Examining Risk for Frequent Cocaine Use: Focus on an African American Treatment Population

Introduction: Cocaine is among the most frequently abused illicit drugs in the United States, with an estimated 1.1 million individuals 12 years or older meeting abuse or dependence criteria. Race disparities have also been observed in both prevalence of cocaine use and its myriad negative health consequences among African-Americans relative to other ethnic groups. Moreover, within African American populations, patterns of cocaine use appear to differ significantly based on sex. To date, few studies have examined sex differences in premorbid factors related to the frequency of cocaine use among African Americans. The aim of this study is to examine sex differences in the etiologies of cocaine use by focusing on the role of age of onset, childhood trauma, and stress reactivity among African American cocaine users.

Methods:  A subsample of 450 African American adults (mean age=43.6, SD=9.9; 69.6% male) in residential drug treatment participated in the study. Assessment procedures were completed within 7 days of entering treatment. Study measures included childhood trauma, temperamental traits, age of crack use onset, and frequency of crack/cocaine use during the first year of use and in the past year..

Results: Sex differences were observed in prevalence of risk factors: Females reported higher rates of childhood emotional abuse (t(271)=2.28, p=.02), childhood sexual abuse (t(271)=2.87, p=.004), and stress reactivity (M=8.0; SD=4.4). No significant sex differences were found for age of onset. Furthermore, females reported both higher past year crack use (t(150)=2.21, p=.029) and cocaine use (t(429)=3.53, p =.000) than males. Related to risk for heavy past year crack/cocaine use, all predictor variables except age of onset, were positively correlated. However, significant sex differences were observed: For males, baseline levels of both cocaine (β=.65, p < .001) and crack use (β =.73, p < .001) predicted past year cocaine and crack use, respectively, with high stress reactivity explaining additional variance (β=.16,  p < .01). For females, age of onset significantly predicted past year frequent crack use (β= -.57, p < .001), while baseline levels of cocaine use (β=.69, p <.001) significantly predicted past year cocaine use.

Conclusion: These findings provide evidence of significant sex differences in the frequency of crack/cocaine use among lower income treatment-seeking African Americans. Moreover, the current study provides a clearer understanding of the unique risk factors of crack/cocaine abuse specific to African-American males and females, providing useful implications for prevention and treatment programing among this population.