Intimate Partner Violence and Alcohol Use

1. Intimate Partner Violence and Alcohol Use Carol R. Schermer MDDirector of Trauma and Critical CareUniversity of New Mexico

2. Intimate Partner Violence(IPV) Lifetime prevalence of IPV 18-30% Annual incidence physical IPV : 1-13% Leading cause of serious injury for women 15-44 1/3 female homicide victims killed by intimate partner Up to 33% of ED visits by women for injury are due to IPV Subsequent Health problems well described 77% of women never screened for IPV Women go unrecognized by health care providers The severity and consequences of intimate partner violence are far reaching. Over 1/3 of female homicide victims are killed by a current or former intimate partner. Victims of abuse increase their health care utilization and maintain higher levels of resource utilization for 12 months after a single violent episode. Women who are victims of IPV have higher risks of depression and suicide Yet despite its significant prevalence, nearly 80% of women have never been screened for IPV . The severity and consequences of intimate partner violence are far reaching. Over 1/3 of female homicide victims are killed by a current or former intimate partner. Victims of abuse increase their health care utilization and maintain higher levels of resource utilization for 12 months after a single violent episode. Women who are victims of IPV have higher risks of depression and suicide Yet despite its significant prevalence, nearly 80% of women have never been screened for IPV .

3. Risk Factors for IPV IPV risk is multi-factorial Physical aggression is accepted or tolerated Poverty Unemployment Racial/ethnic differences Power and control Excessive alcohol consumption is considered controversial

4. Magnitude of the problem In the general population alcohol problems are over-represented in partner-violent men Men in batterer intervention programs high rates of alcohol abuse and dependence Men seeking alcohol treatment High rates of partner violence 50-60% in year prior

5. Views of Alcohol and IPV Broad agreement that Violent men are often heavy drinkers Heavy drinking often accompanies violence Disagreement whether alcohol plays a causal role Some argue �no credible evidence� Alcohol is an �excuse� Aggression does not stop with successful alcohol Tx Causal Resolution of drinking problems yields decreased IPV

6. Association of Alcohol and IPV Extensive theoretical and empirical evidence linking substance abuse and male to female IPV Alcohol is the drug MOST commonly associated with IPV Paucity of good studies linking acute intoxication Female victims report partners had consumed alcohol prior 40-90% of time Can�t separate out from drinking in general Hard to tell if drinking and violence are related

7. Magnitude of the Problem Evaluation of men recruited from DV intervention programs and men entering alcoholism treatment programs M to F IPV 8-10 times more likely to occur on a day the male partner drank compared to those he did not drink 17-20 times more likely to occur on a heavy drinking day compared to a non-drinking day (Fals-Stewart 2003)

8. Alcohol and Aggression Studies of aggressive behavior show Alcohol makes subjects more aggressive Increases negative verbal behavior Old research shows no associations Newer research consistently shows associations of Acute intoxication and IPV Physical violence more prevalent than verbal Episodes where husband was drinking More acts of violence and More severe violence

9. Alcohol and Violence Events Alcohol use more common in serious physical assault events Violence most likely to occur within 4 hours after drinking Men more likely to have had 6 or more drinks prior to the events Estimated Blood alcohol concentrations: 0.19 during violence episodes 0.11 during non-violent conflict episodes

10. Alcohol and personality Alcohol appears to act synergistically with hostile motivations Except in those with very high hostile motivations Certain subsets of men are SO violent (ASPD) Violence episodes are not related to alcohol But alcohol worsens the severity of violence that occurs

11. Interventions If there is evidence of causality between alcohol and violence: can intervene Addressing excessive drinking behavior in individuals who behave in a violent way while drinking Relative ineffectiveness of batterer intervention programs may be due to Different types of batterers One-size fits all treatment programs

12. Data on Alcohol and IPV Case control and epidemiologic studies Consistent associations of heavy drinking and DV 2/3 of all IPV: alcohol is involved (DOJ 1996) Upper half of drinkers 2X risk of violence as lower half (Lipsey 1997, meta-analysis) Longitudinal studies report Drinking patterns are predictive of subsequent DV Controlling for prior DV

13. Data on Alcohol and IPV Multivariate studies show drinking behavior associated with DV independent of Age Socio Economic Status Occupational status Race/ethnicity Hostility and anti-social behavior Normative views of aggression Drug problems

14. Alcohol Treatment and IPV Recent reports show successful alcohol treatment reduces Verbal aggression IPV Decrease in drinking improves the relationship which improves the violence Couples alcohol treatment may work better than individual treatment Does not eliminate violence Makes it equal to those in non-alcoholic couples Alcoholics who relapse do not reduce their violence

15. IPV and Female Problem Drinking Conflicting findings Women screening positive for IPV more likely to screen positive for problem drinking Little work has been done evaluate female problem drinking while controlling for partner drinking

16. Study Objectives Identify women experiencing IPV Determine acceptability of screening Identify a potentially treatable IPV risk factor problem drinking

17. Hypotheses: Prevalence of IPV among female trauma center patients is greater than national samples Alcohol problems among abused women and their partners are greater than those among non-abused women Female problem drinking is an independent risk factor for IPV Female trauma patients endorse IPV screening

18. Methods Women ages 18-80 admitted to Trauma Service Anonymous interview Eligible patients English speaking Excluded severe head injury major psychiatric disorder

19. Measures IPV: Conflict Tactics Scales (CTS) Severe items: physical assault, sexual coercion, injury Not psychological items Lifetime and Past year IPV were evaluated Past year asked if partner >2 months Alcohol Use Disorders Identification Test (AUDIT) AUDIT >8 defined as problem drinkers

20. Participant Demographics (n=95)

21. Demographics (continued) Partners N=77 Unemployed: 23% Problem Drinkers (AUDIT> 8): 38% Missed subjects (10) Non-English speaking (5) Missed due to short hospital stay (5) No women declined interview