The role of alcohol and substance abuse in the occurrence of intimate partner violence

Kenneth LeonardResearch Institute on Addictions andThe Department of PsychiatryUniversity of Buffalo

Presentation at the American Psychological Association Violence Summit February 29, 2008

Contemporary Controversy

• Alcohol and Other Drugs are Key Causal Agents of Violence

– Jerry P. Flanzer- Chapter in Current Controversies on Family Violence

• Alcohol and Other Drugs are Associated with Violence-They Are Not Its Cause

– Richard J. Gelles

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

Countries with at least one controlled study finding an association between partner drinking and domestic violence

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

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.

• 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.

Odds ratio for different patterns of abuse as a function of partner alcohol /drug use in primary care sample

Coker, Smith, McKeown, & King, 2000

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

Strength of cross-sectional associations

• Lipsey, Wilson, Cohen, and Derzon (1997)• Across 34 studies of domestic violence and chronic

alcohol use, there was an effect size of .22• "We imagine dividing the aggregate sample into two

groups : those with no or low alcohol use and those with moderate to high use.... If 10% of the low-alcohol-use group engaged in domestic violence, then 20% of the high-alcohol-use group would also (p. 265)"

Lipsey, M.W., Wilson, D.B., Cohen, M.A., & Derzon, J.H. (1997). Is there a causal relationship between alcohol use and violence? A synthesis of evidence. Recent Developments in Alcoholism, 13, 245–282

Illustration of effect size impact on violence rates

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O’Leary, K.D., & Schumacher, J.A. (2003). Addictive Behaviors, 28, 1575-1585.

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– is probably the result of the acute effects of

alcohol

Husband Report Wife Report____________________________________________________________________________________

Verbal Moderate Severe Verbal Moderate SevereN=218 N=45 N=61 N=211 N=44 N=67

____________________________________________________________________________________

Alcohol InvolvedHusband Only 0.0% 8.9% 26.2% 7.1% 25.0% 28.4%Wife Only 8.3% 0.0% 6.6% 0.5% 0.0% 3.0%Both 3.2% 2.2% 11.5% 2.4% 2.3% 14.9%

Total Husband 3.2% 11.1% 37.7% 9.5% 27.3% 43.3%Total Wife 11.5% 2.2% 18.1% 2.9% 2.3% 17.9%

Alcohol Use Among Participants with Alcohol Use Among Participants with Verbal, Moderate Physical, or Severe Verbal, Moderate Physical, or Severe Physical Aggression EpisodesPhysical Aggression Episodes

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, 537-545.

Comparing conflict episodes with and without violence

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Murphy, C.M., Winters, J., O’Farrell, T.J., Fals-Stewart, W., & Murphy, M. (2005). Psychology of Addictive Behaviors, 19(1), 35-42.

Any Violence Severe Violence Any Violence Severe Violence0

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Domestic Violence Sample Alcoholic SampleFals-Stewart (2001)

Odds of violence (wife report) as a Odds of violence (wife report) as a function of drinking (husband report)function of drinking (husband report)

Fals-Stewart, W. (2003). Journal of Consulting and Clinical Psychology, 71, 41-52.

Key aspects of the alcohol/ domestic violence relationship.

• The relationship between excessive alcohol use and domestic violence– The relationship appears stronger among

individuals motivated to aggress

Moderators of the alcohol/domestic violence relationship

• Hostility (Leonard & Blane, 1992; Margolin, John ,& Foo,1998; Leonard, Schumacher, Homish, & Kearns,under review)

• Marital satisfaction (Leonard & Blane, 1992)

• Verbal aggression (Quigley and Leonard,1999 )

• Life stress (Margolin, John ,& Foo,1998)

• Negative affect (Leonard & Blane, 1992)

Prediction of Marital Aggression from Marital Satisfaction, Hostility, and Alcohol Dependence scores

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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

Negativity among High Antisocial and Low Antisocial Alcoholics and their wives as a function of alcohol

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Jacob, T., Leonard, K.E., & Haber, J.R. (2001). Family interactions of alcoholics as related to alcoholism. Alcoholism: Clinical & Experimental Research, 25, 834-843.

Aggressive verbalizations to angry scenarios

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Eckhardt, C.I. (2007). Effects of alcohol intoxication on anger experience and expression among partner assaultive men. Journal of Consulting & Clinical Psychology, 75(1), 61-71.

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Trait Anger Scale scores and Alcohol effects on Composite ATSS Aggressive Verbalizations.

Eckhardt, C.I. (2007). Effects of alcohol intoxication on anger experience and expression among partner assaultive men. Journal of Consulting & Clinical Psychology, 75(1), 61-71.

Key aspects of the alcohol/ domestic violence relationship.

• Successful treatment of alcoholism is associated with substantial reductions in domestic violence

Prevalence of violence after individually based alcoholism treatment

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Severe Violence

O’Farrell, T.J., Fals-Stewart, W., Murphy, M., & Murphy, C.M. (2003). Journal of Consulting & Clinical Psychology, 71, 92-102

And, the number of days drinking after treatment was significantly associated with overall violence

Severe aggression after treatment for couples treatment

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O’Farrell, T.J., Murphy, C.M., Stephan, S.H., Fals-Stewart, W., & Murphy, M. (2004). Journal of Consulting & Clinical Psychology, 72(2), 202-217.

Key aspects of the alcohol/ domestic violence relationship.

• The relationship between excessive alcohol use and domestic violence– Is probably the result of the acute effects of

alcohol • Successful treatment of alcoholism is associated with

substantial reductions in domestic violence• With respect to alcohol and domestic violence,

alcohol appears to be a contributing cause.

What are the major needs/gaps in the field

• Although there is evidence that other substance use is associated with domestic violence, it is not as extensive or as consistent as the evidence regarding alcohol

• And the processes underlying an association has not been investigated.

• For some drugs, the psychopharmacological effects may be consistent with an acute effect ( e. g cocaine, methamphetamine), but not for other drugs ( e.g. marijuana, ,opiates)

What are the major needs/gaps in the field

• The evidence is quite strong with respect to men’s drinking and men’s violence. It is less clear whether women’s drinking is important as a factor contributing either to her victimization or to her own aggression

What are the major needs/gaps in the field

• Although alcohol treatment has a positive impact among men who are seen in alcoholism treatment, it is unclear whether treatment of alcohol or substance abuse in criminal justice samples would have the same impact.

What are the major needs/gaps in the field

• It is also unclear whether prevention programs geared toward alcohol /substance use would prevent partner violence.

What are the major needs/gaps in the field

• There is a need to augment our treatments for alcoholism /substance abuse to prevent violence if the alcoholic relapses.

Major issues/barriers in overcoming theneeds/gaps

• Uncritical acceptance of the argument that alcohol has no causal relevance, and that it is only an excuse.

• Generalizing from findings based on very severe samples (criminal justice, shelters) to other samples (e.g. alcoholic, community).

• Increasing difficulty of conducting research on partner violence.

“if only….then I (we) could…” [the change the world question

Improve Parent-child Relationships and Parenting Behavior

Hostile propensities Self-regulation

Alcohol & Substance Abuse

Partner Violence

Bibliography

• Galanter , M (1997) (Vol. Ed.), Recent developments in alcoholism, Vol. 13, Alcohol and violence. (4th ed. , pp. 57-75). New York: Plenum Press.

• Leonard, K.E. & Eiden, R.D. (2007) Marital and Family Processes in the Context of Alcohol Use and Alcohol Disorders. Annual Review of Clinical Psychology. Volume 3, 207-232.

• Leonard, K. (In press). The Role of Drinking Patterns and Acute Alcohol Use in Violent Interpersonal Behaviors. In Understanding Patterns of Violence. Washington, DC: International Center for Alcohol Policies.

• Wekerle, C. & Wall, A. (2002)(Eds.), The violence and addiction equation: Theoretical and clinical issues in substance abuse and relationship violence Philadelphia, PA: Brunner/Mazel.