Substance Use and Violent Injury Among Black Men in Baltimore, Maryland: A Qualitative Study

Objective: Community violence continues to be a public health crisis that disproportionately impacts Black men. Adults who have experienced violence have increased risk for substance use. Little is known about factors that influence the substance use–violence relationship. The aim of this study was to describe factors related to substance use and violent injury as perceived and experienced by Black men recovering from a recent violent injury in Baltimore, Maryland. Methods: Twelve Black men who reported substance use and were hospitalized for an assault injury were recruited from a trauma center in Baltimore, Maryland. Each participant completed one semi-structured individual interview focused on their experiences and perspectives about developmental, psychological, and contextual influences related to substance use and violence. Using inductive content analysis, five themes were identified. Results: Participants described the following: (a) parental substance use, (b) trauma and violence-related motivations to continue substance use (coping and participation in drug markets), (c) inequitable distribution of alcohol outlets and drug markets, (d) lack of community mental health and substance use services, and (e) high burdens of community violence. Conclusion: Participants described complex, multilevel factors that influence substance use and violence in their communities. These findings reinforce the need for targeted and community-centered interventions that address trauma, violence prevention, and substance use. Addressing violence exposures may be a pathway to reducing substance use–related harm. Research-based policy must also be directed at eliminating structural factors that lead to racial disparities in violence.