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Intimate Partner Violence and Co-Occurring Substance Abuse/Addiction
Intimate partner violence (IPV) is a major public health concern. Recent national media attention has increased discussion regarding this significant health care issue.
Definition and Background
The Futures Without Violence Association (FWV) defines intimate partner violence (IPV) as “A pattern of assaultive and coercive behaviors that may include inflicted physical injury, psychological abuse, sexual assault, progressive social isolation, stalking, deprivation, intimidation and threats. These behaviors are perpetuated by someone who is, was, or wishes to be involved in an intimate or dating relationship with an adult or adolescent, and one aimed at establishing control by one partner over the other.”
Substance abuse has been found to co-occur in 40-60% of IPV incidents across various studies. Several lines of evidence suggest that substance use/abuse plays a facilitative role in IPV by precipitating or exacerbating violence. Some studies also suggest the benefit of interventions that focus on substance abuse/addiction in men who have histories of IPV.
Spousal abuse has been identified as a predictor of developing a substance abuse problem and/or addiction. Additionally, women in abusive relationships have often reported being coerced into using alcohol and/or drugs by their partners. Substance abuse and high-risk alcohol use/abuse are more prevalent among women who experience IPV compared to a cohort with no IPV experience. In a study of prenatal patients in North Carolina, victims of violence were significantly more likely to use multiple substances before and during pregnancy than those who had no experience of IPV (American Journal of Public Health). It is known that many episodes of IPV involve alcohol and/or illicit drug consumption. Research has found that on days of heavy drug and/or alcohol use, physical violence was 11 times more likely among IPV batterers and victims.
Greater than 20% of male perpetrators report using alcohol and/or illicit drugs prior to the most recent and severe acts of violence. Victims of IPV also report the offender had been consuming alcohol and/or using illicit drugs. Many studies find excessive alcohol use to be strongly associated with perpetrating partner violence, though there is debate as to whether heavy drinking causes men to be violent or whether it is used to excuse violent behavior.
The strong relationship between substance abuse and perpetration of IPV has been found in primary health care settings, family practice clinics, prenatal clinics, and rural health clinics. The incidence of IPV and relationship to substance abuse is frequently observed and reported among individuals presenting at psychiatric and substance abuse treatment settings.
The United States Bureau of Justice Statistics report on intimate violence found that 85% of victims are female.
Women are five to eight times more likely than men to be victimized by an intimate partner. Seventy-five percent of perpetrators are males. Of note, IPV also occurs in lesbian, gay, bisexual and transgender (LGBT) relationships.
There is a lack of much-needed research specific to IPV and the LGBT communities. In a recent survey of men in same-gender relationships, the lifetime prevalence of IPV was nearly 40%, with 22% of men reporting physical abuse in the past five years.
Prevalence
According to Futures Without Violence, “On average, more than three women a day are murdered by their intimate partner in the United States,” and “Nearly one in four women in the United States report experiencing violence by a current or from a former spouse or boyfriend at some point in their life.” The most current data available from Centers for Disease Control and Prevention finds women experience over 2,000,000 injuries from intimate partner perpetrators. In the United States, the vast majority of nonfatal intimate partner victimizations of women (66%) occur in the home.
“15.5 million children in the US live in families in which partner violence occurred at least once in the past year,” (Futures Without Violence), and young women who were in shelters as children are now seeking protection from domestic violence situations themselves, according to the 2013 Mary Kay Truth about Abuse Survey.
Also of importance, nearly 50% of Native American women experience IPV in their life, the highest rate amongst US population groups.
Health Consequences of IPV
“IPV is the leading cause of female homicides and injury-related deaths during pregnancy, and accounts for significant preventable injuries and ED visits by women,” (Intimate Partner Violence and Healthy People 2010 Fact Sheet). A 2002 study by the US Department of Justice found that most victims injured by an intimate partner did not report seeking professional medical treatment for their injuries.
Victims of IPV are at increased risk for suffering serious mental health problems; 56% of women who experience IPV are diagnosed with a psychiatric problem, and victims of IPV are more likely to use tobacco and marijuana. Several studies suggest a significant correlation between IPV, morbid obesity and disturbed eating behaviors. Victims of IPV are 70 percent more likely to drink alcohol heavily than the non-experienced IPV cohort. IPV is also linked to a variety of reproductive health issues.
The American College of Obstetrics and Gynecology Committee on Health Care for Underserved Women recommends with “clinical signs of depression, substance abuse, mental health problems, requests for repeat pregnancy tests when the patient does not wish to be pregnant, new or recurrent STIs, asking to be tested for an STI, or expressing fear when negotiating condom use with a partner” to assess the patient for IPV.
Conclusions
Although intimate partner violence remains a public health concern, there have been advances in our basic understanding of how to treat perpetrators with co-occurring substance abuse and addiction. “For example, when substance use and IPV co-occur, research suggests that substance use plays a facilitative role in IPV by precipitating or exacerbating violence,” (Psychiatric Times – The Role of Substance Abuse in Intimate Partner Violence).
Hence, it is imperative to treat the substance abuse/addiction.
The United States is making progress in addressing this violence. Standard IPV interventions have shown to be ineffective, so referrals to substance abuse or mental health treatment are necessary (Psychiatric Times – The Role of Substance Abuse in Intimate Partner Violence).
Centers of higher educations are developing a stronger role in prevention as well, training students to intervene on behalf of one another and assist victims.
Addiction Medicine specialists can use therapeutic relationships with patients to: “identify intimate partner violence, make brief office interventions, offer continuity of care, and refer them for subspecialty and community-based evaluation, treatment, and advocacy,” (American Family Physician - Intimate Partner Violence).
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References and Resources
Psychiatric Times – The Role of Substance Abuse in Intimate Partner Violence
American College of Obstetricians and Gynecologists – Intimate Partner Violence
American Psychological Association - Intimate Partner Violence Facts and Resources
US Dept. of Justice - Intimate Partner Violence, 1993-2010
American Journal of Public Health - Violence and Substance Abuse Among North Carolina Pregnant Women
Office on Violence Against Women
Violence Prevention Evidence Database - World Health Organization
Hotlines
National Domestic Violence Hotline: 1-800-799-SAFE (7233)
Rape Abuse & Incest National Network (RAINN) Hotline: 1-800-656-HOPE (4673)
Additional Review Articles & Books
Avery-Leaf, S., & Cascardi, M. (2002). Dating violence education: Prevention and early intervention strategies. In P. A. Schewe (Ed), Preventing violence in relationships: Interventions across the life span (pp.79-105). Washington, DC, US: American Psychological Association.
Babcock, J. C., Green, C. E., & Robie, C. (2004). Does batterers' treatment work? A meta-analytic review of domestic violence treatment. Clinical Psychology Review, Jan;23(8):1023–1053.
CDC Report on Intimate Partner and Sexual Violence in the U.S. Explores Victimization and Impact http://www.cdc.gov/violenceprevention/intimatepartnerviolence/
Foshee, V.A. & Reyes, H. L. M. (2009). Primary Prevention of Adolescent Dating Abuse Perpetration: When to Begin, Whom to Target, and How to Do It. In D. J. Whitaker and J. R. Lutzker’s Preventing partner violence: Research and evidence-based intervention strategies. Washington, DC: American Psychological Association, pp. 141–168.
Hickman, L. J., Jaycox, L. H., & Aranoff, J. (2004) Dating violence among adolescents: Prevalence, gender distribution, and prevention program effectiveness. Trauma, Violence, and Abuse, 5, 123–142.
Mitchell, C. & Anglin, D. (Eds.), (2009). Intimate partner violence: A health based perspective. New York: Oxford University Press.
Nelson, H.E., Bougatsos, C., & Blazina, I. (2012). Screening women for intimate partner violence: A systematic review to update the 2004 U.S. Preventive Services Task Force recommendation. Annals of Internal Medicine, 156 (11), 796–808.
Ruff, S., McComb, J.L., Coker, C.J., & Sprenkle, D.H. (2010). Behavioral Couples Therapy for the treatment of substance abuse: A substantive and methodological review of O’Farrell, Fals-Stewart, and colleagues’ program of research. Family Process, 49:439–456.
Black, M.C., Basile, K.C., Breiding, M.J., Smith, S.G., Walters, M.L., Merrick, M.T., Chen, J., & Stevens, M.R. (2011). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
Whitaker DJ, Baker CK, & Arias I. (2007). Interventions to prevent intimate partner violence. In L. Doll, S. Bonzo, D. Sleet, J. Mercy & E. Hass (Eds.), Handbook of Injury and Violence Prevention (183–201).New York, NY: Springer.
Whitaker, J.D. & Lutzker, J.R. (Eds.), (2009). Preventing partner violence: Research and evidence-based intervention strategies. Washington DC: American Psychological Association.
Whitaker DJ., Morrison S., Lindquist CA., Hawkins SR, O'Neil JA, Nesius AM, Mathew A, Reese L. (2006) A critical review of interventions for the primary prevention of perpetration of partner violence.
