The interplay between substance use and intimate partner violence perpetration: A meta-ethnography

BackgroundThe relationship between intimate partner violence (IPV) perpetration and substance use is not well understood. We conducted a meta-ethnography of qualitative studies to explore how substance use features in survivors’ and perpetrators’ accounts of IPV perpetration.MethodsQualitative studies from 1995 to 2016 were identified from PsycINFO, ASSIA and Web of Science, with an update in PsycINFO and ASSIA to December 2017. 7654 abstracts were screened for accounts of heterosexual IPV perpetration, then full-texts were screened for mentions of substance use. Key concepts from 26 qualitative studies (363 female survivors’ and 219 male perpetrators’ views) were synthesised to develop a grounded theory that put similarities and differences between studies into an interpretive order.ResultsSix themes emerged: five related to the complex interplay between substance use and IPV perpetration in the context of intoxication, withdrawal and addiction, impact on relationship and wider dynamics of power and control and psychological vulnerabilities; a final theme related to survivors’ agency and resistance to IPV perpetration. Survivors and perpetrators noted how both intoxication and withdrawal could pre-empt IPV perpetration. Survivors, however, were more likely to see intoxication and withdrawal as part of a pattern of abusive behaviour, whereas perpetrators tended to describe a causal relationship between intoxication and discrete incidents of IPV perpetration. Irritability and frustration during withdrawal from or craving alcohol, heroin and stimulants, and/or a failure or partner refusal to procure money for drugs increased the likelihood of violence. Survivors were more likely than perpetrators to identify abuse in relation to the impact of substance use on their relationship and dynamics of power and control.ConclusionThe interplay between substance use and IPV perpetration occurs at numerous contextual levels and is perceived differently by perpetrators and survivors. Behaviour change interventions must address the meanings behind divergent narratives about IPV perpetration and substance use.     

Prediction of intimate partner violence by type of substance use disorder

The present study investigated whether (combinations of) specific substance use disorders predicted any and severe perpetration and victimization in males and females entering substance abuse treatment. All patients (N = 1799) were screened for IPV perpetration and victimization; almost one third of the sample committed or experienced any IPV in the past year. For males, an alcohol use disorder in combination with a cannabis and/or cocaine use disorder significantly predicted any IPV (perpetration and/or victimization) as well as severe IPV perpetration. For females, alcohol and cocaine abuse/dependence predicted both any IPV (perpetration and/or victimization) and severe IPV perpetration. Results from the present study emphasize the importance of routinely assessing IPV in patients in substance abuse treatment and demonstrate that clinicians should be particularly alert for IPV in patients with specific substance use disorder combinations.     

Harmful alcohol use as a predictor of intimate partner violence during the transition to parenthood: Interdependent and interactive effects

Harmful alcohol use is known to increase the risk of intimate partner violence (IPV), however very little is known about the role of alcohol use during the transition to parenthood. The current study was designed to examine harmful alcohol use as a dyadic and interactive time-varying risk factor for psychological and physical IPV across the transition to parenthood using a sample of 98 couples assessed prenatally and again at one and two years postpartum. Longitudinal actor–partner interdependence models demonstrated that changes in harmful alcohol use during the transition to parenthood were significantly related to changes in psychological IPV for both men and women and with physical IPV for men only, whereas harmful alcohol use was actually negatively related to variations in women's physical IPV. Partners' harmful use of alcohol during the transition to parenthood also explained additional variance in psychological IPV for men and physical IPV for women over time. Time-varying interactions between actors' and partners' harmful alcohol use were additionally predictive of greater psychological IPV for women and greater physical IPV for both men and women. Contrary to some past research, time-varying discrepancies in levels of harmful alcohol use between men and women were related to a lower risk of psychological IPV for women and physical IPV for both genders. Findings from this study indicate that harmful alcohol use by both men and women combines in a dyadic and interactive manner to place couples at risk for IPV during the transition to parenthood. Prenatal interventions may benefit from strategies to reduce the harmful use of alcohol by both men and women during the prenatal and postpartum periods.     

Treatment of co-occurring alcohol dependence and perpetration of intimate partner violence: The role of anger expression

The purpose of the current study was to examine the role of high self-reported anger on violence and substance use across treatment. Seventy-three, alcohol-dependent males, with a domestic violence arrest within the past year, completed baseline anger measures and engaged in a 12 week cognitive behavioral therapy or 12 step facilitation group. Monthly assessments of substance use and violence were completed. At baseline, participants high on anger expression reported more physical violence in the prior month and more violent arrests. Participants high on anger expression had a greater proportion of positive breathalyzers across treatment, higher frequency of reported drug use across treatment, and higher reported frequency of verbal violence at discharge. These findings suggests that participants who are high on anger expression may need longer-term or more intensive treatments to maintain gains made during treatment because of the increased risk of relapse to both substance use and violence.     

The role of smoking expectancies in the relationship between PTSD symptoms and smoking behavior among women exposed to intimate partner violence

Intimate partner violence (IPV) is a public health problem associated with negative health consequences, including higher rates of tobacco smoking. Smoking expectancies are related to motivation to quit and relapse. IPV-exposed women endorse higher rates of PTSD symptoms, which are related to smoking and smoking expectancies. The present study sought to examine the relationship among smoking behavior, smoking expectancies, and PTSD symptoms among IPV-exposed women. Participants were 83 women who reported experiencing IPV within the last month, smoked an average of 12 cigarettes per day, and reported moderate levels of nicotine dependence (FTND mean=4.4). Participants completed baseline and follow-up interviews. Multiple regression analyses assessed the relationships among smoking expectancies and PTSD symptoms to cigarettes smoked per day and nicotine dependence. Findings demonstrated that Stimulation/State Enhancement expectancies were positively related to cigarettes per day, whereas PTSD arousal symptoms were negatively related to cigarettes per day, p's<.05. Neither smoking expectancies nor PTSD symptoms were significantly related to nicotine dependence. Supplemental analyses revealed that PTSD re-experiencing symptoms were negatively related and PTSD avoidance/numbing symptoms were positively related to Stimulation/State Enhancement expectancies, p's<.05. This study extends findings regarding the association between PTSD symptoms and smoking among an understudied population - IPV-exposed women. The relationship between PTSD symptoms and smoking differed across PTSD symptom clusters and expectancy scales, which may have implications for treatment development. The fact that expectancies and PTSD symptoms are related to smoking behavior among IPV-exposed women may be important for enhancing prevention and intervention efforts.     

Effect of co-occurring disorders and intimate partner violence on substance abuse treatment outcomes

This retrospective cohort study examined risk factors for co-occurring substance use and mental disorders (COD) and the effect of COD and intimate partner violence (IPV) victimization among women and IPV-related arrest among men on 1-year substance abuse treatment outcomes. The study sample included clients admitted to Washington State publicly funded substance abuse treatment facilities in 2004–2007. COD was associated with a high substance use and IPV risk profile at admission. Having a COD decreased the odds of completing treatment by 30% among men and women and increased the risk of treatment reentry by 9% and 12% among men and women, respectively. IPV also decreased the odds of completing treatment among women and increased the risk of treatment reentry among men. Men with COD were less likely than those without COD to be arrested for substance-related crimes but more likely to be arrested for violence-related crimes in the follow-up period. Implications of these findings are discussed.     

Women's substance use and experiences of intimate partner violence: a longitudinal investigation among a community sample

Although cross-sectional studies reveal an association between women's substance use and experiencing physical violence from one's intimate partner, the temporal ordering of these variables is not clearly established. The current study involved longitudinal examination of the association of women's substance use with subsequent experiences of intimate partner violence as well as the association between women's experiences of intimate partner violence and their subsequent substance use. Women ages 18-30 who were in heterosexual relationships (n=724) were recruited through random digit dialing in the Buffalo, NY, area. Within ongoing relationships, women's use of hard drugs was associated with increased odds of experiencing intimate partner violence over the next 12 months. Both marijuana and hard drug use were associated with increased likelihood of experiencing violence in new relationships. Women's heavy episodic drinking did not predict subsequent experiences of partner violence in ongoing or new relationships. Experiences of intimate partner violence had a significant effect on subsequent relationship satisfaction, which was modestly associated with subsequent heavy episodic drinking but not with subsequent drug use.     

Childhood sexual abuse characteristics, intimate partner violence exposure, and psychological distress among women in methadone treatment

Traumatic experiences and their biopsychosocial sequelae present complex challenges in substance use treatment. For women with substance use problems, childhood sexual abuse (CSA), intimate partner violence exposure (IPV), posttraumatic stress disorder (PTSD), and overall psychological distress are often co-occurring concerns. To address gaps in knowledge and to strengthen practice regarding these critical issues in substance use treatment, we drew upon cross-sectional and longitudinal data from baseline and 12-month interviews with a random sample of 416 women in methadone treatment to examine relationships between CSA characteristics, particularly the presence of force and involvement of family, IPV, and mental health concerns. Although CSA involving force and family was not associated with IPV as hypothesized, it was associated with increased risk of PTSD and overall psychological distress. The multivariate findings underscore the psychological vulnerabilities associated with CSA involving force and family and suggest that drug use and financial circumstances may be important targets to reduce IPV risk.     

Age of onset of smoking among alcohol dependent men attending substance abuse treatment after a domestic violence arrest

This study examined differences between alcohol dependent offenders of intimate partner violence (IPV) with early initiation of cigarette smoking versus alcohol dependent offenders of IPV with later initiation of cigarette smoking. Seventy-eight alcohol dependent men who were arrested for domestic and referred to substance abuse treatment were randomly assigned to manual-guided behavioral therapies (Cognitive Behavioral Therapy or Twelve Step Facilitation). Sixty-two clients reported smoking cigarettes (85%) while 52 reported smoking cigarettes (71%) on a daily basis. Early initiation of smoking was defined as smoking cigarettes before the age of 16 years of age, while later initiation of smoking was defined as smoking cigarettes from 16.5 years and older. Regarding baseline characteristics, participants assigned to the early initiation of smoking condition had significantly more domestic violence arrests and significantly higher anger expression scores at baseline compared to the late smoking initiation group. Despite more severity of substance abuse, legal and violence characteristics at the baseline assessment in the early initiation group, both smoking initiation groups responded equally as well across 12 weeks of manualized behavioral treatments. The implications of these findings are discussed.     

Differences in treatment outcome between male alcohol dependent offenders of domestic violence with and without positive drug screens

Men who are violent toward their partners tend to have a dual problem with alcohol and drug use, yet little is known about differences between men with single rather than dual problems. This study was one of the first to evaluate differences between alcohol dependent men who were arrested for Intimate Partner Violence (IPV) with and without concurrent illicit drug use. Seventy-eight participants were randomly assigned to manual-guided group behavioral therapies (Cognitive Behavioral Therapy or Twelve Step Facilitation) and assessed across 12 weeks of treatment. Despite denying drug use at baseline, thirty-two clients (43%) tested positive for illicit drug use (cocaine and marijuana) during the 12 weeks of treatment. The study specifically addressed whether there were differences between clients using alcohol only versus individuals using both alcohol + drugs in terms of 1) baseline characteristics; 2) treatment compliance (e.g., attendance and substance use during treatment; and 3) treatment outcomes (alcohol, drug use, anger management, and aggression at the completion of treatment). The results showed that there were comparatively few differences between the alcohol versus the alcohol + drug using groups at baseline. Regarding treatment compliance and retention, alcohol + drug using participants attended significantly fewer sessions, had significantly fewer percent days abstinence from alcohol use, significantly more total days of positive breathalyzer results. Regarding treatment outcomes across anger management and aggression scores, the alcohol + drug using participants had significantly more impairments in anger management styles from pre- to post-treatment. However, there were no differences between the groups across verbal or physical aggression. Both groups improved in their verbal aggression from pre- to post-treatment. The findings suggest that alcohol dependent men who continue to use illicit drugs may require additional interventions to effectively control their drug use and, their anger management styles.     

Intimate partner violence and receptive syringe sharing among women who inject drugs in Indonesia: A respondent-driven sampling study

BackgroundIntimate partner violence (IPV) and HIV are overlapping public health problems that disproportionately affect women who inject drugs. Little is known about the relationship between IPV and HIV-related unsafe injecting practices among women in low- and middle-income settings. This study investigated whether IPV victimisation was associated with receptive syringe sharing among women who inject drugs in Indonesia.MethodsRespondent-driven sampling (RDS) was used to recruit 731 women aged 18+ years, injecting drugs in the preceding 12 months, and residing in Greater Jakarta or Bandung, West Java. Population estimates were derived using the RDS-II estimator. Multivariate logistic regressions assessed relationships between different forms of past-year IPV (i.e. psychological abuse, physical and/or injurious assault, forced sex) and receptive syringe sharing, controlling for city differences and sociodemographic cofactors.ResultsOverall, 21.1% of participants reported engaging in past-month receptive syringe sharing. In multivariate analyses controlling for all forms of IPV, receptive syringe sharing was significantly positively associated with experiencing psychological abuse (OR = 1.86; 95% CI = 1.06,3.24; p = 0.030), physical and/or injurious assault (OR = 1.73; 95% CI = 1.04,2.89; p = 0.034), and several covariates: injecting pharmaceuticals only (versus heroin only) (OR = 3.58; 95% CI = 1.66,7.69; p = 0.001), experiencing unstable housing and/or homelessness (OR = 2.89; 95% CI = 1.41,5.95; p = 0.004), and residing in Bandung, West Java (versus Greater Jakarta) (OR = 2.33; 95% CI = 1.40,3.90; p = 0.001).ConclusionIPV is a significant risk factor for HIV-related injecting risk among women who inject drugs in Indonesia. These findings indicate the urgent need to scale up harm reduction interventions and align existing programs with IPV prevention and support services, with specific efforts targeting the needs of female injectors.     

Intimate partner violence outcomes in women with PTSD and substance use: A secondary analysis of NIDA Clinical Trials Network “Women and Trauma” Multi-site Study

Studies have shown strong associations between intimate partner violence (IPV) and both posttraumatic stress disorder (PTSD) and substance use disorders (SUD). Despite these linkages, research on the dual diagnosis of PTSD–SUD and its relationship to IPV is in an early stage, and little is known about how PTSD–SUD treatment might influence IPV outcomes. The current study is a secondary analysis of a larger NIDA Clinical Trials Network study exploring the effectiveness of two behavioral interventions for women with comorbid PTSD–SUD. Participants (n = 288) were randomly assigned to Seeking Safety (SS), a cognitive-behavioral treatment that focuses on trauma and substance abuse symptoms, or to Women's Health Education, a psychoeducational group. Logistic regressions were used to examine how treatment condition, identified risk factors and their interactions were related to IPV. Results showed that participants who were abstinent at baseline were significantly less likely to experience IPV over the 12-month follow-up period, whereas participants living with someone with an alcohol problem were significantly more likely to experience IPV over follow-up. Findings also showed that at a trend level participants with recent interpersonal trauma at baseline and higher total of lifetime trauma exposures were more likely to report IPV during follow-up. Although there was no main effect for treatment condition, a significant interaction between treatment condition and baseline abstinence was found. Participants who were abstinent at baseline and in the SS condition were significantly less likely to report IPV over follow-up. These findings indicate that an integrated treatment for PTSD and SUD was associated with significantly better IPV outcomes for a subset of individuals. The possibility that women with PTSD–SUD may differentially benefit from SS has important clinical implications. Further research examining the intersection of PTSD, SUD and IPV, and the impact of treatment on a range of outcomes is needed.     

Legal factors associated with change in alcohol use and partner violence among offenders

Intimate partner violence (IPV) is a pervasive social concern that may be exacerbated by high rates of alcohol dependence among perpetrators. Society has attempted to combat IPV through various legal interventions, but the effects of specific legal factors on behavioral change and treatment compliance remain largely unexamined. The primary focus of the current study was to comprehensively evaluate the impact of various legal factors (i.e., judicial mandate, judicial monitoring, stage of change, and stake in conformity) on mandatory treatment compliance and behavioral change over a 12 week post-adjudication period among a high-risk sample of alcohol dependent IPV offenders (N = 60). Growth curve analyses revealed effects of judicial monitoring and stage of change such that participants reporting low perceived judicial monitoring and early stages of change reported higher initial levels and a more rapid reduction in IPV than those reporting high perceived judicial monitoring and late stages of change, who reported consistently low IPV. Although we found that legal factors were poor predictors of treatment compliance and alcohol use during treatment, the association between alcohol and IPV was moderated by the legal factors. Stake in conformity was negatively associated with IPV among low alcohol users and positively associated among high alcohol users whereas stage of change was negatively associated with IPV among high alcohol users. The current results suggest that pretreatment legal factors may represent an important consideration in reducing IPV among alcohol dependent offenders. Further research is required to determine the efficacy of legal factors in isolation of treatment as well as methods of manipulating these factors to optimally compliment a prescribed course of treatment.     

Women's condom use assertiveness and sexual risk-taking: effects of alcohol intoxication and adult victimization

This experiment examined relationships among adulthood victimization, sexual assertiveness, alcohol intoxication, and sexual risk-taking in female social drinkers (N=161). Women completed measures of sexual assault and intimate partner violence history and sexual assertiveness before random assignment to 1 of 4 beverage conditions: control, placebo, low dose (.04%), or high dose (.08%). After drinking, women read a second-person story involving a sexual encounter with a new partner. As protagonist of the story, each woman rated her likelihood of condom insistence and unprotected sex. Victimization history and self-reported sexual assertiveness were negatively related. The less sexually assertive a woman was, the less she intended to insist on condom use, regardless of intoxication. By reducing the perceived health consequences of unprotected sex, intoxication indirectly decreased condom insistence and increased unprotected sex. Findings extend previous work by elucidating possible mechanisms of the relationship between alcohol and unprotected sex - perceived health consequences and situational condom insistence - and support the value of sexual assertiveness training to enhance condom insistence, especially since the latter relationship was robust to intoxication.     

Intimate partner violence and substance use: a longitudinal day-to-day examination

The likelihood of male-to-female physical aggression on days of male partners' substance use, during a 15-month period, was examined. Participants were from married or cohabiting partner violent men entering a drug abuse treatment program (N=149). Compared to days of no drug or alcohol use, the likelihood of male-to-female physical aggression was significantly higher on days of substance use, after controlling for male partners' antisocial personality (ASP) disorder and couples' global relationship distress. Of the psychoactive substances examined, the use of alcohol and cocaine was associated with significant increases in the daily likelihood of male-to-female physical aggression; cannabis and opiates were not significantly associated with an increased likelihood of male partner violence.     

Initiation of alcohol use in early adolescence: Links with exposure to community violence across time

Early alcohol use initiation has been linked with exposure to community violence, but the direction of these associations and the roles of witnessing violence vs. victimization are not clear. This study used a cross-lagged structural equation model to examine the prospective relationships between alcohol use initiation and witnessing community violence and victimization in early adolescence. A sample of 603 boys and girls provided two waves of data 16 months apart. After controlling for continuity in alcohol use and violence exposure, early initiation of alcohol use predicted later victimization in the community. Witnessing community violence increased and victimization decreased the risk of subsequent alcohol use. Prevention programs targeting early alcohol initiation may result in decreased victimization, while interventions addressing constructive ways of coping with witnessing community violence may also reduce early adolescents' alcohol use.     

Relationship aggression and substance use among women court-referred to domestic violence intervention programs

Although there is extensive theoretical and empirical evidence linking men's alcohol abuse and marital violence, no previous studies have assessed the substance use characteristics of women arrested for domestic violence. We recruited 35 women who were arrested for domestic violence and court-referred to batterer intervention programs. We administered multiple measures of substance use and abuse and assessed the women's marital aggression, marital satisfaction, depressive symptomatology, use of general violence, and their relationship partners' substance use. We also divided the sample into groups of hazardous drinkers (HD) and nonhazardous drinkers (NHD). Across the entire sample, almost half of the women were classified as HD. Over one-quarter of the women reported symptoms consistent with an alcohol abuse or dependence diagnosis, and approximately one-quarter of the sample reported symptoms consistent with a drug-related diagnosis. Over one-half of the total sample reported that their relationship partners were HD. Relative to the NHD group, the HD group scored higher on measures of drug problems, relationship aggression, general violence, and marital dissatisfaction. The results of the study suggest that substance use and abuse should routinely be assessed as part of batterer interventions and that batterer programs would be improved by offering adjunct or integrated alcohol treatment.     

BSAFER: A Web-based intervention for drug use and intimate partner violence demonstrates feasibility and acceptability among women in the emergency department

ABSTRACT

Background: Addressing violence along with drug use change goals is critical for women with coexisting intimate partner violence (IPV) and substance use disorders (SUDs). Methods: This was an acceptability and feasibility study of BSAFER, a brief Web-based program and booster phone call addressing violence and drug use. A screening survey identified women with recent drug use and IPV in the emergency department (ED). Participants were randomized to BSAFER or a Web-based control program and booster call providing education about home fire safety. Program completion, usability, satisfaction, and motivational interviewing (MI) adherence were primary outcomes. Drug use and IPV outcomes were measured at baseline, 1 month, and 3 months. Results: Forty women were enrolled (21 BSAFER, 19 control); 50% were nonwhite and mean age was 30 years. The most commonly used drugs were marijuana (88%) and cocaine (30%); 45% reported physical abuse, and 33% reported severe combined physical and sexual abuse. Thirty-nine (98%) completed the Web program, 30 (75%) completed the booster, and 29 (73%) completed the 3-month follow-up. Mean System Usability Scale (SUS) for the BSAFER Web program was 84 (95% confidence interval [CI]: 78–89) of 100; mean Client Satisfaction Questionnaire (CSQ-8) was 28 (95% CI: 26–29) of 32. MI adherence scores were high and similar for both the Web program and the booster. Both intervention and control groups had small mean decreases in weekly drug use days (0.7 vs. 1.5 days); participants using drugs other than marijuana demonstrated greater average reductions in drug use than those using marijuana only. Conclusions: An ED Web-based intervention for SUDs and IPV in women demonstrated feasibility and acceptability. Future studies will examine efficacy of the BSAFER program and investigate whether specific subgroups of drug using women may be most responsive to ED-based Web interventions.     

Cross-lagged relationships between substance use and intimate partner violence among a sample of young adult women

OBJECTIVE: The goal of this study was to examine the longitudinal relationship between substance use and intimate partner violence (IPV) victimization and perpetration among a sample of young adult women. METHOD: A sample of 509 women who participated in Waves 8 (age 23) and 9 (age 29) of a multiyear panel study and who indicated they were living with a partner or spouse at both time points provided the data for this investigation. Path analysis was used to examine the cross-lagged relationships between women's substance use and IPV victimization and perpetration over the two waves of data. RESULTS: Although strong within- and across-time associations between substance use and IPV victimization and perpetration were found at the bivariate level, substance use did not predict women's subsequent IPV victimization or perpetration in the cross-lagged model. Instead, victims of IPV at age 23 were found to be at an increased risk for later heavy drinking. Perpetrators of IPV at age 23 were less likely than nonperpetrators to report heavy drinking at age 29. CONCLUSIONS: The results suggest that substance use does not increase women's long-term risk of experiencing or perpetrating IPV but that victimization by IPV puts women at risk for subsequent heavy drinking.     

Domestic violence and alcohol use: trauma-related symptoms and motives for drinking

Alcohol use is frequently associated with posttraumatic stress disorder (PTSD), especially in the face of chronic traumatic experiences. However, the relationship between alcohol use and symptoms associated with chronic trauma exposure has not been evaluated. This study examined alcohol use in recently battered women (N=369). Differences were found in trauma symptoms between abstainers, moderate drinkers, and heavy drinkers, with heavy drinkers reporting more severe symptoms. Mediational analyses suggest that the relationship between drinking and trauma symptoms is mediated by drinking to cope, which has not been previously demonstrated in a battered population. Results suggest the importance of assessing trauma symptoms and motives for drinking in understanding alcohol use in recent survivors of domestic violence.