Alcohol-related domestic violence
and its prevention through the
MALVA project
Xavier Ferrer,
Psych. D.
Scientific Director, FSC (Foundation Health and Community, Spain)
and
Director, Postgraduate Degree in Addictions, Univ. of Barcelona
ALCOHOL ABUSE
and domestic violence
(focusing on violence
against intimate partner)
(“domestic” or “family” violence
includes also violence against
children and older adults, as well as
against parents from their offspring)
SUMMARY:
• Alcohol abuse is one of the better known and most
relevant risk factors on violence against intimate partner.
• Alcohol facilitates aggression by 3 main ways:
– 1) Decreasing self-control (an almost specific effect of alcohol,
and a widely known factor).
– 2) Stimulating onset of mental aggressive pathologies
caused by substance abuse (mostly the alcoholic psychotic
disorder, ICD-F10.5). This is a common problem with
amphetamines, cocaine, and some psychodysleptic drugs (and
is widely underestimated).
– 3) Worsening or difficulting to solve other violenceinducing mental disorders: schizophrenia, paranoidism,
depression, personality disorders… (also widely
underconsidered)
SUMMARY (2)
•
Besides the support to the victims, a relevant effort is needed in order to:
– 1) Implement measures aimed to reduce high alcohol per capita
consumption.
– 2) Implement specific actions addressing the relationship among
alcohol abuse, aggressiveness and violence:
• Information and education to the general public about these specific
risks of facilitation of aggression, especially when mixed with
“macho” attitudes.
• Awareness-raising among possible victims, aggressors and
professionals involved, to facilitate early detection and intervention.
• Selective action in the cases found to avoid repetition of the
victimisation.
– 3) Given the innovative character of these actions, a strong evaluation
effort is needed to improve them and select the most efficient ones.
FSC- FUNDACIÓN SALUD Y COMUNIDAD
FOUNDATION HEALTH AND COMMUNITY
•
FSC is a health and welfare professionals- lead NGO, aiming to promote
health and quality of life for all, but especially for those more
underprivileged, as the victims of HIV-aids, alcohol and other drugs abuse,
violence and social exclusion.
•
It runs over 60 centres and projects in several regions of Spain, employing
more than 1400 professionals and relying on the help of more than 500
volunteers. FSC has been involved in many European and international
projects. In 2008 there were more than 75000 beneficiaries.
•
One of the strengths of FSC is its multi-subject specialisation, which makes
us able to adopt and combine different points of view. In this case, for
instance, we have the perspective of the organisations helping alcoholics,
along with the vision of the NGOs helping battered women and fighting
against domestic violence.
What do we do in the field of
domestic violence? (some examples, not
exhaustive):
* Centre for Intensive psychosocial care aimed to women victims
of violence and their children (CIE) (region of Tarragona, Catalonia, Spain).
* First Contact and care Centre for women victims of violence
and their children (EAD) (City Council of Barcelona, Spain)
* Women’s meeting place (Espai de Dones) Municipal Service promoting
women’s rights and development , Badalona, Barcelona, Spain
* Shelter Home (3-5 month stay) and longer-term stabilisation
support for victims of domestic violence and their children.
(Casa i pis del Segrià). Lleida, Catalonia, Spain.
* Service for shelter of Women, Children and Families (SADIF)
(City of Palma de Mallorca; Balearic Islands, Spain).
* Promotion of the rights of women, sexual and
reproductive health, and education against
violence (Projet Repère-Lewhi) (Kabylie region,
Algeria). In coop. with the “Ligue de Prévention pour la Jeunesse
et l’Enfance” de Tizi-Ouzou .
What do we do in the field
of alcohol and addictions?
•Outpatient centres (Barcelona)
•Day- care centres (L’Hospitalet, Barcelona)
•In-patient facilities for short and medium-term stays (up to 6 months)
(Catalonia)
•Protected apartments to support long-term recovery (Catalonia)
•Occupational and rehabilitation workshops (Catalonia)
•Outreach contact and harm-reduction centres and programmes (Castelló,
Valencia, Madrid), including drug consumption rooms
•Alcohol and drug Rehabilitation programmes inside 3 prisons (Barcelona,
Lleida, Can Brians). Syringe exchange in the prison of Valencia.
•Prevention programmes in communities, schools and aimed to families
•Specific prevention programme addressed to and carried through
University students (11 Universities)
Evidence about involvement of alcohol in violent
crimes is overwhelming, and just as examples:
From the WHO synopsis “Interpersonal violence and alcohol”,
Geneva, 2006:
Alcohol has been a factor in about 3/4 homicides in Russia.
In the USA, 35% among victims of violence reported that their
aggressor/s had been drinking.
In England and Wales, the same figure amounts to 50%, in South
Africa 44%.
Our own data: among 1070 battered women cared in
our Centre at Barcelona (EAD) (2008), 46% said
addictions had a relevant role in the aggressor’s
behaviour. Alcohol alone amounted to 30%.
According to the “Descriptive Note” of WHO about “Violence
inflicted by the intimate partner and alcohol” (Geneva,
2006), alcohol intake is one of the main risk factors for
violence among the couple. And this, because:
● Alcohol directly impairs cognitive and physical functioning, and lowers selfcontrol, thus making individuals less able to find non-violent solutions to
interpersonal conflicts.
● The belief -individual and general – about alcohol generating violence may
facilitate violent behaviour after its intake, and also may lead to drink searching
an excuse for these behaviours.
● Being victim of violence in a relationship may lead to drink as a way of coping
or as self-medication.
According to the WHO-sponsored GENACIS Project [1], drinking alcohol
is in many cases a determinant factor for violence. Moreover, it exists a
negative association between alcohol abuse and the overall quality
of the couple relationship.
Around half of the people involved in aggressions had been drinking
immediately before these episodes, being
- The aggressor (25% of the cases),
- Both aggressor and victim (16,7%)
- The victim (3,5%)
[1]
Sánchez, L; Navarro, J; Valderrama, JC; (2004) GENder, Alcohol and Culture
International Study. Report. Sociedad Española de Toxicomanías: Alicante.
OUR UNDERSTANDING: AN INTEGRATIVE MODEL FOR
THE RELATIONSHIP ALCOHOL – DOMESTIC VIOLENCE
Aspects of the interaction:
1. Elements
individuals.
usually
generating
aggressiveness
among
“normal”
2. Psychopathological states and processes which use to produce
aggressiveness.
3. System for inhibition and control of aggressiveness and anger,
avoiding it to become aggression.
4. Role of alcohol:
* Worsening pre-existing mental disorders
* Decreasing self-control over aggressiveness
* Generating specific mental disorders which
induce aggressiveness.
5. Violence: as a result a of a failure in the system for inhibition and control to
block the aggressive drives (wrath, anger)
6. Mechanisms of feedback maintaining violent behaviour afterwards
1. Concepciones y actitudes
sociales hacia la violencia
2. Concepciones y actitudes
sociales hacia los roles de
género
4. Generación de expectativas de
comportamiento propio y ajeno:
13. Consumo
puntual de
alcohol
suficientemente
intenso
10. Consumo
crónico intenso
y/o dependencia
del alcohol
Ej. “Yo soy quien lleva los pantalones y quiero que la cena
esté hecha cuando llegue a casa”.
Ej. “Si me impongo de forma agresiva se me hará caso y
se me tomará más en serio ”.
3. Aprendizaje escolar,
familiar, medios de
comunicación
5. Deseos frustrados
12. Provoca trastornos
mentales por abuso de
alcohol:
11. Agrava
trastornos
mentales previos:
- Trastorno psicótico / Celotipia/
Paranoidismo
- Trastorno afectivo (Reacción
maníaca o depresiva)
- Delirium Tremens
(Ver casilla nº 9 del esquema)
7. Falta de habilidades de
comunicación y solución de
problemas.
9. Estados y procesos
psicopatológicos:
- Paranoidismo
- Manía/ Depresión
- Trastorno de personalidad
6. Intolerancia la frustración
14. Afecta e incluso anula el sistema de
filtro y control de la agresividad
8. Agresividad/Estado emocional de IRA
15. SISTEMA DE FILTRO Y CONTROL DE LA AGRESIVIDAD
16. Deslegitimación
cognitivo-moral de
la violencia
21. Mecanismos de
autojustificación y
legitimación a
posteriori
17. Consideración afectiva de las
consecuencias para el otro y
terceros (influenciable por
evaluación negativa de la
víctima)
18. Consideración
de las
consecuencias
para el propio
agresor
20. VIOLENCIA
19.
- Respuesta esperada de la víctima
(vulnerabilidad percibida)
- Respuesta social e institucional
esperada (tolerancia o sanción)
22. Obtención de
objetivos del agresor
(satisfacción del deseo,
poder)
24. Mantenimiento
23. - Legitimación cultural e institucional de la violencia.
- Impunidad de los perpetradores.
Basics about the MALVA PROJECT
It aims to prevent violence against intimate partner linked to alcohol
(and other drugs) abuse. Its name is an acronym for
“Machismo plus ALcohol, Violence Assured”, but besides this, the
Malva / mallow flower was considered a symbol for female
submission, and violet is also the colour symbolizing fight for
women’s rights.
 The MALVA team is made out of experts in addictions, in
domestic violence and in the mass-media.
 Their actions are developed in three regions: Madrid, Valencian
Community and Catalonia.
It was originally started with support of the European Commission,
DAPHNE programme, with a German partner NGO (IFT-Nord, Kiel).
Today it runs thanks to the Ministry of Health of Spain (National
Plan on Drugs), The autonomous Governments of Catalonia, the
Valencian Community and the Anti-drug Agency of Madrid.
MALVA Objectives: Primary prevention
1. Contributing to avoid, even for the first time, episodes of
violence against the intimate partner (usually the woman).
That is: helping to avoid / identify / manage aggressiveness
before it leads to aggression.
-
Information and awareness-raising of the general population through the
Mass Media.
-
Information and awareness-raising aimed to potential victims and
aggressors about processes leading to violent behaviour, with especial
relevance to the involvement of alcohol.
-
Information to the main target groups about the available resources for
support and counselling about alcohol abuse and/or violence.
-
Awareness raising to professionals from different fields (health services,
social services, justice, education…) about strategies of prevention of
family violence associated to alcohol abuse.
MALVA Objectives: Early detection
2. Early detection of the already existing violence cases in
an early and moderate stage, trying to avoid its
consolidation.
-Educate and train the various professional groups in the detection of
cases, patterns of action and strategies for prevention of family violence
associated with alcohol abuse
-Improve the responsiveness on detection situations, contributing to
the unification of criteria between specialized services.
-Help the people involved in a violent relationship (aggressor, victim,
surrounding others) to early identify it and to behave efficiently to stop
the process, when related to the alcohol abuse.
MALVA Objectives: Harm Reduction
3. Contribute to reduce the intensity of the violence in the
most difficult-to-solve cases, furnishing to the victims tools
and ideas to reduce the negative impact of the situation they
go through, provided this is not possible yet to change it in a
more substantial way.
- Furnishing the victims with some tools (patterns of behaviour to
follow and resources) to reduce the harm associated to family
violence.
- Facilitating to the relevant professionals tools and procedures to
provide the support the victims do require.
Working areas of the project:
1. Continued theoretical analysis on the relationship between
domestic violence and alcohol (and other drugs) abuse.
2. Awareness-raising and training professionals related with this
type of violence, i.e., health, social services, justice, police…
3. Workshops with adolescents (in high schools).
4. Training to selected university students.
5. Workshops with women at risk of social exclusion.
6. Awareness raising, dissemination of early detection
intervention messages through the mass media.
and
7. Information and awareness-raising for the general population
about the link between alcohol abuse and domestic violence,
and how to avoid both (distribution of leaflets, posters…). Selfdetection tests and advice in our website.
Monography: “Abuso de alcohol y violencia doméstica”
Training professionals:
-Training workshops
-Online training (www.fsyc.org/malva)
-Distribution of guidelines for action
-Cooperation in University Master Degrees on addictions and on domestic
violence, where lessons about this interaction are included.
Guidelines for professionals
Some actions through the Media
- Informing about the MALVA project and its development.
- Publishing Press releases, opinion articles, human stories with
good examples or ideas…
-Giving advice to the screenwriters of TV series to depict this
phenomenon (e.g., “Hospital Central”, audience beyond 5.000.000
people)
-Following-up of the published news about domestic violence,
trying to highlight the relationship with alcohol abuse, often
hidden or distorted.
Some publications at the Media
News and opinion articles
Materials for prevention (adults)
Self-detection test in the web site