Intimate partner violence and substance use: A longitudinal day-to-day examination
Introduction
Although once viewed as primarily a private family matter, intimate partner violence (IPV) has become increasingly recognized as a significant public health concern during the last 20 years. Nationally representative surveys of couples in the United States indicate 15–20% of dyads experience an incident of IPV each year (e.g., Schafer et al., 1998, Straus & Gelles, 1990). As pervasive as IPV is in the general population, its prevalence is substantially higher among couples in which one or both partners abuse alcohol or other drugs. For example, the prevalence of male-to-female physical aggression among married or cohabiting men seeking treatment for alcoholism is four to six times higher than demographically matched nonsubstance-abusing individuals (e.g., Murphy & O'Farrell, 1994). A similarly high prevalence of male-to-female physical aggression has been found among married or cohabiting men seeking treatment for abuse of drugs other than alcohol (e.g., Fals-Stewart, Kashdan, O'Farrell, & Birchler, 2002).
Although multiple studies have found a fairly strong relationship between the use of alcohol and the occurrence of IPV (for reviews, see Hotaling & Sugarman, 1986, Leonard, 1993, Schumacher et al., 2001), the functional role of alcohol consumption in episodes of IPV has been the subject of considerable and, at times, heated debate. Some have argued that alcohol intoxication, via its psychopharmacologic effects of ethanol on cognitive processing (e.g., Chermack & Taylor, 1995) or the expectancies associated with intoxication (Critchlow, 1983), facilitates all types of violence, including IPV. This explanation of the link between alcohol use and violence is often referred to as the proximal effects model. However, others have countered that the relationship between alcohol use and violence is spurious (e.g., alcohol use and violence are related to another variable, such as the presence of antisocial personality (ASP), and thus appear directly connected when they, in fact, are not) or is largely indirect (e.g., drinking leads to poor relationship adjustment, which creates an environment conducive to aggression). Although these competing explanations have focused mostly on the relationship between alcohol use and IPV, they also apply more broadly to the relationship between the use of and intoxication from any psychoactive substance and violence (e.g., Wekerle & Wall, 2002).
Implicit in the proximal effects model is that there should be a temporal relationship between substance use and violence, that is, it would be expected that episodes of violence (including IPV) would most likely occur after drinking or drug use and within a comparatively brief time period after consumption (i.e., when the perpetrator is experiencing the intoxicating effects of the ingested substance or suffering from the residual effects of intoxication, such as withdrawal). Unfortunately, because of limitations in data collection and general assessment methods, it has been difficult to ascertain the temporal association between substance use and IPV. Most investigations to date have relied largely on correlational analyses, demonstrating, for example, that individuals who report more frequent drug or alcohol use are more likely to report engaging in IPV compared to individuals who use psychoactive substances less frequently or not at all. Although the information from such studies provides some support for the role of substance use in IPV, the inherent difficulty in drawing more substantive conclusions from these findings is that it is not clear when the substance use and when the episodes of violence occur. From most studies, it cannot be ascertained whether substance use and the episodes of IPV even occurred on the same day; as such, drawing valid inferences about the proximal relationship of intoxication in IPV is not possible.
However, in a study recently completed by our group (Fals-Stewart, 2003), we addressed many of these issues. In this investigation, we collected detailed daily diaries, covering a 15-month period, about the occurrence and timing of daily episodes of drinking and male-to-female physical aggression from male and female partners with histories of IPV in which the male partners were entering an alcoholism or domestic violence treatment program. The diaries contained information about not only the occurrences of male-to-female aggression but also information about (a) the time of day these episodes happened, (b) whether the male partner drank alcohol during the same day when the violence occurred, and (c) what time of day the drinking started and ended. This allowed for a detailed examination of the daily temporal relationship between male-to-female aggression and drinking. Counting alcohol and male-to-female aggression as linked only on days when the drinking occurred before the IPV episode, for men entering the domestic violence treatment program (alcoholism treatment program odds in parentheses), the odds of any male-to-female physical aggression were more than 8 times (11 times) higher on days when men drank than on days of no alcohol consumption. The odds of severe male-to-female physical aggression were more than 11 times (11 times) higher on days of men's drinking than on days of no drinking. Moreover, in both samples, over 60% of all episodes occurred within 2 h of drinking by the male partner. From an assessment and methodological standpoint, this investigation was an important advancement and increased our understanding of the role of alcohol use and intoxication in episodes of male-to-female physical aggression.
However, a major limitation of this investigation was its exclusive focus on alcohol use. In their extensive review of the link between substance use and violence, Miczek et al. (1994) note that the association between alcohol use and aggression is, by far, the most widely researched and most well established. Research on the links between use of other drugs and the occurrence of violence in general, and IPV in particular, is not nearly as evolved as alcohol-violence research. Most of the research exploring the relationship between illicit drug use and IPV has been correlational in nature, with the temporal association between drug use and IPV remaining unexplored. Moreover, the relationship between violence and illicit substance use is obfuscated by the presence of ASP characteristics observed among many individuals who abuse drugs, which can serve to create a spurious relationship between the occurrence of violence (both in general and between intimate partners) and substance use.
Thus, the purpose of the present study is to examine the day-to-day relationship between substance use and IPV among men seeking treatment for drug abuse who reported a history of male-to-female aggression. This present investigation used the same methods of assessment and data collection used in our earlier work focusing on alcohol use, thus, allowing for the day-to-day examination of the relationship between the occurrence of male-to-female physical aggression and the male partners' use of various psychoactive drugs, in addition to alcohol. In these analyses, we controlled for the presence of ASP among male partners', which could have spuriously inflated the relationship between substance use and violence. Because alcohol and other drug use is associated with relationship distress (e.g., Fals-Stewart, Birchler, & O'Farrell, 1999), which may create a context for IPV and thus spuriously inflate the day-to-day association between substance use and violence, we also controlled for couples' levels of dyadic adjustment.
Section snippets
Sociodemographic characteristics
Participants were married or cohabiting male and female partners who reported at least one act of male-to-female physical aggression in their relationship during the previous year. Participants were recruited from partner violent male patients entering a 12-week outpatient substance abuse treatment program and their female partners.
Of the 421 married or cohabiting men consecutively admitted to the program, at least one of the partners in 245 (58%) of these dyads reported at least one act of
Male partners' substance use and male-to-female physical aggression during the assessment period
The mean (S.D.) number of days of face-to-face contact between partners was 249.3 (104.6). Among these couples, 52 (35%) of the female partners reported at least one act of male-to-female physical aggression and 102 (68%) of the male partners reported drinking or using another psychoactive substance on one or more of the days of face-to-face contact. Pooled across couples, the number of days of male-to-female physical aggression was 499; of these, 179 (36%) were episodes of severe aggression.
Discussion
After controlling for the presence of ASP disorder among male participants and couple relationship distress, we found a significant conditional daily relationship between male partners' substance use and the occurrence of male-to-female aggression. Follow-up analyses indicated consumption of alcohol and use of cocaine significantly increased the likelihood of any and severe male-to-female physical aggression among these couples on any given day during the 15-month assessment interval. In
Acknowledgements
This project was supported, in part, by grants from the National Institute on Drug Abuse (R01DA12189, R01DA14402, and R01DA015937) and the National Institute on Alcohol Abuse and Alcoholism (R21AA013690).
We thank Christopher M. Murphy, Department of Psychology, University of Maryland at Baltimore County, Timothy J. O'Farrell, Department of Psychiatry, Harvard Medical School, and Gary R. Birchler, Department of Psychiatry, University of California San Diego Medical School, for their helpful
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