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).

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(Drug information on 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).

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.

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.