance use on risk of incarceration from the impacts of other adverse circumstances is generally problematic.
Here, we use a common version of propensity score matching (Dehejia and Wahba, 2002, Rosenbaum and Rubin, 1983a), one-to-one matching, to guard against the influence of factors that could confound the association between substance use disorders and incarceration risk. Mechanistically, propensity score matching generates treated and untreated comparison samples that closely resemble one another, or are “balanced,” with respect to their observed characteristics and estimated propensity for exposure to the “treatment” (Dehejia and Wahba, 2002). Once matched, the outcomes of individuals in the comparison sample and those of individuals in the treatment sample – in this case having a substance use disorder – are compared, using mean comparisons or multivariable regression to estimate the marginal influence of exposure to the treatment.
The internal validity of propensity score analyses depends critically on the available covariate measures. Even if the matched samples have similar observed characteristics, other unobserved characteristics could be correlated with both exposure to the treatment and with the outcome of interest. The propensity score analysis of the present study is enhanced by an unusually rich set of covariate predictors of participation in crime and substance use. Consequently, the resulting estimates of the association of substance use disorders to incarceration risk may be more robust to residual unobserved differences between the substance use disordered and comparison groups than is normally the case in studies based on observational data.
Section snippets
Sample selection
The data used in this study are from a sample of young men, ages 18–24 years old, who originally were participants in the Preventive Intervention Research Center (PIRC) randomized trials of two school-based, preventive interventions, which targeted early learning and aggression in first and second grades in 19 schools in Baltimore, Maryland (Dolan et al., 1993). Child participants began the study in two consecutive cohorts, which were recruited during the 1985–1986 and 1986–1987 school years.
Substance use disorder prevalence
Table 2 shows the lifetime prevalence of substance use disorders among the 279 young men who reported onset of a substance use disorder by age 20 or 21, and compares individuals who reported initial onset by age 16 to those who reported initial onset was after age 16. Although alcohol and marijuana use disorders are prevalent among a majority in both onset groups, the earlier onset group reported a higher prevalence of marijuana, cocaine, heroin, and other drug disorders, and also reported a
Discussion
In this study we used data on a cohort of predominantly urban, low income, African-American males followed through early adulthood to assess the association between onset of substance use disorders and risk of criminal incarceration and other criminal justice system outcomes in early adulthood. The main finding of this study is that young men with substance use disorders beginning by age 16 have an approximately fourfold greater probability (0.35 vs. 0.09) of incarceration for substance related
Conflict of interest
Authors have no conflict of interest in relation to the content of this article.
Acknowledgements
We also thank two anonymous reviewers for many constructive suggestions.
Role of funding source: Financial support for this research from the National Institute of Mental Health (P30-MH066247 and R34-MH081303) and from the U.S. Department of Veterans Affairs (VA), VISN5 Capitol Network Mental Illness Research and Education Clinical Center is gratefully acknowledged. The NIMH and the VA had no further role in study design; in the collection, analysis and interpretation of data; in the writing of
References (65)
- et al.
The short-term impact of two classroom-based preventive interventions on aggressive and shy behaviors and poor achievement
J. Appl. Dev. Psychol.
(1993) - et al.
Antecedents and outcomes of marijuana use initiation during adolescence
Prev. Med.
(2004) - et al.
Arrests and convictions for cannabis related offences in a New Zealand birth cohort
Drug Alcohol Depend.
(2003) - et al.
Associations between drug use and deviant behavior in teenagers
Addict. Behav.
(1996) - et al.
Differential contributions of family and peer factors to the etiology of narcotic addiction
Drug Alcohol Depend.
(1998) - et al.
Utility of TOCA-R scores during the elementary school years in identifying later violence among adolescent males
J. Am. Acad. Child Adolesc. Psychiatry
(2004) - et al.
Teenage smoking and substance use as predictors of severe alcohol problems in late adolescence and in young adulthood
J. Adolesc. Health
(2004) - et al.
DATStats: results from 85 studies using the Drug Abuse Treatment Cost Analysis Program
J. Subst. Abuse Treat.
(2003) - et al.
A randomized controlled trial of two primary school intervention strategies to prevent early onset tobacco smoking
Drug Alcohol Depend.
(2002) - et al.
Association between intravenous drug use and early misbehavior
Drug Alcohol Depend.
(1990)
Interventions to reduce harm associated with adolescent substance use
Lancet
The development of suicide ideation and attempts: an epidemiologic study of first graders followed into young adulthood
Drug Alcohol Depend.
Diagnostic and Statistical Manual of Mental Disorders
Costs of drug abuse to society
J. Ment. Health Policy Econ.
Drugs and predatory crime
Developmental neurocircuitry of motivation in adolescence: a critical period of addiction vulnerability
Am. J. Psychiatry
Parent monitoring and the incidence of drug sampling in urban elementary school children
Am. J. Epidemiol.
Aggression upon adolescent cocaine exposure linked to serotonin anomalies: theoretical comment on Ricci et al. (2004)
Behav. Neurosci.
Propensity score-matching methods for nonexperimental causal studies
Rev. Econ. Stat.
A synthesis of the relationship of marijuana use with delinquent and problem behaviors
School Psychol. Int.
Individual and peer characteristics in predicting boys’ early onset of substance abuse: a seven-year longitudinal study
Child Dev.
Ten-year prospective study of public health problems associated with early drinking
Pediatrics
Multiple Problem Youth: Delinquency, Substance Use and Mental Health Problems
Intoxication and aggression
Early onset cannabis use and psychosocial adjustment in young adults
Addiction
Alcohol abuse and crime: a fixed-effects regression analysis
Addiction
Show me the child at seven: the consequences of conduct problems in childhood for psychosocial functioning in adulthood
J. Child Psychol. Psychiatry
Cannabis use and psychosocial adjustment in adolescence and young adulthood
Addiction
Deviant peer affiliations, crime and substance use: a fixed effects regression analysis
J. Abnorm. Child Psychol.
Outpatient marijuana treatment for adolescents economic evaluation of a multisite field experiment
Eval. Rev.
Cited by (70)
Pathways from prenatal cocaine exposure to adult substance use and behavior
2024, Neurotoxicology and TeratologyFeasibility and preliminary outcomes from a non-randomized trial of the free talk program in a short-term juvenile detention facility
2022, Children and Youth Services ReviewPreschool blood lead levels, language competency, and substance use in adolescence
2022, Environmental ResearchCitation Excerpt :Although the adverse relationship of early lead exposure with cognitive development and behavioral problems in children has been well-documented even with low lead levels (National Toxicology Program, 2012), few prospective studies have examined the association of childhood lead levels with later adolescent behavioral outcomes such as substance use (Desrochers-Couture et al., 2019; Dietrich et al., 2001). Substance use in adolescents is a critical public health priority (Degenhardt et al., 2016), as it may disrupt healthy transition to adulthood by increasing the risk of substance dependency (Behrendt et al., 2009; Guttmannova et al., 2012) and accompanying problems including academic failure (Yule and Prince, 2012; King et al., 2006), unemployment (Huang et al., 2011), greater mental health symptoms (Saban and Flisher, 2010), relationship difficulties (Fergusson and Boden, 2008; Brook et al., 2011), and incarceration (Slade et al., 2008; Bennett et al., 2008). The purpose of the present study is to examine the long-term association of early blood lead level (BLL) with adolescent substance use.
Missed opportunities: Arrest and court touchpoints for individuals who fatally overdosed in Philadelphia in 2016
2020, International Journal of Drug PolicyPsychiatric comorbidities in alcohol use disorder
2019, The Lancet Psychiatry