Alcohol Use and Predictors of Intimate Partner Violence: A ... · • The model assumes IPV occurs...
Transcript of Alcohol Use and Predictors of Intimate Partner Violence: A ... · • The model assumes IPV occurs...
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Alcohol Use and Predictors of Intimate
Partner Violence: A framework for
understanding moderation in the alcohol-
aggression relationship. Addressing intimate partner violence among substance
misusers: advancing aetiologies and treatment approaches
Conference sponsored by the Economic and Social
Research Council. Rochester, New York
July 21, 2014
Kenneth Leonard
Research Institute on Addictions and
The Department of Psychiatry
University of Buffalo
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Goals of this talk
• Review key aspects of alcohol-violence
relationship.
• Discuss the challenges of studying moderation
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Key aspects of the alcohol/
domestic violence relationship. • The relationship between excessive alcohol use and
domestic violence
– has been observed in many different cultural
contexts
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Netzahualcoyotl of Texcoco
• “It [alcohol] is like a tornado
that destroys everything in its
path. It is like a hellish
tempest that brings with it all
evils. Drunkenness … causes
violence among kinfolks.
Yelling and brawls are
caused by octli and its
accompanying drunkenness (Soustelle, 1955 cited in Paredes, 1975
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Countries with at least one controlled study finding an association
between partner drinking and domestic violence
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Key aspects of the alcohol/
domestic violence relationship. • The relationship between excessive alcohol use and
domestic violence
– has been observed in many different cultural
contexts
– has been found across many different kinds of
samples
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Samples / representative studies supporting alcohol/ domestic
Violence association.
• Alcoholic/substance abuse samples
– O’Farrell, T.J., Fals-Stewart, W., Murphy, M., & Murphy, C.M.
(2003). Journal of Consulting & Clinical Psychology, 71, 92-102.
• Batterers
– Stuart, G.L . , Meehan, J.C., Moore, T.M., Morean, M. ,Hellmuth, J.,
& Follansbee., K. Journal of Studies on Alcohol. Jan 2006 v67 i1
p102(11).
• Emergency Room
– Kyriacou, D.N., McCabe, F., Anglin, D., Lapesarde, K., & Winer,
M.R. (1998). Annals of Emergency Medicine, 31, 502-506.
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Samples / representative studies supporting alcohol/ domestic
Violence association.
• Prenatal and Antenatal Clinics
– Muhajarine, N., & D’Arcy, C. (1999). Canadian Medical Association
Journal, 160, 1007-1011.
• Primary Care Settings
– Coker, A.L., Smith, P.H., McKeown, R.E., & King, M.J. (2000).
American Journal of Public Health, 90, 553-559.
• Community and representative samples
– Kaufman Kantor, G., & Straus, M.A. (1990).. In M.A. Straus & R.J.
Gelles (Eds.), Physical violence in American families: Risk factors and
adaptations to violence in 8,145 families (pp. 203-224). New
Brunswick, NJ: Transaction Publishers.
– Arseneault, L., Moffitt, T.E., Caspi, A., Taylor, P.J., & Silva, P.A.
(2000). Archives of General Psychiatry, 57, 979-986.
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Key aspects of the alcohol/
domestic violence relationship. • The relationship between excessive alcohol use and
domestic violence
– has been observed in many different cultural
contexts
– has been found across many different kinds of
samples
– represents an association of at least moderate
strength
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Meta-analyses across cross-sectional studies
show that the relationship largely consistent.
Lipsey, Wilson, Cohen, and Derzon (1997)
N=67 N=29 N=34
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Strength of cross-sectional associations
• Lipsey,Wilson, Cohen, and Derzon 1997
– 34 studies of domestic violence including child abuse
– Effect size .22
• Stith, Smith, Penn, Ward, & Tritt, 2004
– 22 studies of partner violence and alcohol use
– Effect size .24
• Foran and O’Leary, 2008
– 50 studies of partner violence and alcohol
– Effect size .23
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Key aspects of the alcohol/
domestic violence relationship. • The relationship between excessive alcohol use and
domestic violence
– has been observed in many different cultural
contexts
– has been found across many different kinds of
samples
– represents an association of at least moderate
strength
– the acute effects of alcohol contribute to the
violence, even in chronic heavy drinker
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Husband and wife alcohol use in conflict
episodes
Husband alcohol use Wife alcohol use Leonard, K.E., & Quigley, B.M. (1999). Drinking and marital aggression in newlyweds: An event-based analysis of
drinking and the occurrence of husband marital aggression. Journal of Studies on Alcohol, 60(4), 537-545. Reproduced
with permission of the publisher
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Comparing conflict episodes with and
without violence
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
0.16
0.18
0.2
absent present
HBAC
WBAC
0
0.02
0.04
0.06
0.08
0.1
0.12
0.14
0.16
absent present
HBAC
WBAC
Murphy, C.M., Winters, J., O’Farrell, T.J., Fals-Stewart, W., & Murphy, M. (2005).
Psychology of Addictive Behaviors, 19(1), 35-42. . Published by the American
Psychological Association and adapted with permission.
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Alcohol involvement in Police-Citizen
Encounters
Crime Type Percent Alcohol
involved
Odds Ratio N
Violent crime/sexual assault 43.3 2.5 250
Spousal Assault 43.4 2.5 103
Robbery 39.1 2.1 ns 36
Public order, vandalism 46.1 2.8 250
Nonviolent crimes 23.4 597
McClelland & Teplin, Alcohol intoxication and violent crime: Implications for public health policy
The American journal on addictions, 10 (supplement), 70-85, 2001
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Experimental Studies of Alcohol and
Physical Aggression
• General Methodological Approach
– Random Assignment to alcohol versus control,
which is sometimes no alcohol, sometimes
placebo, sometimes both.
– Experimental Context is which mild aggressive
behavior (usually shock or noise) is enabled.
– Often the context includes manipulation of other
variables.
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Meta-analyses of Experimental Studies of Alcohol and
Physical Aggression
Ito, Miller, & Pollock, 1996
Bushman, 1997
Effect sizes compared to no alcohol control
Alc. w/out aware -0.01
Placebo 0.1
Alcohol 0.43
Effect sizes of different alcohol levels
compared to no alcohol controls.
Low BAC .35
High BAC .53
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Experimental Studies of Alcohol and
Aversive Verbal Behavior
• Seen as more ecologically valid than other
aggression paradigms
– Less artificial than reaction time or teacher learner.
– Verbal aggression more natural response than
setting shock
– Links between verbal aggression and physical
aggression
– Primarily has been used in studies of intimate
partners.
*
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Negativity as a function of alcohol
condition and time Husband Wife
Leonard, K.E., & Roberts, L.J. (1998). The effects of alcohol on the marital interactions of aggressive
and nonaggressive husbands and their wives. Journal of Abnormal Psychology, 107(4), 602-615. .
Published by the American Psychological Association and adapted with permission.
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Key aspects of the alcohol/
domestic violence relationship. • Alcohol does not increase violence for everyone,
there are numerous factors that moderate the
relationship.
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Challenges to understanding moderation
• Virtually unlimited number of moderators
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Moderators of the alcohol/violence
relationship
• Hostility (Leonard & Blane, 1992)
• Marital satisfaction (Leonard & Blane, 1992)
• Verbal aggression (Quigley and Leonard,1999 )
• Life stress (Margolin, John ,& Foo,1998)
• Negative affect (Leonard & Blane, 1992)
• Social Support (Caldeira and Woodin, 2012)
• Mindfulness (Gallagher, Hudepohl, & Parrott, 2010)
• Cognitive Reappraisal Ability (Stappenback & Fromme, 2013)
• Locus of Control (Gallagher & Parrott, 2010)
• Jealousy (Foran & O’Leary, 2008)
• Impulse Control (Watkins, Maldonado, & DiLillo 2014)
• Trait Displaced Aggression (Denson, White, & Warburton, 2009)
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Alcohol, Hostility, and Escape Coping
Schumacher, Homish, Leonard, Quigley & Kearns-Bodkin , Longitudinal Moderators of the Relationship Between Excessive
Drinking and Intimate Partner Violence in the Early Years of Marriage, Journal of Family Psychology
2008, Vol. 22, No. 6, 894–904. Published by the American Psychological Association and adapted with permission
Low hostility High hostility
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Alcohol should be most strongly associated with aggression when
there are strong aggression facilitating and weak inhibitory
factors.
Parrot and Giancola (2004) conducted an experimental study
and found that alcohol led to the largest increase in aggression
relative to placebo for participants who were high in trait
anger and low in anger control.
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Interaction of husband alcohol use and husband executive
cognitive functioning predicting husband ->wife aggression
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Interaction of male alcohol use and executive cognitive
functioning predicting shock settings.
Giancola, PR (2004) Executive functioning and alcohol-related aggression. Journal of Abnormal
Psychology, 114(4), 541-555. Published by the American Psychological Association and adapted
with permission.
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Interaction of husband alcohol use and husband perceived
emotional support predicting husband ->wife aggression
Caldeira and Woodin, (2012) found that high alcohol use
was associated with husband to wife aggression only among
those in low perceived emotional support.
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Alcohol should be most strongly associated with aggression when
there are strong aggression facilitating and weak inhibitory
factors.
Low provocation High Provocation
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Challenges to understanding moderation
• Virtually unlimited number of moderators
• The potential for interactions to involve two or
more moderators.
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Prediction of Marital Aggression from Marital
Satisfaction, Hostility, and Alcohol Dependence scores
0
0.1
0.2
0.3
0.4
0.5
0.6
Low ADS High ADS
L MS
H MS
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
Low ADS High ADS
L MS
H MS
Leonard, K.E., & Blane, H.T. (1992). Alcohol and marital aggression in a national sample of
young men. Journal of Interpersonal Violence, 7(1), 19-30.
Low Hostility High Hostility
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Challenges to understanding moderation
• Virtually unlimited number of moderators
• The potential for interactions to involve two or
more moderators.
• Counterintuitive findings
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Low Alc Problems High Alc Problems
Current alcohol problems
1
1.5
2
2.5
3
3.5
4
Pa
role
e t
o S
po
us
e V
iole
nc
e Low Criminal Violence
High Criminal Violence
Parolee to spouse violence by Parolee to spouse violence by self reported criminal violence self reported criminal violence and current alcohol problemsand current alcohol problems
Blane, Miller, Leonard, Nochajski,
Bowers, & Gondoli, 1988
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Interaction of Jealousy and Anger Control
Foran & O’Leary (2008)
Males with high jealousy and problems with anger
control were aggressive irrespective of alcohol use.
Males who were low in jealousy were low in
aggression irrespective of alcohol use.
Males who were jealous, but who had good anger
control, were more aggressive if they were also
problem drinkers.
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Addressing these challenges
• A consideration of outcomes, occurrence vs
severity vs frequency.
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Husband and Wife Alcohol Dependence scores as
predictors of occurrence vs frequency of H->W violence
Probability of Occurrence Frequency
Testa, M., Kubiak, A., Quigley, B.M., Houston, R.J., Derrick J.L., Levitt, A., Homish, G.G., & Leonard, K.E. (2012). Husband and wife alcohol use as
independent or interactive predictors of intimate partner violence. Journal of Studies on Alcohol and Drugs, 73(2), 268-276.
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Addressing these challenges
• A consideration of outcomes, occurrence vs
severity vs frequency.
• A consideration of cognitive neuroscience
observations into our approaches.
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Threat sensitivity
(Amygdala)
Poor Decision making
Poor Inhibitory control
(PFC)
Empathy Attachment
(Amygdala) Instrumental
aggression
Under-regulated
response to social
provocation
Threat-based
reactive aggression
Conceptual linkage between cognitive processes and violence
Blair, R. J. R. (2013). The neurobiology of psychopathic traits in youths. Nature Reviews:Neuroscience, 786-799.
Published by Macmillan Publishers Limited
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Threat sensitivity
(Amygdala)
Poor Decision making
Poor Inhibitory control
(PFC)
Empathy Attachment
(Amygdala)
Some moderators are directly related to these systems, others are
combinations of these systems, others may be outgrowths of
these systems
Marital satisfaction
History of Aggression
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Threat sensitivity
(Amygdala)
Poor Decision making
Poor Inhibitory control
(PFC)
Empathy Attachment
(Amygdala)
Some moderators are directly related to these systems, others are
combinations of these systems, others may be outgrowths of
these systems
(Blair, 2013)
Angry expression
Emotion Regulation
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Threat sensitivity
(Amygdala)
Poor Decision making
Poor Inhibitory control
(PFC)
Empathy Attachment
(Amygdala)
Some moderators are directly related to these systems, others are
combinations of these systems, others may be outgrowths of
these systems
Social support
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Addressing these challenges
• A consideration of outcomes, occurrence vs
severity vs frequency.
• A consideration of cognitive neuroscience
observations into our approaches.
• A consideration of dyadic factors
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Interaction of wife alcohol use and husband negative affect
predicting husband ->wife aggression
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Addressing these challenges
• A consideration of outcomes, occurrence vs
severity vs frequency.
• A consideration of cognitive neuroscience
observations into our approaches.
• A consideration of dyadic factors
• A consideration of the total load of instigatory
and inhibitory factors
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Multiple Thresholds Model
• Aggression occurs as a function of external provocations, aggressive
motivations, and inhibitory processes.
• Provocation increases aggressive motivations and decreases aggressive
inhibitions.
• The model assumes IPV occurs when an individual’s aggression threshold
is exceeded; that is, when the strength of the aggressive motivations
exceeds the strength of the inhibitions.
• There may be multiple thresholds, e.g. moderate and severe aggression,
or a threshold and then a linear effect.
• Intoxication is hypothesized to lower these aggression thresholds by
impairing inhibitions through its effect on cognitive functioning
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One unit provocation
Aggression Curve For Individuals with Weak
Aggressive Motivations and Strong Aggressive Inhibitions
Aggressive Motivations Aggressive Inhibitions
Aggressive
threshold
Provocation
Two unit provocation
Inhibition reduced
by drinking
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One unit provocation
Aggression Curve For Individuals with Moderate
Aggressive Motivations and Moderate Inhibitions
Aggressive Motivations Aggressive Inhibitions
Aggressive
threshold
Provocation
Two unit provocation
Inhibition reduced
by drinking
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One unit provocation
Aggression Curve For Individuals with Strong
Aggressive Motivations and Low Inhibitions
Aggressive Motivations
Aggressive Inhibitions
Aggressive
threshold
Provocation
Two unit provocation
Inhibition reduced
by drinking
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One unit provocation
Aggression Curve For Individuals with Strong
Aggressive Motivations and Low Inhibitions for Severe Violence
Aggressive Motivations
Aggressive Inhibitions
Aggressive
threshold
Provocation
Two unit provocation
Inhibition reduced
by drinking
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Clinical implications