Impacts of age of onset of substance use disorders on risk of adult incarceration among disadvantaged urban youth: A propensity score matching approach

https://doi.org/10.1016/j.drugalcdep.2007.11.019Get rights and content

Abstract

Background

Age of onset of substance use disorders in adolescence and early adulthood could be associated with higher rates of adult criminal incarceration in the U.S., but evidence of these associations is scarce.

Methods

Propensity score matching was used to estimate the association between adolescent-onset substance use disorders and the rate of incarceration, as well as incarceration costs and self-reported criminal arrests and convictions, of young men predominantly from African American, lower income, urban households. Age of onset was differentiated by whether onset of the first disorder occurred by age 16.

Results

Onset of a substance use disorder by age 16, but not later onset, was associated with a fourfold greater risk of adult incarceration for substance related offenses as compared to no disorder (0.35 vs. 0.09, P = 0.044). Onset by age 16 and later onset were both positively associated with incarceration costs and risk of arrest and conviction, though associations with crime outcomes were more consistent with respect to onset by age 16. Results were robust to propensity score adjustment for observable predictors of substance use in adolescence and involvement in crime as an adult.

Conclusion

Among young men in this high risk minority sample, having a substance use disorder by age 16 was associated with higher risk of incarceration for substance related offenses in early adulthood and with more extensive criminal justice system involvement as compared to having no disorder or having a disorder beginning at a later age.

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

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