Association Between Intimate Partner Violence and Help Seeking for Alcohol Problems

Abstract

Objectives: The primary aim of this study is to determine the association between intimate partner violence, alcohol problems, and help seeking behaviors for alcohol problems. In addition, the study was conducted to examine ethnic differences in the reporting of intimate partner violence, alcohol problems and treatment or help seeking for alcohol problems.

Methods: A probability sample (n = 1468) of White, Black and Hispanic couples 18 years of age or older in the U.S. household population was interviewed in 1995 with a response rate of 85%. Help seeking was defined as talking to someone or seeking treatment for an alcohol problem; therefore, the bivariate and multivariate analyses exclude lifetime abstainers.

Results: Multivariate analysis controlling for ethnicity, gender, age, education, and income indicated that those with alcohol problems and intimate partner violence together were 1.5 (95% CI = 0.8-2.6) times more likely to seek help than those reporting alcohol problems alone.

Conclusions: The coexistence of intimate partner violence and alcohol problems may prompt individuals to seek help for alcohol problems. However, a majority of people who report intimate partner violence and alcohol problems or alcohol problems alone do not seek help.     

Psychosocial and substance-use risk factors for intimate partner violence

OBJECTIVE: Few emergency department (ED) studies have described the relationship between family violence and subsequent intimate partner violence (IPV) or accounted for partner alcohol use in IPV victimization. This study sought to identify family history and substance-use factors associated with IPV among women presenting to an urban emergency department. METHODS: Case-control study in which cases (women identified as having IPV concerns and an IPV history) and controls (women without IPV) were frequency-matched by age group and race/ethnicity. Logistic regression was performed to calculate adjusted odds ratios (AOR) for any IPV, physical IPV, and sexual IPV. RESULTS: The sample included 182 cases and 147 controls. Living with a partner (not married) and witnessing parental violence were independent risk factors for any IPV (AOR 2.55 and AOR 2.21, respectively). Partner's alcohol use (AOR 1.22 for every five drinks consumed per week) and heavier drinking (AOR 5.07) were also significant risk factors, but not subject's substance-use. The pattern of risk factors varied only slightly for physical IPV and sexual IPV. CONCLUSION: This study suggests a substantial relationship between partner alcohol use and IPV among women beyond the woman's substance-use and confirms previous reports regarding the cycle of violence in women's lives.     

Risk Factors for Alcohol-Related Problems Among Victims of Partner Violence

Despite the high prevalence of alcohol-related problems and disorders among women who experience intimate partner violence (IPV), factors related to current alcohol use are understudied. We examined current risk factors for alcohol-related problems among 143 substance-using, IPV-exposed women recruited from an urban community from 2007 to 2010. Posttraumatic stress disorder (PTSD) symptom severity was associated with alcohol-related problems and a positive alcohol screen; physical IPV severity was related to alcohol dependence. Post hoc analyses revealed that PTSD symptom severity mediated relationships between physical IPV severity and hazardous, harmful, and dependent drinking. Focusing on managing PTSD symptoms and physical IPV in community-based interventions may halt the progression from alcohol use to dependence.     

The longitudinal association between alcohol use and intimate partner violence among ethnically diverse community women

Research has consistently demonstrated a strong link between substance misuse and the perpetration of intimate partner violence (IPV). However, studies examining whether substance misuse is associated with IPV victimization have been mixed. Using data collected from 835 low-income ethnically diverse community women, this study extends previous research by utilizing a longitudinal design, considering men's and women's alcohol use, and examining multiple forms of abuse. Despite overall decreases in drinking and abuse, the frequency of male partners' drinking continued to be associated with their perpetration of threats, violence, and sexual aggression. Women's alcohol use frequency was associated with sustaining physical violence, but not threats of violence or sexual aggression.     

Reporting interpersonal violence and abuse: What pharmacists need to know

ObjectiveTo examine and describe the reporting requirements for pharmacists related to interpersonal violence and abuse in the United States.MethodsA comprehensive search of state laws related to mandatory reporting of intimate partner violence and domestic violence (IPV), child abuse, and elder abuse was conducted. Identified statutes were reviewed to determine if pharmacists were mandatory reporters for each type of violence.ResultsPharmacists are specifically identified as mandatory reporters of intimate partner violence in 10 states, of child abuse in 11, and of elder abuse in 20. They may also have reporting requirements in more states as statutes sometimes identify health care providers as mandatory reporters, but do not specify which types of providers. Additionally, many states require reporting of child and elder abuse by anyone who is aware of or suspects abuse. IPV statutes mainly require reporting when treating wounds from gunshots, stabbings, and burns.ConclusionsPharmacists are accessible health care providers who should be aware of reporting requirements for their practice location and setting. They have mandatory reporting requirements in much of the United States, especially for child and elder abuse. They should seek specific guidance about their reporting requirements and reporting methods, as well as identify educational and local referral resources for victims they may encounter in practice.     

Risk factors for alcohol-related problems among victims of partner violence

Despite the high prevalence of alcohol-related problems and disorders among women who experience intimate partner violence (IPV), factors related to current alcohol use are understudied. We examined current risk factors for alcohol-related problems among 143 substance-using, IPV-exposed women recruited from an urban community from 2007 to 2010. Posttraumatic stress disorder (PTSD) symptom severity was associated with alcohol-related problems and a positive alcohol screen; physical IPV severity was related to alcohol dependence. Post hoc analyses revealed that PTSD symptom severity mediated relationships between physical IPV severity and hazardous, harmful, and dependent drinking. Focusing on managing PTSD symptoms and physical IPV in community-based interventions may halt the progression from alcohol use to dependence.     

Intimate Partner Violence and HIV Among Drug-Involved Women: Contexts Linking These Two Epidemics—Challenges and Implications for Prevention and Treatment

Intimate partner violence (IPV) and HIV are two serious overlapping public health epidemics that disproportionately affect drug-involved women. This article reviews research that has identified a number of contexts that may explain the links between IPV and HIV transmission risks. These contexts include sexual coercion, fear of violence, negotiation of condom use, extradyadic relationships, disclosure of sexually transmitted infections or HIV seropositivity to intimate partners, drug involvement of women and their male partners, low social status of drug-involved women, relationship dependencies, and sex ratio imbalances. The article focuses on how the bidirectional relationship between IPV and HIV risks may be mediated by a history of childhood sexual abuse and post-traumatic stress disorder. Also addressed are the challenges that substance user treatment programs face in dealing with female clients who experience IPV and the implications for HIV prevention.     

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.     

Alcohol Misuse Among Female Veterans: Exploring Associations With Interpersonal Violence and Mental Health

Background: The correlates of alcohol misuse among female Veterans are not well understood. The present study explored associations among alcohol misuse, demographic/military-related characteristics, interpersonal violence exposure, and posttraumatic stress disorder (PTSD) and depression symptom severity. Method: Participants were 369 female Veteran patients of the VA New England Healthcare System. Participants completed a paper-and-pencil mail survey that included validated assessments of alcohol misuse, interpersonal violence, and psychological distress. Results: Younger age, adulthood physical abuse, military sexual trauma, past-year psychological aggression by an intimate partner, and PTSD and depression symptom severity showed significant univariate associations with alcohol misuse (as indicated by unsafe drinking levels, presence or incipience of an alcohol use disorder, intrapersonal alcohol-related concerns, and/or interpersonal alcohol-related concerns). A couple of these associations remained significant when examined in logistic regression models. Conclusions: Findings suggest that female Veterans who are at risk for alcohol use disorders and/or are experiencing alcohol-related problems may benefit from screening and intervention efforts that take into account interpersonal violence exposures and mental health symptoms on a case-by-case basis. Results also suggest the importance of future research examining correlates and risk factors for substance misuse among female Veterans.     

Intimate Partner Violence Among Individuals in Methadone Maintenance Treatment

ABSTRACT. Background: Intimate partner violence (IPV) is a highly prevalent and concerning problem among methadone maintenance populations, and previous studies have shown a relationship between a history of IPV and increased substance use and affective disturbances. Methods: The current study examined (1) the association between recent IPV victimization and alcohol and cocaine use and (2) the relationship between recent IPV victimization and depression in a sample of smokers (N = 203) in methadone maintenance treatment (MMT). Participants in this study completed a battery of assessments that included standard questionnaires of trauma, alcohol and substance use, and depression. Parallel logistic and linear regression models were used to estimate the adjusted association of IPV victimization and depressive symptoms and evaluate the adjusted association of victimization with recent substance use. Results: Participants recently victimized by partners were shown to have significantly higher mean Center for Epidemiologic Studies Depression Scale (CES-D) scores (b = 0.54, 95% confidence interval [CI]: [0.07; 1.02], P <.05) and were found to have a 6 times greater likelihood of cocaine use (odds ratio [OR] = 6.65, 95% CI: [1.61; 27.46], P <.01) after controlling for age, gender, education, opiate use, and ethnicity. Conclusions: These findings support the notion that IPV victimization can potentially increase depression and other substance use among MMT patients, which can have a deleterious impact on treatment.     

Acute alcohol use temporally increases the odds of male perpetrated dating violence: A 90-day diary analysis

Objective

Despite an extensive theoretical literature on acute alcohol intoxication likely increasing the odds of aggression between intimate partners, there have been few temporal studies on the relation between alcohol use and increased odds of intimate partner violence (IPV). Moreover, the literature on the temporal relation between marijuana use and IPV is in its infancy. The existing temporal research has yet to examine in the same study the three distinct types of IPV that occur most often between partners: physical, psychological, and sexual. Thus, the present study examined the temporal relationship between acute alcohol use, marijuana use, and male perpetrated physical, psychological, and sexual dating violence.

Method

College men who had consumed alcohol in the previous month and were in a current dating relationship participated (N = 67). Men completed daily surveys that assessed their alcohol use, marijuana use, and violence perpetration (psychological, physical, and sexual) for up to 90 consecutive days.

Results

On any alcohol use days, heavy alcohol use days (5 or more standard drinks), and as the number of drinks increased on a given day, the odds of physical and sexual aggression perpetration increased. The odds of psychological aggression increased on heavy alcohol use days only. Marijuana use days did not increase the odds of any type of aggression.

Conclusions

These findings contribute to a growing body of research on the temporal relation between acute alcohol use and IPV perpetration among college men. Combined with previous research, our findings suggest that dating violence intervention and prevention programs should target reductions in alcohol use.     

Risk Factors for Recent Intimate Partner Violence among Methamphetamine-Using Men and Women

The Substance Abuse, Violence, and HIV/AIDS (SAVA) syndemic model describes how the confluence of the three epidemics of substance abuse, violence, and HIV risk work synergistically to create excess burden among populations. We sought to identify risk factors associated with recent intimate partner violence (IPV) victimization among heterosexual methamphetamine (meth)-using men (n = 108) and women (n = 122) enrolled in FASTLANE-II, an HIV behavioral intervention in San Diego, CA. Women and men reported high rates of physical-only (women: 20%; men: 18%) and sexual (women: 25%; men: 23%) IPV. Multinomial regression analysis revealed that individuals who reported lower social support and individuals who reported a greater likelihood of engaging in risky sexual behaviors while high on meth were more likely to report IPV versus no IPV. Women who reported a greater likelihood of engaging in risky sexual behaviors while high on meth were 1.58 times more likely to report physical-only IPV versus no IPV, while men who reported similar behaviors were 1.15 times more likely to report physical-only IPV versus no IPV. Our findings highlight the influence of interpersonal factors on IPV. This research supports further study on gender-specific risk/protective factors and the development of gender-specific interventions targeting the SAVA syndemic among meth users.     

Gender,alcohol and intimate partner violence: Qualitative comparative study

Aims: The study compares young adults’ cultural understandings of intimate partner violence (IPV) and its connections with alcohol use and gender roles.

Data and analyses: Comparative focus group interview data were collected in seven countries (Argentina, Finland, Italy, Nigeria, Uganda, Uruguay, Sri Lanka). Similar lists of codes and coding procedures were used in analyzing the data in all countries.

Findings: According to the dominant image of IPV, the perpetrator is a man and the victim is a woman. Many discussions dealt with the gender-specific legitimation of IPV, and the groups from different countries expressed somewhat different views on the gender differences, the moral responsibility of both parties and the mitigating factors of violent behaviour in these discussions. Views on alcohol as a contributing factor for IPV were more similar in all cultures. According to most of the groups, intoxication offers a culturally acceptable excuse to escape responsibility, alcohol's pharmacological effects make violent behaviour more likely, heavy drinking can affect the relationship in a negative way, and the victim's drinking increases the risk of violence. Alcohol was said to have a somewhat different role in situational and in continuous IPV.

Conclusions: Results give support to reduction of heavy use of alcohol as an available and feasible method of prevention of IPV. However, prevention of IPV requires paying attention to its other reasons as well, especially the structural gender inequality.     

College Student Dating Partner Drinking Profiles: Differences in Relationship Functioning and Relationship-Specific Alcohol Expectancies

Background: Although the majority of research on partner drinking styles has examined married couples, dating partners may influence one another's problem behaviors including alcohol use. Objectives: This study identified patterns of at-risk alcohol use in college women and their dating partners using a person-centered statistical approach (i.e., latent profile analysis). Methods: Participants were 286 college student women in dating relationships. They completed questionnaires regarding their own and their partners' drinking, alcohol use severity, intimate partner violence (IPV), relationship satisfaction, and relationship-specific alcohol expectancies. Data were collected in 2012 through 2013. Results: Results revealed three distinct, latent classes based on both partners' alcohol outcomes. The “Low-Risk” group (58%) consisted of non-heavy drinking partners. In the “High-Risk – Higher Men” class (27%), men drank more than women; however, both men and women were high-risk drinkers. The “High-Risk – Higher Women” group (15%) consisted of high-risk drinking partners but women consumed more alcohol than men. Both high-risk couple groups were more dissatisfied in their relationships and experienced more IPV, but held stronger beliefs about how alcohol influenced their relationship. Conclusions/Importance: Findings indicate that there are several distinct classes of dating couples that differ in relationship problems and beliefs about alcohol's impact on their relationship. Riskier couples differ in behaviors and alcohol-related beliefs from low-risk couples. These findings may inform the development of more efficacious alcohol interventions tailored toward high-risk drinking dating couples.     

Is there a relationship between victim and partner alcohol use during an intimate partner violence event? Findings from an urban emergency department study of abused women

OBJECTIVE: This study sought to identify factors associated with drinking during an intimate partner violence (IPV) event among abused women presenting to an urban emergency department (ED). METHODS: We use a cross-sectional study of IPV cases among adult female patients seen at an urban ED. Bivariate and logistic regression analyses were performed to identify substance use factors associated with an abused woman drinking while victimized or perpetrating IPV. RESULTS: Among the 182 cases, an increased number of drinks per week, consuming five or more drinks per occasion, alcohol abuse and dependence, and illicit drug use were significantly associated with the abused woman's drinking while victimized or perpetrating IPV Partner's drinking five or more drinks per occasion was associated only with the woman's drinking while victimized. Partners were more likely to drink while perpetrating IPV in the relationship whether or not the woman drank while victimized. Among couples in which the abused woman also perpetrated violence, the partner's drinking more closely paralleled the woman's drinking in events perpetrated by the woman. Independent risk factors associated with the abused woman drinking during victimization included number of drinks she consumed per week (adjusted odds ratio [adj. OR] = 1.31 for every five drinks) and her illicit drug use (adj. OR = 4.3). The odds of an abused woman drinking while perpetrating IPV increased 1.4 times for every five drinks she consumed per week. CONCLUSIONS: These findings suggest that alcohol-related behavior by both couples and individuals are important factors to consider in the relationship between IPV and alcohol use in this population.     

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.     

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.     

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.     

Health Profiles of Clients in Substance Abuse Treatment: A Comparison of Clients Dependent on Alcohol or Cocaine With Those Concurrently Dependent

The purpose of this study was to assess whether, among clients receiving substance abuse treatment (n = 616), those dependent on alcohol or cocaine differed significantly from those concurrently dependent on both drugs in terms of physical, mental, social, and economic harms as well as substance use behaviors. Methods: Clients from five substance abuse treatment agencies presenting with a primary problem of cocaine or alcohol were classified into three groups as dependent on: (1) alcohol alone, (2) cocaine alone, or (3) both cocaine and alcohol (i.e. concurrent dependence). Participants completed a self-administered questionnaire that included details of their drug and alcohol use, physical health, mental health, social health, economic health, and demographic characteristics. Results: The concurrent group drank similar amounts of alcohol as those in the alcohol group and used similar amounts of cocaine as the cocaine group. The alcohol group had significantly (p < .05) poorer health profiles than the concurrent group across most variables of the four health domains. An exception was significantly more accidental injuries (p < .05) in the alcohol group. In both bivariate and multivariate analyses, the concurrent group had significantly (p < .05) more accidental injuries, violence, and overdoses than the cocaine group. As well, the concurrent group had significantly (p < .05) higher scores on the anxiety and sexual compulsion scales than the cocaine group, controlling for demographic variables. Conclusion: These findings can aid health care professionals to better respond to issues related to concurrent dependence of cocaine and alcohol.     

Sexual Orientation Disparities in Substance Misuse: The Role of Childhood Abuse and Intimate Partner Violence Among Patients in Care at an Urban Community Health Center

This study examined disparities in lifetime substance misuse by sexual orientation among 2,653 patients engaged in care at an urban community health center in Boston, MA, as well as the potential mediating roles of childhood abuse <age 15 (CA) and intimate partner violence (IPV). Violence indicators were highly associated with substance misuse, as was identifying as a sexual minority compared to heterosexual. CA and IPV experiences partly explained disparities in substance abuse by sexual orientation with differences seen by sex. Clinicians should assess history of CA and IPV among sexual minorities presenting with a history of substance abuse disorders. The study's limitations are noted.