The role of alcohol and substance abuse in the
occurrence of intimate partner violence
Presentation at the American Psychological Association Violence Summit
February 29, 2008
Kenneth Leonard
Research Institute on Addictions and
The Department of Psychiatry
University of Buffalo
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
–
•
Batterers
–
•
Muhajarine, N., & D’Arcy, C. (1999). Canadian Medical Association Journal, 160, 1007-1011.
Primary Care Settings
–
•
Kyriacou, D.N., McCabe, F., Anglin, D., Lapesarde, K., & Winer, M.R. (1998).. Annals of
Emergency Medicine, 31, 502-506.
Prenatal and Antenatal Clinics
–
•
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
–
•
O’Farrell, T.J., Fals-Stewart, W., Murphy, M., & Murphy, C.M. (2003). Journal of Consulting &
Clinical Psychology, 71, 92-102.
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 lowalcohol-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
12
10
8
6
4
2
0
NSFH
NSFH
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
Alcohol Use Among Participants with
Verbal, Moderate Physical, or Severe
Physical Aggression Episodes
Husband Report
Wife Report
____________________________________________________________________________________
Verbal Moderate
Severe
Verbal Moderate
Severe
N=218
N=45
N=61
N=211
N=44
N=67
____________________________________________________________________________________
Alcohol Involved
Husband Only
Wife Only
Both
0.0%
8.3%
3.2%
8.9%
0.0%
2.2%
26.2%
6.6%
11.5%
7.1%
0.5%
2.4%
25.0%
0.0%
2.3%
28.4%
3.0%
14.9%
Total Husband
Total Wife
3.2%
11.5%
11.1%
2.2%
37.7%
18.1%
9.5%
2.9%
27.3%
2.3%
43.3%
17.9%
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
0.2
0.18
0.16
0.14
0.12
0.1
0.08
0.06
0.04
0.02
0
0.16
0.14
0.12
0.1
HBAC
WBAC
HBAC
WBAC
0.08
0.06
0.04
0.02
0
absent
present
absent
Murphy, C.M., Winters, J., O’Farrell, T.J., Fals-Stewart, W., & Murphy, M. (2005).
Psychology of Addictive Behaviors, 19(1), 35-42.
present
Odds of violence re: Non drinking day
Odds of violence (wife report) as a
function of drinking (husband report)
25
NonHeavy drinking
Heavy Drinking
20
15
10
5
0
Any Violence
Severe Violence
Domestic Violence Sample
Any Violence
Severe Violence
Alcoholic Sample
Fals-Stewart (2001)
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
Low Hostility
High Hostility
0.6
0.8
0.7
0.5
0.6
0.4
0.5
L MS
H MS
0.3
L MS
H MS
0.4
0.3
0.2
0.2
0.1
0.1
0
0
Low ADS
High ADS
Low ADS
High ADS
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.
Negativity among High Antisocial and Low Antisocial
Alcoholics and their wives as a function of alcohol
3
2.5
2
No Alcohol
Alcohol
1.5
1
0.5
0
HAS
Husbands
Wives of
HAS
LAS
Husbands
Wives of
LAS
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
16
14
12
10
No alc
Placebo
Alc
8
6
4
2
0
NV
MV
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.
Marital Violent Men
Trait Anger Scale scores and Alcohol effects on Composite
ATSS Aggressive Verbalizations.
20
AGGRESSIVE
VERBALIZATIONS
18
16
14
12
Placebo/Control
10
Alcohol
8
6
4
2
0
Low anger
High anger
ALCOHOL CONDITION
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
And, the number of days drinking
after treatment was significantly
associated with overall violence
35
30
25
20
Overall physical
Severe Violence
15
10
5
0
Relapsed
Remitted
O’Farrell, T.J., Fals-Stewart, W., Murphy, M., & Murphy, C.M. (2003). Journal of Consulting & Clinical
Psychology, 71, 92-102
Severe aggression after treatment for couples
treatment
20
Relapsed Year 1
Relapsed Year 2
Remitted Year 1
Remitted Year 2
18
16
14
12
10
8
6
4
2
0
M->F severe
F->M severe
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 the
needs/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.