Trauma Profiles and Cocaine Use Among Formerly Incarcerated Black Men Who Co-Use Opioids and Stimulants

Trauma

To contextualize these vulnerabilities, it is important first to define trauma and its manifestations among Black men. Trauma is defined as distressing events that occur to a person and have a sustained negative influence on that person’s well-being and daily functioning (American Psychological Association, n.d.). Trauma has devastating physiological and psychological impacts that have the potential to affect an individual for a lifetime. Psychologically, trauma manifests itself as chronic stress, depression, anxiety, and other mental illnesses (Maeng & Milad, 2017) that make daily life functioning a challenge. Further, stress works as an impetus, synergistically aggravating the effects of trauma (Duric et al., 2016).

The types of trauma individuals may experience vary according to the overarching descriptive classification, age during exposure, and whether it was personally experienced or witnessed (Kira, 2001). Traumatic life events can consist of but are not limited to a vehicular accident, physical assault with or without a weapon, involving or not involving sexual assault, war, or terroristic attack (Weathers et al., 2013). Notably, Jones and colleagues (2022) found that 5-6% of Black men met criteria for a PTSD diagnosis; Black men are disproportionately exposed to multiple forms of violence across the life course, including but not limited to gun violence, which contributes to elevated risk for PTSD and related mental health conditions such as anxiety, depression, and substance use disorders (Motley & Banks, 2018; Smith & Patton, 2016; Ugwuede, 2023).

Contextually, incarceration warrants particular attention as a potent and often overlooked source of trauma among Black men, especially given that the study’s sample is composed largely of formerly incarcerated individuals. This focus is further underscored by the disproportionate representation of Black men within the U.S. prison system, who constitute approximately 35% of individuals who are incarcerated despite representing only 13% of the general population (Johnson & Manyweather, 2023). Incarceration can be viewed as a three-fold cord of trauma: exposure to adverse events prior to incarceration, the state of being incarcerated, and reentry challenges. Jäggi and colleagues (2016) found that repeated exposure to trauma, witnessed or perpetrated, is associated with increased justice involvement. Witnessing brutalities toward inmates, experiences of racism, the pressure to perpetuate violence, hypervigilance and paranoia, and forced loneliness have been cited as points of trauma for incarcerated Black men (Addison et al., 2025). The reentry phase is a critical period marked by diminished access to essential resources and a sharp decline in social support within the first 6 months post-release, a trend that continues over time (Pettus-Davis et al., 2020). Nearly half of individuals experience at least one traumatic event within the first 8 months of release (e.g., violent assault, witnessing serious injury or death, or losing a loved one) (Pettus-Davis et al., 2020). The compounded effects of such trauma on Black men first became evident during the War on Drugs, when the criminalization of drug use fueled community violence and contributed to the disproportionate incarceration of Black men nationwide (Fornili, 2018). Thus, further highlighting the relationship between trauma and substances among Black men.

Medical Mistrust, Masculinity, and Coping

Lifetime experiences of traumatic events can be exacerbated by perceived discriminatory interactions with clinicians, which contributes to the medical mistrust among Black men (Hammond, 2010). Their mistrust of the healthcare system may become heightened when considering stigmatized conditions, like mental health and drug use treatment. Cultural messages surrounding masculinity and reliance on willpower may also widen the gap between Black men and receiving adequate care (Klingemann & Klingemann, 2023).

Research suggests that rigid masculine norms can constrain emotional expression and psychological help-seeking among Black men, particularly in response to trauma-related distress (Coleman-Kirumba et al., 2022; Dennis & Zolnikov, 2023). In the context of cumulative trauma and structural stressors, these constraints may increase reliance on alternative coping strategies, including substance use, as a means of regulating distress while preserving masculine identity when professional support is perceived as inaccessible or stigmatizing.

These culturally and structurally rooted challenges influence how Black men cope with stress and trauma, often leading to emotion-based strategies such as distancing and finding meaning through spirituality or religiosity, which are used more frequently by Black adults than by their white counterparts (Brantley et al., 2002). Moreover, spirituality and religiosity are protective factors for Black men; however, distancing as a coping strategy can be detrimental as it may lead to destructive behaviors and discourage individuals from seeking treatment (Seidler et al., 2016).

Polysubstance Use and Coping

When systemic trauma and discrimination are minimized or unacknowledged, Black men may attribute psychological distress to individual-level stressors rather than structural oppression, increasing the likelihood of coping through substance use as a form of self-medication (Oh et al., 2025). Studies have shown that although Black men and women report similar frequency of PTSD symptoms, Black men are more likely to have substance use as a comorbidity (Cross et al., 2015). Stimulant and opioid co-use is rapidly rising among Black individuals, as is the fatal opioid-related overdose (Tanz, 2025). Individuals report using stimulants like cocaine and methamphetamine with opioids to mitigate the effects of opioid withdrawal and the anxiety of using opioids, leaving individuals feeling alert and productive (Leri et al., 2003; Rigg et al., 2025), characteristics often praised by the patriarchy.

Opioid-Stimulant Co-Use and Overdose Risk

Opioid and stimulant co-use poses a unique heightened overdose risk for Black men. Unintentional opioid exposure from fentanyl-adulterated stimulants further amplifies this danger (National Institute on Drug Abuse [NIDA], 2025). In 2022, the age-adjusted overdose death rate among Black men (69 per 100,000) exceeded that of white men (45 per 100,000) and persisted longer across the life course, declining around age 45 for white men but not until age 65 for Black men (Windsor & Reeves, 2025). In the same year, fentanyl was the leading contributor to opioid-related deaths among Black men, and cocaine-related fatalities also rose sharply (Windsor & Reeves, 2025). The complexity of polysubstance use patterns, particularly when unintentional opioid exposure occurs among individuals seeking only stimulants, underscores an urgent need to better understand overlapping risk pathways and intervention opportunities, especially as overdose deaths among Black men in their 30s and 40s are projected to rise substantially (Harris, 2023).

Current Study

This study responds to recent calls within Black psychology for research on Black men’s mental health that moves beyond homogeneous models to examine heterogeneity in trauma exposure and coping processes, including substance use (Gran-Ruaz et al., 2022; Hurd et al., 2014). Specifically, we examine patterns of trauma exposure and their associations with substance use among Black men. Using latent class analysis of 14 trauma indicators, we identified distinct trauma profiles among Black men who use stimulants and reported opioid use within the past 6 months, an understudied yet highly impacted population. We then assessed how latent class membership was associated with stimulant use, specifically crack and powder cocaine, to better understand within-group variation and its implications for polysubstance use outcomes and prevention strategies.

Theoretical Framework

Guided by the self-medication hypothesis, which posits that individuals may engage in substance use as a means of alleviating psychological distress, regulating mood, or coping with unresolved trauma (Khantzian, 1997), this study conceptualizes substance use as a coping response to traumatic stress within a polysubstance use context. This perspective is further informed by the stress and coping theory, which emphasizes that individuals respond to stressors using coping strategies shaped by available resources, prior experiences, and social context (Lazarus & Folkman, 1984). Within this combined framework, cocaine and crack use among Black men may reflect attempts to manage the lingering psychological effects of traumatic experiences, particularly in the contexts where adaptive coping resources (e.g., social support and spirituality) are constrained. These coping responses may be further shaped by structural inequities, racism, and stigma surrounding both substance use and victimization, which may limit access to social support and mental health resources (Hammond, 2010). Over time, reliance on substance use as a form of self-medication can reinforce substance dependence and increase the risk of overdose and accidental opioid exposure. Together, self-medication and stress and coping theory provide an integrated framework linking trauma exposure, coping responses, including substance use behaviors within structurally constrained contexts.

Method

Results

Latent Class Enumeration and Model Fit

LCA models with one to three classes were estimated, and fit statistics are presented in Table 1. The three-class model showed the best fit, with the lowest AIC/BIC values (AIC = 5461.50; BIC = 5635.90) and an acceptable entropy of 0.81, indicating good classification quality. Therefore, the three-class solution was retained for subsequent analyses.

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Table 1.

Class Comparison

Classes	Log Likelihood	AIC	BIC	Entropy
1	−3107.35	6242.71	6298.20	–
2	−2785.73	5629.47	5744.41	0.80
3	−2686.75	5461.50	5635.90	0.81

Trauma Class Characteristics

Table 2 shows conditional probabilities of trauma endorsement by latent class. Class 1 (36%) had low probabilities across most events (“Low Trauma”). Class 2 (42%) had high probabilities of physical violence and accidents but low sexual trauma endorsement (“High Non-Sexual Trauma”). Class 3 (21%) exhibited high probabilities across nearly all categories, including sexual assault (“High Trauma Across All Categories”).

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Table 2.

Probabilities of Trauma Experiences by Latent Class

Latent class analysis results			n = 389
	Class 1	Class 2	Class 3
Pr (Class)	0.36	0.42	0.21
Probability of
Ever been in serious transportation accident	0.37	0.66	0.69
Ever witnessed serious transportation accident	0.25	0.85	0.82
Ever been physically assaulted	0.32	0.85	0.92
Ever witnessed a physical assault	0.55	0.95	0.99
Ever been assaulted with a weapon	0.23	0.72	0.85
Ever witnessed anyone assaulted with a weapon	0.35	0.88	0.96
Ever been sexually assaulted	0.10	0.03	0.56
Ever witnessed a sexual assault	0.00	0.04	0.53
Ever had any other unwanted sexual experience	0.07	0.04	0.69
Ever witnessed unwanted sexual experience	0.04	0.00	0.71
Ever experienced combat	0.04	0.33	0.35
Ever had life threatening illness/injury	0.14	0.35	0.56
Ever witnessed sudden violent death	0.13	0.61	0.71
Ever witnessed sudden accidental death	0.10	0.51	0.61

Bivariate Differences by Trauma Class

Bivariate analyses were conducted to examine differences in demographic and contextual variables across the three trauma classes. Education (χ² (2, N = 387) = 16.32, p = .00) and marital status (χ² (2, N = 388) = 9.63, p = .05) differed significantly by class. All bivariate results and demographic information are reported in Table 3.

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Table 3.

Sample Characteristics by trauma class

Variable	Class 1 (Low trauma)	Class 2 (High non-sexual trauma)	Class 3 (High trauma all categories)	Test statistic	p-value
Categorical variables
Education	​	​	​	χ2 = 16.32	0.00
Less than HS	37	40	25	​	​
High School/GED	76	63	22	​	​
Post secondary	32	62	30	​	​
Marital status	​	​	​	χ2 = 9.62	0.05
Married/Committed	15	26	10	​	​
Widowed/Divorced	17	36	17	​	​
Single	113	104	50	​	​
Incarcerated as adult	​	​	​	χ2 = 2.30	0.32
No	18	14	11	​	​
Yes	127	153	66	​	​
Continuous variables
Age (Mean ± SD)	39.90 ± 13.19	42.29 ± 13.05	44.91 ± 13.58	F = 1.22	0.16
Spiritual well-being	36.99 ± 6.36	36.64 ± 6.82	35.05 ± 6.46	F = 0.98	0.50
Emotional support	19.66 ± 9.72	19.45 ± 9.10	19.13 ± 8.70	F = 0.78	0.80

Trauma Class and Substance Use

Results from logistic regression models examining the relationship between trauma class membership and cocaine use are shown in Table 4. For crack cocaine use, individuals in Class 3 (High Trauma Across All Categories) had higher odds of lifetime use compared to those in Class 1 (Low Trauma) (OR = 2.08, p = .05, 95% CI = 1.00–4.35). No significant difference was observed for individuals in Class 2.

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Table 4.

Binary Logistic Regression Predicting Stimulant Use by Most Likely Class

Predictors of crack cocaine	β (SE)	OR	p-value	95% CI
LCA Class
Class 2	−0.41 (0.30)	0.66	0.17	0.37–1.19
Class 3	0.73 (0.38)	2.08	*0.05	1.00–4.35
Age	0.11 (0.01)	1.11	**0.00	1.09–1.14
Education	0.07 (0.17)	1.07	0.66	0.77–1.51
Incarceration	0.56 (0.52)	1.75	0.28	0.63–4.91
Spirituality scale	0.01 (0.02)	1.01	0.53	0.97–1.06
Marital status
Widowed/Divorced	−0.15 (0.47)	0.86	0.74	0.34–2.14
Single	−0.64 (0.37)	0.52	0.08	0.25–1.09
Emotional support scale	0.03 (0.01)	1.03	*0.04	1.00–1.06

Predictors of powder cocaine	β (SE)	OR	p-value	95% CI
LCA Class
Class 2	0.02 (0.32)	1.02	0.94	0.54–1.91
Class 3	1.42 (0.50)	4.12	**0.00	1.55–10.95
Age	0.12 (0.02)	1.13	**0.00	1.09–1.17
Education	−0.10 (0.20)	0.90	0.60	0.61–1.33
Incarceration	1.69 (0.50)	5.44	**0.00	2.04–14.78
Spirituality scale	−0.01 (0.02)	0.99	0.74	0.95–1.04
Marital status
Widowed/Divorced	−0.37 (0.68)	0.69	0.59	0.18–2.61
Single	−0.31 (0.50)	0.73	0.53	0.28–1.96
Emotional support scale	0.01 (0.02)	1.01	0.67	0.98–1.04

Note. * denotes statistical significance at the 0.05 level; 88 denotes statistical significance at the .01 level.

In the powder cocaine use model, membership in Class 3 was significantly associated with higher odds of use (OR = 4.13, p = .00, 95% CI = 1.55–10.95), while Class 2 was not significantly different from Class 1.

Among the covariates, older age was positively associated with both crack (OR = 1.11, p < .001, 95% CI = 1.09–1.14) and powder cocaine use (OR = 1.13, p < .001, 95% CI = 1.10–1.17). Incarceration history was significantly associated with higher odds of powder cocaine use (OR = 5.44, p = .00, 95% CI = 2.04–14.48) but not crack cocaine use. Greater emotional support was significantly associated with increased odds of crack cocaine use (OR = 1.03, p = .04), though it was not associated with powder cocaine use. Additionally, single marital status approached significance and was associated with lower odds of crack cocaine use (OR = 0.52, p = .08). No other covariates were significantly associated with either outcome.

Discussion

The current study aimed to identify latent subtypes of trauma experiences among Black men who co-use substances, and to determine the extent to which these subtypes predict powder and crack cocaine use. Three trauma subtypes were identified. Low trauma (class 1), High Non-Sexual Trauma (class 2), and High Trauma Across All Categories (class 3). Class 3 was significantly associated with greater odds of lifetime powder cocaine and lifetime crack use compared to Class 1. No differences between Class 2 and Class 1 in odds of lifetime cocaine use were detected. The present findings advance the limited literature on trauma experiences among Black men, a group often underrepresented in substance use research.

Sexual trauma, including sexual assault and childhood sexual abuse, is robustly linked to substance use in general populations (Khoury et al., 2010; Kihas et al., 2024; Levin et al., 2021). However, far less is known about how sexual trauma operates within the broader patterns of trauma among Black men who may underreport such experiences due to stigma and cultural norms. The current study found that cocaine and crack use were more likely among men classified in the High Trauma Across All Categories profile, a class characterized by co-occurring sexual, physical, and violent trauma exposures. These findings should be interpreted as reflecting associations with trauma profiles, rather than the independent effect of any single trauma type.

The elevated risk observed among the High Trauma Across All Categories class may reflect the cumulative psychological burden associated with exposure to multiple forms of trauma. Sexual trauma, as one component of the broader trauma profile, has been linked to lower self-esteem, greater self-criticism, less secure attachment style, and heightened internalized shame (Dorahy & Clearwater, 2012; Schnittker, 2022). The impact of trauma on a sense of personal power and control may be particularly salient for Black men due to chronic experiences of racial discrimination and systematic disadvantage that impede a sense of personal agency (Khazvand et al., 2022). In addition, culturally grounded masculine norms emphasizing emotional restraint, self-reliance, and resilience, as well as a desire to avoid appearing vulnerable, may further deter help-seeking for traumatic experiences among Black men. Prior research suggests that these norms are linked to greater frequency of substance use as means of coping with sexual trauma for Black men relative to men of other races (Myrie & Schwab, 2023; Payne et al., 2014). The multiplicative effect of these experiences may explain why Black individuals with sexual trauma have more severe PTSD symptoms than other races (Ceroni et al., 2023).

Despite these potential implications, sexual trauma remains understudied among Black men, likely due to lower reported prevalence relative to White individuals and Black women (Clark et al., 2012) and prior evidence suggesting stronger associations between sexual abuse and substance use among women (Hyman et al., 2008). The current findings suggest that even when sexual trauma is underreported (Thomas & Kopel, 2023), its presence within the broader pattern of cumulative trauma exposure may be particularly relevant for understanding cocaine use risk among Black men. Importantly, sexual trauma is also associated with various other comorbid mental health concerns (Chen et al., 2010), suggesting that men in the High Trauma Across All Categories class may have high symptom acuity in other domains that may require additional services and resources. Given the growing risk of fatal overdose associated with cocaine use among Black men (Volkow, 2024), these findings underscore the urgency of trauma-informed, culturally responsive interventions for this population.

While trauma class membership was significantly associated with both lifetime use of powder cocaine and crack cocaine, the difference in magnitude of these associations suggests need for further study. Our findings are consistent with previous research examining associations between crack and cocaine use and trauma among predominately Black samples (Jester et al., 2024; Zapolski et al., 2016). Crack cocaine use is typically more strongly associated with structural disadvantage that predisposes individuals to encountering and witnessing traumatic events, such as neighborhood disorder and disinvestment, whereas cocaine use is associated with higher socioeconomic status (Palamar et al., 2015; Sterk et al., 2014). Thus, it might be expected that the strength of the association between membership in the High Trauma Across All Categories class would have been more pronounced in the crack cocaine model compared to the powder cocaine model. Contrarily, our models showed that belonging to the most severe trauma class was associated with four-fold greater odds of powder cocaine use, whereas it was associated with two-fold greater odds of crack cocaine use. One other study found a similar difference in robustness of association between crack/cocaine and sexual trauma in all Black sample (Zapolski et al., 2016). This previous study noted potential methodological limitations that may have contributed to this finding that may also be reflected in the current sample (i.e., lower proportion of the sample used crack compared to powder cocaine). It may be that crack cocaine use is more robustly predicted by socioeconomic indicators, whereas powder cocaine has stronger direct associations with cumulative psychological burden reflected in the severe trauma profiles.

Conclusion

This study highlights the significance of examining patterns of trauma among Black men who co-use substances. The findings suggest the need for trauma-informed and culturally responsive interventions that address both substance use and overdose risk within this population, while acknowledging differences between the substances used (e.g., powder vs crack cocaine) and incorporate naloxone education and expanded access. Such strategies should be integrated across clinical, community, and reentry settings to support holistic recovery and overall well-being. Future research directions should expand these findings to deepen understanding of the intricacies of how traumatic experiences shape substance use trajectories among Black men, an understudied yet disproportionately effected group.