Understanding Alcohol-Related Domestic Violence: Impact and Interventions

1. ALCOHOL-RELATED DOMESTIC VIOLENCE • Angela Taft (with Ingrid Wilson and Kate Graham) • Professor and Director • Judith Lumley Centre • 29th October 2014

2. Alcohol-related domestic violence = • neglected space

3. Living with alcohol-related partner violence: what women say • “…waiting for him to come home from work…this is before the alcohol as well on a night time and I used to think oh god that’s going to make it worse and I had to look at his face to see if he was in a happy or a sad mood… and you shouldn’t have to think like that.’(Janet) • “ He’ll start to kick off and then he’ll realise when he’s in [the] pub and then he’ll stop and then he’ll calm down…so he can stop when he wants to stop” (Margaret) • “Its like the Jekyll and Hide thing, isn’t it, they have a drink and they flip”(Kim) • Galvani S. Women’s Perspectives: the Role of Alcohol in Violence Against Women. LAP, 2010

4. Why domestic violence is a public health policy issue Disproportionately affects women and their children Impact on women’s mental, physical and reproductive health well documented (WHO, 2013) Impact of partner violence perpetration on men’s health and wellbeing (Fulu et al, UN Multi-country Study, Lancet 2013) Major economic impact - $13.6 billion Australian economy (National Council to Reduce VAWC, 2009) Can impact on families over generations Most common among young people 18-24 years (ABS 2013)

5. Domestic/partner violence and alcohol - what is the link? • Not all partner violence is alcohol-related • Alcohol plays causal contributing role in aggression generally • Alcohol dependency and heavy episodic (binge drinking) involved (Foran & O’Leary, 2008) • Effect stronger for men – gender is important (Giancola et al., 2009) • The impact of alcohol-related partner violence is more severe, when one or both partners drink (Abramsky et al., 2011; Graham et al., 2011)

6. How prevalent is alcohol-related partner violence? • Alcohol is implicated in partner violence globally (WHO, 2006, Fulu et al 2013) • Alcohol is involved with a third to a half of domestic violence incidents in Australia • 35% of recent PV incidents alcohol-related (Mouzos and Makkai 2004) • 39.6% females vs 11.4% males alcohol-related physical abuse in last 12 months (AIHW 2011, 2010 NDSHS) • In Australia, females over-represented (73%) as victims of partner murder (Chan and Payne, 2013) • 44% of partner murders alcohol-related, 87% of Aboriginal partner murders (Deardon and Payne, 2009)

7. Ten year trend - rates of alcohol-related family violence in Victoria • Source: AODstats, Turning Point, 2014

8. Ten year trend - rates of alcohol-related family violence for 18-24 year olds in Victoria • Source: AODstats, Turning Point, 2014

9. How and where can we intervene in alcohol-related partner violence? An ecological model • Society • Community • Relationship • Individual WHO Ecological model for understanding violence against women (Krug et al., 2002; Bronfenbrenner, 1979)

10. Society level – what do we know? Alcohol-pricing and taxation Alcohol pricing strategies are generally effective in reducing consumption and related harms Few studies have looked at taxation and impact on domestic violence Only one American study found price reduction may reduce partner violence Limited evidence base Strategic policy: We need to know more to target pricing mechanisms How perpetrators are affected by alcohol price: type of alcohol/drinking patterns/forms of partner violence

11. Community level - what do we know? Reducing physical availability decreases consumption and harm by increasing effort to obtain alcohol Alcohol sales restriction Reduce hours or days of sale Shows promise (Aboriginal communities) but no rigorous or clear evidence Alcohol outlet density Some good Australian evidence of links between packaged liquor (off-premises) & increase in partner violence police incident rates ( 28.6%) Two other US studies found associations between outlets and police reports of domestic violence (inconsistent about type of outlet) Evidence is still weak, but worth investigation

12. Relationship level – what do we know? Couple-based treatment Aims to reduce alcohol consumption and improve marital relations in couples where one partner has alcohol problems Some evidence for brief interventions reducing both problem drinking and aggression in dating university couples (but reductions not linked) Other uncontrolled studies showed reductions in clinical populations (treatment seeking, middle-aged couples, long-term relationships); effects not often sustained Overall weak evidence from limited studies

13. Individual level - what do we know? Individual treatment • Aims to reduce alcohol problems in individuals with diagnosed problems • Standard batterer program compared with batterer and substance use treatment (motivational interview brief intervention) had effect but lost over time • The remaining few intervention studies (using CBT and telephone motivational interviewing) showed limited evidence, effects not sustained and unclear if violence reduction mediated by alcohol reduction • Evidence for individual-based alcohol treatment reducing domestic violence is limited

14. What do we know and what do we still need to know Alcohol contributes to violence Alcohol increases severity of intimate partner violence Certain types of drinking are implicated in partner violence – i.e., heavy and binge drinking Partner violence and binge-drinking common among young people Evidence for what to do at any level is scarce and limited quality – does not address problem among young people

15. Alcohol use ‘one of the factors most open to intervention and change’ • (Lori Heise in Graham et al., 2008)

16. Conclusion • We need more strategic research – current research focussing on generalised alcohol policies may not be sensitive enough • We need: • Focus on those at risk (young/binge) and heavy drinkers • Better research quality • Targeted interventions at all levels of ecological model

17. Some practical things we can do Service provision and safety planning • Better identification of heavy drinkers and risk to partners • Develop specific safety planning for partners of heavy drinkers • Better integration between men’s behaviour change programs and substance use treatment

18. Better research and evaluation • Improve data collection • Recording of alcohol-related IPV versus non-alcohol-related IPV Measure prevalence • Surveys of populations at risk (young people; heavy drinkers) • Personal Safety Survey – specifically include alcohol use in domestic violence • More longitudinal research – alcohol risk and perpetration and victimisation Research and Evaluation • Evaluations of alcohol policy interventions should include measures of domestic violence • Investigate alcohol availability, drinking location and domestic violence

19. The impact of alcohol-related domestic violenceWhat women say • “kicked in the stomach for being pregnant…like his family say they say ‘oh it’s the drink’…cos he can’t control you. I think it all boils down to control. Like I say, he’s just like a little [child] bairn having a tantrum.” (Margaret) • “ he knows that I wouldn’t fight back in front of the kids. So I would rather stand there and take the punch and walk off rather than cause a bigger scene in front of them and risk upsetting them (Linda). • Galvani S. Women’s Perspectives: the Role of Alcohol in Violence Against Women. LAP, 2010

20. Wilson IM, Graham K, Taft AJ. Alcohol interventions, alcohol policy and intimate partner violence: a systematic review. BMC Public Health. 2014;14:881. • http://www.biomedcentral.com/content/pdf/1471-2458-14-881.pdf