Violence, The Family, & Substance Abuse 02-23-00

1. Violence, The Family, & Substance Abuse02-23-00 Marti Wilkerson, Assistant Professor - Rehabilitation Science

2. Definitions • Family: “Two or more people in a committed relationship from which they derive a sense of identity as a family” - this includes “nontraditional family forms that are outside the traditional perspective…families not related by blood, marriage or adoption.” Nunnley, Chilman & Cox, (1998). Family Centered Welfare Services Theory & Practice

3. Definitions Continued • Violence:An act carried out with the intention or perceived intention of causing physical pain or injury to another person. 1. Normal Violence.Normal violence is the commonplace slaps, pushes, shoves, and spankings that frequently are considered a normal or acceptable part of raising children or interacting with a spouse. 2. Abusive Violence.Acts that have the high potential for injuring the person being hit. Included in this definition are punches, kicks, bites, chokings, beatings, shootings, stabbings, or attempted shootings or stabbings. Gelles, R.J., (1997). Intimate Violence in Families. Thousand Oaks, CA: Sage Publications, Inc.

4. Nurturing vs. ViolenceFamily Factors • Time at risk.The ratio of time spent interacting with family members and intimates far exceeds the ratio of time spent interacting with others, although the ratio will vary depending on stages in the family life cycle. • Range of activities and interests.Not only do family members and intimates spend a great deal of time with one another, the interaction ranges over a much wider spectrum of activities than nonfamilial interaction.

5. Family Factors Continued • Intensity of involvement.The quality of family and intimate interaction is also unique. The degree of commitment to family interaction is greater. A cutting remark made by a family member or an intimate partner is likely to have a much greater effect than the same remark in another setting or by someone else. • Impinging activities. Whether it involves deciding what television show to watch or what car to buy, there will be both winners and losers in intimate relations.

6. Family Factors Continued • Right to influence.Belonging to a family carries with it the implicit right to influence the values, attitudes, and behaviors of other family members. • Age and sex differences.The family is unique in that it is made up of different ages and sexes. Thus, there is the potential for battles between generations and sexes. • Ascribed roles.In addition to the problem of age and sex differences is the fact that the family is perhaps the only social institution that assigns roles and responsibilities based on age and sex rather than interest or competence.

7. Family Factors Continued • Privacy.The modern family is a private institution, insulated from the eyes, ears, and often rules of the wider society. Where privacy is high, the degree of social control will be low. • Involuntary membership.Families are exclusive organizations. Birth relationships are involuntary and cannot be terminated. Whereas there can be ex-wives and ex-husbands, there are no ex-children or ex-parents. Being in a family involves personal, social, material, and legal commitment and entrapment. When conflict arises, it is not easy to break off the conflict by fleeing the scene or resigning from the group.

8. Family Factors Continued • Stress.Families are constantly undergoing changes and transitions. The birth of children, maturation of children, aging retirement, and death are all changes recognized by family scholars. Moreover, stress felt by one family member (such as unemployment, illness, bad grades at school) is transmitted to other family members.

9. Family Factors Continued • Extensive knowledge of social biographies.The intimacy and emotional involvement of family and intimate relations reveal a full range of identities to members of a family. Strengths and vulnerabilities, likes and dislikes, loves and fears are all known to family members. Although this knowledge can help support a relationship, the information can also be used to attack intimates and lead to conflict (P. 124-125). Gelles, R. J., (1997). Intimate Violence in Families. Thousand Oaks, CA: Sage Publications, Inc.

10. Violence & Alcohol • Alcohol is a CNS depressant, however, when the alcohol abuser benzodiazepines combined with alcohol, a result may be “paradoxical rage reaction”. • “In this condition, a drug that is normally a depressant brings about an unexpected period of rage in the individual, who may become self-destructive or harm others”. • “The individual may have no conscious memory of what he or she did during the “paradoxical rage reaction”. • Research suggests that 25-50% of alcoholics are also addicted to benzodiazepines (an anti-anxiety medication). • The chronic alcoholic can control his/her withdrawal symptoms by using benzodiazepines during the day without having the smell of alcohol on the breath.

11. In 1960, benzodiazepines were initially thought to be a non-addictive substitute for barbituates. They were used to control such symptoms as: anxiety, insomnia, muscle strains and seizures. Examples of benzodiazepines include: valium (diazepam); librium (chlordiazepoxide); tranxene (clorazepate); xanax (alprazolam); & ativan (lorazepam). The disinhibition effects of benzodiazepines and alcohol when combined, are thought to be the reason for “paradoxical rage reaction”. Doweiko, H.E., (1996). Concepts of Chemical Dependency. Pacific Grove, CA: Brooks / Cole Publishing Company.

12. Violence & Cocaine • “Approximately 20% of the chronic users of crack cocaine in one study were reported to have experienced drug induced periods of rage or outbursts of anger and violent assaultive behavior (Beebe & Walley, 1991).” Doweiko, H.E., (1996). Concepts of Chemical Dependency. Pacific Grove, CA: Brooks / Cole Publishing Company.

13. Violence & MDMA • Street names: ectasy; xtc; m&m; adam; rave; “E” or the “dance making drug.” Clinicians use MDMA. • “Long-time MDMA use has been connected to episodes of violence and to suicide (Medical Update, 1994).” • “The drug can also bring about residual effects, including anxiety attacks, persistent insomnia, rage reactions, and a drug induced psychosis.” (p.173) Doweiko, H.E., (1996). Concepts of Chemical Dependency. Pacific Grove, CA: Brooks / Cole Publishing Company.

14. Violence & Marijuana • It was once believed that marijuana use induced violence. “However, the sedating and euphoric effects of marijuana are more likely to “reduce” any tendency toward violence, rather than bring it about (p.217). Few clinicians believe that Marijuana is associated with increasing violent behavior. Doweiko, H.E., (1996). Concepts of Chemical Dependency. Pacific Grove, CA: Brooks / Cole Publishing Company.

15. Violence & PCP (Phencyclidine) • This hallucinogen was originally used as an intraveneuos surgical anesthetic but its use was discontinued in the mid-60’s due to patients experiencing drug induced delerium. • It is easily produced. • There is no evidence of physical dependence. • Negative effects of PCP intoxication include: “disorientation, mental confusion, assaultiveness, anxiety, irritability and paranoia” (Weiss & Mirin, 1988). P.169. • Symptoms of mild levels of PCP intoxication (< 5mg) “include agitation, some feelings of anxiety, flushing of the skin, visual hallucinations, irritability, possible sudden outbursts of rage, feelings of euphoria or depression.” p.169.

16. Symptoms of moderate levels of PCP intoxication (between 5 - 10mg) can include: “ paranoia, severe anxiety, belligerence and assaultiveness (Grinspoon & Bakalar, 1990). p.170. • Symptoms of severe levels of PCP intoxication (10 - 25mg or higher) can include: the possibility of overdose, coma, seizures, severe psychotic reactions or death. • “Because of the assaultiveness frequently induced by PCP, many users become either the victims or the perpetrators of homicide (Ashton, 1992).” p. 170. Doweiko, H.E., (1996). Concepts of Chemical Dependency. Pacific Grove, CA: Brooks / Cole Publishing Company.

17. Violence & Steroid Abuse • “In 1990, Pope & Katz reported that, in their opinion, steroid abuse had contributed to the violent behavior of 3 individuals, and in all 3 cases, the end result was homicide or attempted homicide. Illicit steroid users often call this drug induced reaction a “roid rage” (Redman, 1990; Fultz, 1991). • Up to 90% of those who abuse steroids may experience an increase in aggressive or violent behavior (Johnson, 1990). Doweiko, H.E., (1996). Concepts of Chemical Dependency. Pacific Grove, CA: Brooks / Cole Publishing Company.

18. Prevention Strategies 1. Eliminate the norms that legitimize and glorify violence in the society and the family. The elimination of spanking as a child-rearing technique, gun control, to get deadly weapons out of the home; elimination of corporal punishment in school; elimination of the death penalty; and an elimination of media violence that glorifies and legitimizes violence are all necessary steps.

19. Prevention Strategies Cont. 2.Reduce violence-provoking stress created by society.Reducing poverty, inequality, and unemployment and providing for adequate housing, feeding, medical and dental care, and educational opportunities are steps that could reduce stress in families. 3.Integrate families into a network of kin and community.Reducing social isolation would be a significant step that would help reduce stress & increase the abilities of familiesto manage stress.

20. Prevention Strategies Cont. 4.Change the sexist character of society.Sexual inequality makes violence possible in homes. The elimination of men’s work and women’s work would be a major step toward equality in and out of the home. 5. Break the cycle of violence in the family. This step repeats the message in step 1 - violence cannot be prevented as long as we are taught that it is appropriate to hit the people we love. Physical punishment of children is perhaps the most effective means of teaching violence, and eliminating it would be an important step in violence prevention.

21. Prevention Strategies Cont. Such steps require long-term changes in the fabric of society. These proposals call for such fundamental change in families and family life that many people resist them and argue that they could not work or would ruin the family. The alternative, of course, is that not making such changes continues the harmful and deadly tradition of intimate violence (p. 166-167). Gelles,R.J., (1997).Intimate Violence in Families. Thousand Oaks, CA: Sage Publications, Inc.