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Substance use/abuse and intimate partner violence (IPV) often coexist. Victims of adult IPV, childhood physical abuse, or sexual violence are more likely to use illicit drugs or alcohol. Perpetrators of IPV also are frequently under the influence of drugs or alcohol. This research paper describes the prevalence of substance use in IPV incidents and the extent to which illicit drugs and alcohol may contribute to the perpetration of IPV. Questions that illuminate the connection between substance use/ abuse and becoming a victim of IPV also will be addressed. For example, does IPV victimization increase the use of illicit drugs or alcohol? Do substance-abusing women have a higher risk of IPV than those who do not abuse alcohol or illicit drugs? These questions must be answered to fully understand the connection between substance abuse/use and victimization from IPV or childhood physical/sexual abuse. Explanations for the association between substance use/abuse and the commission of IPV also are explored, including whether substance use/abuse causes the perpetration of IPV. The research paper concludes with a section on how substance abuse complicates treatment of intimate partner batterers and victims.
Outline
I. Prevalence of Alcohol Consumption in Intimate Partner Violence Incidents
II. Prevalence of Illicit Drug Use in Intimate Partner Violence Incidents
III. Is the Relationship between Substance Use and Intimate Partner Violence Spurious?
IV. Does Substance Use/Abuse Cause Perpetrators to Commit Intimate Partner Violence?
V. The Link between Substance Use/Abuse and Intimate Partner Violence: Does It Vary across Contexts and Groups?
VI. Relationship between Substance Use/Abuse and Intimate Partner Violence Victimization
VII. Treatment Modalities and Responsiveness
I. Prevalence of Alcohol Consumption in Intimate Partner Violence Incidents
IPV often occurs when the batterer, victim, or both have been drinking alcohol (see Testa 2004). Much research has established that alcohol use/abuse and IPV often coexist. In the United States, nationwide probability surveys reveal that between 30 and 40 percent of male perpetrators and 27 and 34 percent of women perpetrators of IPV were drinking alcohol when they physically attacked their partners (Caetano, Schafer, and Cunradi 2001). Men in domestic violence treatment report a rate of alcohol abuse or dependence four times higher than that of nonviolent men (Murphy et al. 2005). In longitudinal survey studies, wives reported that their husbands inflicted more severe violence when the husbands were drinking alcohol than when they were not drinking alcohol (see Murphy et al. 2005). In a study of men in treatment for alcoholism, there was a ten times higher rate of the men committing IPV on days of heavy drinking than on sober days, and heavy drinking also increased the likelihood of severe IPV (Fals-Stewart 2003). Between 33 and 50 percent of IPV incidents reported to the police involve a perpetrator who has been drinking alcohol (see Roberts 2002). Alcohol use also is frequently present in IPV homicides. About 40 percent of men convicted of murdering their female partners had been drinking at the time of the murder (see Wilson et al. 2000). Research also has found that non–substance using partners are at an increased risk of intimate partner homicide if they live in a home with an alcohol or illicit drug user (see Bailey et al. 1997).
Is heavy drinking or alcohol abuse more strongly related to IPV than socially drinking alcohol? Studies have noted that alcohol use alone has a modest relationship to IPV, whereas heavy or binge drinking has a stronger relationship with IPV (see Acierno, Coffey, and Resnick 2003). Research also suggests that IPV involving alcohol abuse is associated with more severe injuries and more chronic IPV. In samples of married men entering alcohol treatment, 50 to 70 percent have committed IPV in the past year and 20 to 30 percent report committing severe violence. Moreover, men with alcohol abuse problems have two to four times higher rates of perpetrating IPV than nonalcoholic men. Women with alcohol abuse problems, compared with nonalcoholic women, are twice as likely to perpetrate violence against their husbands, and wife-perpetrated IPV is twice as likely to occur when the husband has an alcohol problem.
II. Prevalence of Illicit Drug Use in Intimate Partner Violence Incidents
Several studies indicate that a significant proportion of domestic violence cases involve illicit drug use or perpetrators with illicit drug abuse problems. Prior studies of incarcerated domestic batterers indicate that 24 percent reported using illicit drugs alone or more commonly in combination with alcohol at the time of the offense and that 22 percent reported a history of illicit drug addiction. Based on reports from abused women, one assailant in five (21.8 percent) used both alcohol and drugs, and close to one-third used illicit drugs, with the most prominent drugs of choice being marijuana, cocaine, and amphetamines (see Wilson et al. 2000).
Stimulants, such as cocaine, heroin, and crack, are more consistently associated with IPV than are other types of illicit drugs (see Boles and Miotto 2003). Crack and cocaine use increased both the likelihood of IPV victimization and the commission of IPV. The relationship between marijuana use/abuse and IPV has not received as much attention compared with other illicit drugs. In a fifteen-month longitudinal study, researchers compared the likelihood of IPV on days when male partners were using substances and on days when they were not using substances. The use of alcohol and cocaine significantly increased the daily likelihood of male-to-female IPV, whereas the use of marijuana and opiates did not increase male-to-female IPV (see Acierno et al. 2003).
Based on self-reports from domestic batterers who were court referred to enter batterer treatment, illicit drug use predicts the perpetration of IPV and psychological abuse against a partner after removing the influence of alcohol use/abuse (Todd and Stuart 2004). Moreover, illicit drug use compared with alcohol abuse is shown to be a stronger predictor of IPV in several studies (see Wilson et al. 2000). In a sample of male addicts, an early onset of drug/alcohol-related problems and a history of illicit drug use—particularly cocaine use—were related to being a perpetrator of domestic violence. Illicit drug abusers may inflict more severe injuries than alcohol-only abusers and are much more likely to commit repeated IPV compared with domestic batterers who use only alcohol (see Wilson et al. 2000).
III. Is the Relationship between Substance Use and Intimate Partner Violence Spurious?
Research supporting the relationship between substance use and IPV does not explain why substance use/abuse is related to the perpetration of IPV. One possibility is that substance use/abuse does not really increase the risk of committing IPV. The linkage between substance use and IPV may occur because IPV and substance use/abuse are associated with the same demographic or environmental factors; in short, the relationship is spurious. For example, people holding attitudes supportive of IPV may be more likely to use alcohol and/or illegal drugs and more likely to commit violence (‘‘drunken bum’’ theory); thus, the attitudes rather than substance use directly influence the perpetration of IPV, and substance use does not have any causal relationship to committing IPV (see Johnson 2001). Several recent studies have disconfirmed the spurious explanation. These studies have found that alcohol abuse and illicit drug use are the strongest predictors of the commission of IPV after removing the influence of demographic, environment, and background factors (see Coker et al. 2000). Research has found that problem drinking is related to violence even after the influence norms supportive of aggression and social class are removed (see White and Chen 2002). For example, in a sample of 772 women surveyed at a health clinic, their male partners’ alcohol use was significantly associated with the commission of IPV after the effects of age, employment, race, the battered woman’s substance abuse, violence in the family of origin, and access to guns were removed (Coker et al. 2000).
IV. Does Substance Use/Abuse Cause Perpetrators to Commit Intimate Partner Violence?
Researchers still debate whether substance use/ abuse causes perpetrators to commit IPV. The biological disinhibition explanation asserts that alcohol lowers inhibitions against aggression directly through biochemical or physiological changes; and because of these physiological changes, alcohol users become violent toward their partners. This explanation does not explain the linkage of alcohol use/abuse with IPV because experiments have found that when people are not given alcohol but think they are drinking alcohol, aggression increases. Alcohol does not cause biochemical changes that increase aggression; instead, people’s expectations about the effects of alcohol determine the relationship between alcohol and IPV. Thus, what people expect alcohol to do is a better explanation than is biological disinhibition. Moreover, research has found that individuals who report strong expectations of aggression following alcohol consumption were three times more likely to perpetrate IPV than those who did not hold such expectations (Field, Caetano, and Nelson 2004). Cross-cultural research also supports the finding that expectations determine the relationship between alcohol and IPV. Thus, individuals may drink alcohol to provide an excuse for their planned violence (see Roberts 2002).
Moreover, most binge drinkers do not commit IPV, and treated alcoholics do not refrain from IPV. Battered women have reported that batterers increased threats, isolation, and psychological abuse when the batterers were abstaining from substance use as part of their substance abuse treatment (see Roberts 2002). Furthermore, research has not found a link between alcohol and other forms of coercive control such as limiting access to education or resources, limiting access to friends and family, and surveillance or stalking. Thus, as noted previously, a better explanation than biological disinhibition is that alcohol’s relationship to IPV depends upon people’s expectations about its effects. When people expect to become more aggressive after consuming alcohol, they are more likely to be violent than are people who expect to become relaxed after consuming alcohol.
Additionally, abuse of or dependence on alcohol or illicit drugs may indirectly increase IPV through lowering marital satisfaction and increasing conflict. Research has found that alcohol and drug use is a frequent topic of discussion during conflicts involving IPV (Murphy et al. 2005). Experiments in which intimate partners are asked to discuss their most serious area of conflict have found that partners had increased negative verbal interactions when under the influence of alcohol compared with those who were given no alcohol or who were given a placebo that they thought was alcohol (see Fals-Stewart 2003). Illicit drug or alcohol use/ abuse over time may facilitate conflict between couples and have an indirect effect on IPV. Supporting this explanation, substance-using men are significantly more likely to engage in psychological abuse such as insulting their partners and calling them derogatory names (Coker et al. 2000). Moreover, in one study, the strongest predictor of IPV was name-calling and put-downs in the relationship, and after controlling for psychological abuse, alcohol abuse was not related to IPV (Johnson 2001). Research has found that problem drinking has an indirect effect on IPV through increasing marital dissatisfaction, and the direct relationship between problem drinking and IPV is eliminated when marital dissatisfaction is included as a predictor for both male- and female-perpetrated IPV (White and Chen 2002).
Other research, however, suggests that additional cognitive, environmental, or interpersonal processes may account for the link between substance abuse and the commission of IPV. Some research shows that marital discord and psychological abuse do not completely explain the link between substance abuse and IPV. For example, after controlling for demographic factors, hostility, and marital satisfaction, heavy drinking still substantially increased the risk of perpetrating IPV as well as becoming a victim of IPV. Moreover, other research has found that both psychological abuse and illicit drug use were significant predictors of repeat IPV (see White and Chen 2002).
V. The Link between Substance Use/Abuse and Intimate Partner Violence: Does It Vary across Contexts and Groups?
The relationship between substance use/abuse and IPV may differ across social groups and environments. The differential threshold theory asserts that some people may have lower inhibitions against committing violence or more motivation to commit violence than other people (see Fals- Stewart et al. 2005). Support for differential inhibitions against committing violence has been found in comparisons between men with antisocial personality disorder and men who do not have antisocial personality disorder. Fals-Stewart and colleagues (2005) found that men who have antisocial personality disorder are inclined to commit nonsevere IPV, whether intoxicated or not. By contrast, men who do not have antisocial personality disorder are more likely to commit IPV when drinking alcohol than when they are sober. The theory suggests that alcohol lowers inhibitions against nonsevere violence for men who do not have antisocial personality disorder, whereas those with antisocial personality disorder have few inhibitions against committing nonsevere violence. Alcohol drinking lowers inhibitions against committing severe IPV among men with antisocial personality disorder, and these men are more likely to commit severe violence when drinking than when sober. For men who do not have antisocial personality disorder, drinking alcohol is not related to committing severe violence, suggesting that alcohol does not sufficiently lower the inhibitions against severe violence among the general population.
Individuals who are living in poverty or facing racial discrimination or low wages and lack of advancement due to dropping out of high school experience much stress associated with struggling to meet basic needs. Studies have found that women living in poverty are particularly vulnerable to and have much higher rates of IPV victimization and that batterers who are unemployed and/or are high school dropouts are more likely to commit injury-related IPV (see Johnson 2001). Individuals having a low social status may also turn to drugs and alcohol to cope with daily stress, which in turn produces more stress by using their limited money for self-medication rather than to support their family. Substance use also may have a stronger relationship with committing IPV among minorities because of the additional stress due to racial discrimination.
Thus, this argument suggests that a very stressful environment or a relationship that involves much conflict also may need to be present for substance use/abuse to serve as a partial impetus for IPV. Based on empirical studies, the relationship between alcohol abuse and IPV varies across ethnic background. After removing the influence of childhood victimization, approval of aggression, impulsivity, and length of the relationship, alcohol abuse by men or women and IPV were strongly related for African American couples but were not related for Hispanic couples. Among white couples, only women’s alcohol abuse was significantly associated with IPV (Caetano et al. 2001). Other research also has found that heavy alcohol use strongly predicts IPV for minorities but not whites (see Johnson 2001). Additional research needs to examine whether the relationship between substance use/abuse and the commission of IPV varies across living situations.
The research has produced inconsistent findings on whether the relationship between alcohol abuse and IPV is similar for men and women perpetrators. Alcohol abuse or dependence has been associated with IPV for both men and women perpetrators (e.g., Wilson et al. 2000); however, two studies suggest that alcohol abuse is more strongly related to male-perpetrated incidents of IPV (see Thompson and Kingree 2004).
VI. Relationship between Substance Use/Abuse and Intimate Partner Violence Victimization
Numerous studies have found that women using or abusing alcohol or illicit drugs are more likely to be victims of IPV (for a review, see Logan et al. 2002; Roberts 2002). Research estimates that adult victims of IPV have a five times higher rate of alcohol abuse and dependence compared with nonvictims. Women in alcohol treatment are twice as likely to have experienced verbal abuse, sexual abuse, and severe physical abuse as children. Moreover, across studies, battered women have an average prevalence rate of 18.5 percent for alcohol abuse and 8.9 percent for illicit drug abuse, whereas in the general population of women, the lifetime prevalence rate for alcohol abuse is 6.3 percent and 3.5 percent for drug abuse. Batterers also may force their partners to take illicit drugs (Roberts 2002). Across research studies, victims of child sexual abuse compared with nonvictims were significantly more likely to abuse alcohol or illicit drugs as adults and were more likely to start using alcohol and illicit drugs at an earlier age.
The relationship between substance use and victimization from partners may reflect the use of alcohol or illicit drugs to cope with previous victimization experiences. Victimization thus may stimulate individuals to begin using or increase their use of alcohol or drugs to cope with the pain and stress resulting from victimization. Moreover, some battered women may use substances to eliminate the fear of being physically attacked again by their partners (Roberts 2002). Longitudinal research supports the view that IPV victims increased their use of alcohol and drugs after their partners physically attacked them (Logan et al. 2002). Furthermore, research suggests that battered women who develop post-traumatic stress disorder may have the highest risk of developing an alcohol abuse or dependence problem.
Additionally, substance-using women may be more vulnerable and have a higher risk of becoming victims. Marijuana use and harder illicit drug use independently increased the chance of women experiencing IPV victimization across the following twelve months, but heavy drinking did not increase IPV victimization (see Acierno et al. 2003).
Substance-using individuals also may have a higher risk of IPV victimization due to their neighborhoods and social environments. Substance use, especially of hard illicit drugs, is associated with environments that have higher crime rates and cultures that are more supportive of violence. Supporting the risky-environment supposition, women who use crack or cocaine have an increased risk of being physically or sexually assaulted. Research has found that two-thirds to three-quarters of crack users reported that their partners physically attacked them after they started using crack. Several studies have found that the verbal and physical degradation of women is common practice in the crack-using population. Thus, illicit drugs may increase the risk of victimization through increasing exposure to more dangerous subcultures, neighborhoods, or social networks. Women who frequent bars or fraternity houses are more likely to be sexually assaulted because they come in contact with a greater number of young men who drink alcohol. Research has shown that women who more often visit bars have a higher rate of sexual assaults.
In addition, substance use may increase the risk of victimization because it impairs cognitive judgment and decision making. Studies show that a substantial percentage of victims were using illicit drugs or alcohol at the time of being physically attacked by intimate partners or being sexually assaulted. At least half of the sexual assault victims were using illicit substances or alcohol when they were sexually assaulted. Substance-using battered women are less likely to call the police because they believe that the police will be more likely to blame them or to discount their victimization due to their substance use/ abuse. Thus, substance-using battered women are more vulnerable to possible victimization.
VII. Treatment Modalities and Responsiveness
Substance use/abuse complicates the treatment modalities offered to domestic batterers. Although substance abuse may not cause the occurrence of domestic violence, substance abuse that is left untreated may impair batterers’ ability to understand and participate fully in batterer treatment programs. Moreover, substance-abusing batterers who do not undergo treatment for their substance abuse are more likely to drop out of batterer treatment programs (Daly and Pelowski 2000).
Substance-using victims often face many barriers to obtaining the services they need. Only about 10 percent of substance abuse counselors assess whether clients have been victims of IPV (Roberts 2002). Even when substance abuse treatment programs are aware of women’s IPV victimization, it is generally addressed only after completion of substance abuse treatment. Roberts (2002) identified several problems with making sobriety the top priority. The ‘‘sobriety first’’ approach ignores that women who are trying to stop substance use may be at an increased risk of being revictimized. Batterers generally do not tolerate their partners’ attempts to improve themselves and will try to regain control through any means. Moreover, batterers may attempt to sabotage the treatment process by preventing their partners from attending meetings, by keeping drugs or alcohol in the house, by forcing their partners to use substances, and by threatening violence if their partners do not drop out of treatment. Furthermore, women who are revictimized are more likely to relapse.
Substance-abusing victims also receive less assistance from domestic violence programs than victims without substance abuse problems. Most shelters will not admit substance-using battered women because they are perceived as a danger to themselves or others, neglectful toward their children, and unable to follow shelter rules. Even when shelters admit substance-using women, they often fail to conduct thorough assessments of their substance abuse treatment needs. The lack of integration and connection between substance abuse and domestic violence treatment providers further undermines their ability to provide the needed resources and help to substance-using battered women. Coordination initiatives and cross-training have begun. Philosophical differences in treatment, however, will need to be addressed before a truly intertwined and coordinated model of combined treatment can be developed. A few treatment models have started to address philosophical differences and create a more coordinated integrative treatment model for substance-using victims (see Logan et al. 2002; Roberts 2002).
See also:
Bibliography:
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