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The Role of Substance Abuse in Intimate Partner Violence

The Role of Substance Abuse in Intimate Partner Violence

Much of the violence reported in the literature involves intimate partner
violence (IPV) committed by men toward women, a pervasive problem in a
significant proportion of U.S.
families. Roughly 1,800 instances of homicide and manslaughter between intimate
partners occurred in 1998, with more than 1,300 of these involving women as
victims (Rennison and Welchans,
2000). The findings from the National Crime Victimization Survey indicate that
nearly 1 million women are victims of IPV each year (Rennison
and Welchans, 2000). Surveys of representative
samples of couples that include less severe instances of aggression (e.g.,
single episodes of pushing or slapping one's partner) suggested that 8.7 million
couples experience an incident of physical violence from within the dyad each
year (Straus and Gelles, 1990). Additionally, a
survey of U.S.
couples indicated more than one in five experienced at least one episode of
violence during the previous year (Schafer et al., 1998).

IPV and Substance Abuse

Intimate partner violence is a major public health concern. Substance use
has been found to co-occur in 40% to 60% of IPV incidents across various
studies (Easton et al., 2000a, 2000b; Fals-Stewart et
al., in press; Moore and Stuart, 2004). Several lines of evidence suggest that
substance use plays a facilitative role in IPV by precipitating or exacerbating
violence (Fals-Stewart, 2003). Several studies
suggest the promise of interventions that target substance use in men who have
histories of IPV (Fals-Stewart, 2003; Fals-Stewart et al., in press; Moore and Stuart, 2004).

It is known that many IPV episodes involve alcohol or drug consumption.
Kaufman Kantor and Straus (1990) found over 20% of
males were drinking prior to the most recent and severe act of violence. Fals-Stewart (2003) found that on days of heavy drug use,
physical violence was 11 times more likely. Victims of IPV report that the
offender had been drinking or using illicit drugs (Miller, 1990; Roberts,
1998). Miller (1990) reported that offenders of IPV typically use alcohol and have a dual problem with drugs. In addition, the strong
relationship between substance use and perpetration of IPV has been found in
primary health care settings (McCauley et al., 1995), family practice clinics
(Oriel and Fleming, 1998), prenatal clinics (Muhajarine
and D'Arcy, 1999) and rural health clinics (Van Hightower and
Gorton, 1998). The relationship between substance abuse and IPV has also been
observed to be quite prevalent among individuals presenting at psychiatric
settings (Gondolf et al., 1991) and substance abuse
treatment facilities (Easton et al., 2000b).

A Proximal Effects Model

Three primary conceptual models have been posited to explain the observed relationship
between substance use and spousal violence: 1) spurious model; 2) indirect
effects model; and 3) proximal effects model (Fals-Stewart,
2003; Leonard and Quigley, 1999).

The spurious model suggests that the relationship between substance use and IPV
is the result of these variables being related to other factors that influence
both drinking and violence. For example, individuals who are young may tend to
be violent and to use drugs; thus, drug use and violence may appear directly
related when, in fact, they are not. Although not entirely consistent, the
results of several studies suggest that alcohol and other drug use are
associated with IPV after controlling for factors thought to be associated with
both behaviors such as age, education, socioeconomic or occupational status,
and ethnicity (e.g., Leonard and Jacob, 1988; Pan et al., 1994). However, the
relationship between substance use and violence remains strong even after
controlling for levels of general hostility (e.g., Leonard and Senchak, 1993) and normative views of aggression (Kaufman Kantor and Straus, 1990).

In the indirect effects model, substance use is viewed as being corrosive to
relationship quality. Thus, long-term substance use creates an environment that
sets the stage for partner conflict and, ultimately, partner violence. Again,
however, when marital satisfaction, relationship discord or other similar
variables are controlled for when examining the link between substance use and
violence, the relationship remains strong (e.g., McKenry
et al., 1995).

According to this model (Fals-Stewart, 2003),
individuals who consume psychoactive substances are more likely to engage in
partner violence because intoxication facilitates violence, which may be
mediated through the psychopharmacologic effects of drugs on cognitive
processing (Chermack and Taylor, 1995) or the
expectancies associated with intoxication (Critchlow,
1983). It follows from this theory that substance use should precede IPV and
the episode of violence should occur closely in time to the consumption of the
drug. Several longitudinal studies supported temporal ordering consistent with
this model. Fals-Stewart (2003) collected daily
diaries from partners with histories of IPV entering either an alcoholism or
domestic violence treatment program over a five-month period, which allowed for
a detailed examination of the daily temporal relationship between
male-to-female aggression and drinking. The data suggested that alcohol and
male-to-female aggression were linked only on days when the drinking occurred
before the IPV episode. The odds of severe male-to-female physical aggression
were more than 11 times higher on days of men's drinking than on days of no
drinking. Moreover, in both samples, over 60% of all IPV episodes occurred
within two hours of drinking by the male partner. These findings were recently
replicated with another sample of men entering treatment for drug abuse (Fals-Stewart et al., 2003).

Three conceptual models have been put forth to explain the relationship
between alcohol use and violence. Although each may have some merit and may, in
fact, explain part of the relationship between substance use and violence, the
greatest empirical support rests with the proximal effects model (Fals-Stewart, 2003). Hence, it is reasonable that
interventions targeting substance use among men with histories of IPV and
substance use may lead to reductions in partner violence.

Referral for Treatment

Currently, men convicted for IPV are referred to batterer/IPV programs
(e.g., the Duluth Model). The program uses a psychoeducation
structure; actual behaviors are identified and challenged by facilitators, who
model alternative behaviors and solutions to conflict. This approach often
treats men with IPV in a classroom setting with 10 to 20 men in a group format.
This method has the following limitations: 1) lack of structured/standardized
assessments to rule out co-occurring psychiatric or substance abuse disorders;
2) lack of objective indicators to rule out current substance use (e.g., breath
samples, urine toxicology screening); 3) lack of collateral data from the
victim regarding ongoing abuse; and 4) lack of other therapeutic options for
men who request additional or other treatments (e.g., individual therapy, psychiatric
consultation, parenting, couples therapy) (Babcock and LaTaillede,
2000).

In addition to these limitations, there is very little empirical support
regarding the effectiveness of the Duluth Model in reducing violence or
substance use (Babcock and LaTaillede, 2000). In
fact, meta-analytic reviews of outcomes for these approaches have consistently
found them to be of very limited effectiveness, with effect sizes near zero
(Babcock and LaTaillede, 2000). Many batterer
programs do not address substance use, are highly confrontational in nature and
reach far fewer individuals than substance abuse treatment programs. Hence, it
is likely that focusing on IPV with men who batter within the context of a
substance abuse treatment facility may reach a comparatively larger number of
individuals with IPV.

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