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. Author manuscript; available in PMC: 2014 Aug 1.
Published in final edited form as: J Consult Clin Psychol. 2013 May 6;81(4):10.1037/a0032876. doi: 10.1037/a0032876

The Temporal Association between Substance Use and Intimate Partner Violence among Women Arrested for Domestic Violence

Gregory L Stuart 1,4,5, Todd M Moore 1, Sara R Elkins 1, Timothy J O’Farrell 2, Jeff R Temple 3, Susan Ramsey 4, Ryan C Shorey 1
PMCID: PMC3885140  NIHMSID: NIHMS540817  PMID: 23647284

Abstract

Objective

There is a paucity of research on the temporal association between substance use and intimate partner violence (IPV) perpetration and victimization, especially among women arrested for domestic violence. The current study examined whether the probability of IPV perpetration and victimization increases following alcohol or drug use relative to days of no use among women arrested for domestic violence.

Method

Women arrested for domestic violence and court referred to batterer intervention programs who met criteria for hazardous drinking participated in the current study (N=105). Women who reported drinking four or more drinks on one occasion at least once per month for the past six months were considered hazardous drinkers. Violence and substance use were assessed with the Timeline Followback Interviews for substance use and IPV.

Results

Women were more likely to perpetrate physical violence on a drinking day (OR=10.58; 95% CI=5.38–20.79) and on a heavy drinking day (OR=12.81; 95% CI=8.10–33.57), relative to a non-drinking day. Women were more likely to be victimized by physical violence on a drinking day (OR=5.22; 95% CI=2.79–9.77) and on a heavy drinking day (OR=6.16; 95% CI=3.25–11.68), relative to a non-drinking day. They were more likely to be victims of sexual coercion (OR=6.06; 95% CI=1.19–30.80) on a cocaine use day relative to a non-use day.

Conclusions

Alcohol use was temporally associated with physical violence perpetration and victimization, and cocaine use was temporally associated with sexual coercion victimization, suggesting that substance use should be targeted in batterer intervention programs for women.

Keywords: intimate partner violence, substance abuse, alcohol use, drug use

Intimate partner violence (IPV), including physical and sexual violence, is a prevalent public health problem with significant negative consequences. IPV perpetrated by both genders can lead to physical injury, depression, posttraumatic stress symptomatology, suicide, and homicide (Hines & Malley-Morrison, 2001; Schumacher, Feldbau-Kohn, Smith-Slep, & Heyman, 2001). Thus, the importance of identifying factors that contribute to IPV perpetration and victimization cannot be overstated.

There is extensive theoretical and empirical support for a connection between substance abuse and IPV (Stuart, O’Farrell, & Temple, 2009). Meta-analytic studies have demonstrated robust and consistent positive relations between alcohol and cocaine use and IPV perpetration, as well as alcohol use and IPV victimization (Foran & O’Leary, 2008; Moore et al., 2008). Etiological models of IPV have been proposed in which distal and proximal factors are thought to play important roles, with alcohol and drug use serving as potential proximal variables that may reduce the threshold for aggression (Chermack & Giancola, 1997; Leonard, 1993). Moreover, substance abuse is overrepresented in men and women who perpetrate IPV. For example, two-thirds of men in batterer intervention programs drink hazardously and approximately one-third report symptoms consistent with a drug-related diagnosis (Gondolf, 1999; Stuart, Moore, Kahler, & Ramsey, 2003). In two studies of women arrested for domestic violence (Stuart, Moore, Ramsey, & Kahler, 2003; 2004), approximately half of the women drank hazardously and over one-quarter reported symptoms consistent with a drug-related diagnosis.

Theories explaining the relationship between substance use and IPV

Leonard (1993; 2001) developed a theoretical model to explain the multiple pathways in which alcohol use may be etiologically related to IPV among couples. His model proposed that distal influences (e.g., individual and couple characteristics, personality traits, drinking patterns, relationship dissatisfaction), combine with proximal/contextual factors (e.g., physiological and psychological effects of alcohol), to increase the likelihood of IPV during a conflict situation between partners. A number of theorists have described the cognitive and pharmacological mechanisms responsible for the association between acute alcohol use and aggression. For example, Steele and Josephs (1990) argued that being under the influence of alcohol increases the risk for aggression through its narrowing effect on attention, which has been termed the alcohol myopia model. This model postulates that alcohol increases the risk for aggression through reduced information processing, resulting in a narrowing of attention on the most salient, easy-to-access, and immediate aspects of a situation (Giancola, 2002; Giancola, Josephs, Parrott, & Duke, 2010). For example, if an individual is under the influence of alcohol and experiences a negative, provocative situation, it is more likely that the individual will focus his/her attention on the provocation and the accompanying negative thoughts/emotions than on inhibitory cues (e.g., alternative explanations for the situation, emotion regulation), increasing the likelihood of an aggressive response.

Expanding upon the alcohol myopia model, Giancola (2000) proposed that alcohol negatively impacts cognitive abilities, particularly those that underlie executive functioning, which may lead to aggressive behavior. Several distinct processes are thought to be subsumed within the executive functioning construct, including attentional control, information appraisal, abstract reasoning, cognitive flexibility, and self-monitoring (Giancola, 2002). Giancola (2000) proposed that the executive functioning framework for alcohol-related aggression is best suited to predict violence that occurs under provocative situational factors, and that any provocative situation that produces negative affect (e.g., anger, frustration) will increase the odds of alcohol-related aggression.

Temporal association between substance use and IPV

Leonard (2005) reviewed the available literature regarding the association between alcohol use and violence across numerous research methodologies and populations, and concluded that “heavy drinking is a contributing cause of violence” (p. 423). Moreover, a number of experimental studies have shown that alcohol increases both risk factors for aggression (e.g., hostility, negativity, aggressive verbalizations; Eckhardt, 2007; Leonard & Roberts, 1998) and actual aggression perpetration (Duke, Giancola, Morris, Holt, & Gunn, 2011).

Foran and O’Leary (2008) conducted a meta-analysis of the association between alcohol use and IPV. They found a small to moderate effect size for male perpetrated IPV, and a small effect size for female perpetrated IPV. This is consistent with the small to moderate effect sizes found for the association between alcohol use and general aggression (e.g., Bushman & Cooper, 1990; Ito, Miller, & Pollack, 1996). Moore et al. (2008) conducted a meta-analysis of the link between drug use and IPV. Consistent with the findings for alcohol, Moore et al. found a small effect size for the link between drug use and IPV. When examining specific illicit drugs, Moore et al. found that cocaine had the strongest connection to IPV relative to other substances, with a small to medium effect size. Similarly, stimulants such as cocaine and amphetamines have been linked to general aggression with the suggestion that such substances may have a causal connection to violence (e.g., Boles & Miotto, 2003).

Although substance abuse is clearly a risk factor for IPV, a temporal association between the two variables must be established for substance use to be considered a possible contributing cause to individual incidents of IPV. Identifying the temporal connection between substance use and IPV is of critical importance, as it carries significant implications for the prevention and treatment of IPV. If substance use increases the risk for IPV relative to days in which no substance use occurs, intervention and treatment programs for IPV could focus efforts on concurrently reducing substance use.

Many previous studies on the association between IPV and substance use have interviewed battered women (or examined arrest records) and identified the proportion of times in which IPV occurred when an individual was under the influence of alcohol or drugs (e.g., Murphy, Winters, O’Farrell, Fals-Stewart, & Murphy, 2005; Roberts, 1987). However, without comparing this proportion to the percentage of times that IPV occurred when the partner was not using a substance, one cannot conclude that substance use increases the relative risk of IPV when compared to days of no substance use.

To date, only a handful of studies have addressed these issues by using state-of-the-art assessment methods that ascertain the temporal association, or conditional probability (odds ratio; OR), of IPV on days of substance use relative to days of no use. Using a structured interview for alcohol use and IPV, researchers assessed the temporal association between alcohol use and physical and sexual aggression in male and female adolescents recruited from an emergency room department. Rothman and colleagues(in press) demonstrated that the odds of perpetrating physical aggression against a dating partner on a drinking day, relative to a non-drinking day, were higher for males (OR = 2.16) and females (OR = 2.02). They also found that the odds of perpetrating severe physical aggression were higher for males on a drinking day (OR = 2.17), but not for females. On heavy drinking days, the odds of any physical violence perpetration (OR = 3.18), severe physical violence perpetration (OR = 3.34), and sexual violence perpetration (OR = 8.43) were higher for males, but heavy drinking did not significantly increase the risk of violence perpetration for females. Finally, for males, the odds of physical aggression victimization were higher on a drinking day and heavy drinking day (OR = 1.71 and OR = 2.51, respectively) compared to a non-drinking day; females were not at significantly greater risk for physical or sexual violence victimization on drinking days or heavy drinking days. Moore, Elkins, McNulty, Kivisto, and Handsel(2011), using a prospective daily diary design with male and female college students, demonstrated that the odds of perpetrating physical aggression against an intimate partner were higher on drinking days relative to non-drinking days (OR = 3.64), even after controlling for the effects of other substances.

Parks and colleagues(2008) had female college students use a daily phone-based interactive voice response system for eight weeks to report on their experiences with aggression during the previous day. The investigators combined violence victimization and perpetration into one variable rather than assessing their independent associations with substance use. Results showed that physical (OR = 11.84) and sexual (OR = 19.44) aggression were more likely to occur on heavy drinking days relative to non-drinking days. No effect was found for days of non-heavy drinking relative to non-drinking days. In some of the aforementioned temporal association studies, the investigators did not report with whom the aggression occurred (e.g., stranger, dating partner, etc.) (Parks et al., 2008) nor did they assess(Rothman et al., in press) or control (Parks et al., 2008; Rothman et al., in press) for participants’ drug use.

Thus, extant research suggests that alcohol use may be temporally associated with aggression perpetration and victimization, although continued work is needed in this area. Demonstrating a temporal relationship between substance use and IPV would lend further support to theoretical models that highlight the importance of a proximal relationship between substance use and aggression (e.g., Chermack & Giancola, 1997; Giancola, 2000; 2002; Leonard, 1993; Steele & Josephs, 1990). Women arrested for domestic violence are a population that is severely understudied, has extensive substance use problems, and represents an ever increasing number of individuals arrested for domestic violence due to mandatory arrest laws. Information on the temporal relationship between substance use and intimate partner violence in this population could be used to improve batterer intervention programs for women.

Present Study

We investigated whether the probability of IPV perpetration and victimization was higher following alcohol or drug use relative to days of no use in a sample of women entering a violence intervention program. Given the extensive body of literature documenting a link between alcohol and cocaine use and IPV (e.g., Foran & O’Leary, 2008; Moore et al., 2008; Parks et al., 2008; Rothman et al., in press; Shorey, Stuart, & Cornelius, 2011; Stuart et al., 2006; 2008), we hypothesized that alcohol and cocaine use would be temporally associated with IPV perpetration and victimization, such that the relative risk of IPV would be greater on alcohol/cocaine use days relative to non-use days.

Method

Participants

We recruited a sample of 105 women as part of an ongoing clinical trial that is investigating the effectiveness of batterer intervention programs. The women were arrested for domestic violence and court-referred to batterer intervention programs in the state of Rhode Island. Eligibility criteria required all women to meet criteria for hazardous drinking (i.e., drinking four or more drinks on one occasion at least once per month for the past six months). Women participating in the study had to be willing to be randomly assigned to either a standard batterer intervention program or the standard batterer intervention program plus a brief alcohol intervention with our staff. All women were required by the courts to attend batterer intervention programs; however, participation in our study was completely voluntary. Participants were informed that a decision not to participate in the research would have no impact on their status in the batterer intervention program. A Certificate of Confidentiality was obtained to further protect the confidentiality of the data. Women were screened and recruited during their batterer intervention program intakes or in one of their first few batterer intervention group sessions. Eighty percent of the 132 women who were eligible for the study participated. Participants were recruited within the first few weeks of attendance in the violence prevention program (M = 2.76 weeks, SD = 1.96). The data were collected in this study prior to randomly assigning women to treatment condition.

Women reported a mean age of 32.8 years (SD = 10.5), education of 12.4 years (SD = 1.9), 1.6 children (SD=1.7), and annual individual income of $12,638 (SD = $14,510; Median = $7,900). Twelve percent of the sample identified their ethnicity as Hispanic/Latina. In terms of racial categories, 83% of the participants reported that they were Caucasian, 7% Black/African American, 1% Asian, 5% more than one race, and 4% unknown/other races. Thus, 17% of the women in our sample were racial minorities, which is slightly higher than the racial minority population in the state of Rhode Island (13.7%; US Census Bureau, 2011). At the time of the assessment, 31.7% of the women reported that they were living together with a partner, 23.1% were dating, 5.8% were married, 9.6% were separated, 3.8% were divorced, 1.0% were widowed, and 25% had no romantic partner. Among the women in a current relationship, the mean duration of the relationship was 43.0 months (SD=41.3). Six of the women in the sample were involved in a relationship with a female partner. Two-thirds of the women (66.7%) reported that they had consumed at least one drink of alcohol prior to the incident that led to their arrest for domestic violence, 51.2% reported that they had consumed 5 or more drinks prior to arrest, and 29.8% reported that they used drugs prior to their arrest. In terms of criminal history, women reported that they had been arrested for an average of 1.2 domestic violence offenses (SD=1.2) in their lifetime, 0.7 violent offenses against non-intimate partners (SD=1.5), 1.1 alcohol-related offenses (SD=1.8), 0.5 drug-related offenses (SD=1.3), and 1.2 nonviolent offenses (SD=2.2).

Procedures

Assessments were conducted with each participant individually by a trained female research assistant with a bachelor’s degree in psychology. Participation was voluntary, and all participants signed an informed consent statement that was approved by the Butler Hospital Institutional Review Board. Participants were paid $75 in gift certificates to compensate them for their time. Participants first completed the Structured Clinical Interview for DSM-IV (SCID), and subsequently completed the Timeline Followback interview for substance use (TLFB) and the Timeline Followback interview for spousal violence (TLFB-SV). The order of administration of the TLFB and TLFB-SV was counterbalanced.

Measures

Substance Use Disorders

Diagnostic criteria for current and lifetime substance use disorders were assessed with the Structured Clinical Interview for DSM-IV (SCID), a reliable and valid instrument for the assessment of Axis I disorders (First, Spitzer, Gibbons, & Williams, 1995; Kranzler, Kadden, Babor, & Tennen, 1996). Of the 105 women, 96.2% had a current or lifetime alcohol-related diagnosis (49.5% current dependence, 28.6% past dependence, 7.6% current abuse, 10.5% past abuse, 3.8% no alcohol diagnosis). In addition, 49.5% of the women had a current or past drug use disorder.

Alcohol and Drug Use

The Timeline Followback interview (TLFB) (Sobell & Sobell, 1996) was used to assess substance use. The TLFB is a calendar-assisted structured interview that provides a way to cue memory to enhance recall. Participants are given a calendar with holidays and dates of personal significance highlighted (e.g., birthdays, anniversaries) and are asked to report drinking/drug use on each day. The TLFB is considered the gold-standard in retrospective reporting of prior alcohol use(Sobell & Sobell, 1979; Sobell & Sobell, 1980; Sobell & Sobell, 2003). It has excellent reliability(Sobell et al., 1979) and validity (Carney, Tennen, Afflect, del-Boca, & Kranzler, 1998; Sobell et al., 1980; Sobell et al., 2003) with high temporal stability, high correlations between self- and corroborating informants, and high convergent and discriminant validity up to one year. In the present study, the TLFB covered the six month period preceding the interview date. Participants noted whether they consumed alcohol and specific drugs (i.e., marijuana, cocaine, opiates, hallucinogens, benzodiazepines, and other) on each day covered by the interview. If they drank, they reported the number of standard drinks consumed on that day. Heavy drinking was defined as ≥4 drinks on one occasion (National Institute on Alcohol Abuse and Alcoholism [NIAAA], 1995).

Intimate Partner Violence

IPV was assessed with the Timeline Followback Spousal Violence Interview (TLFB-SV). Individuals interviewed with the TLFB-SV are presented with the same calendar used for the TLFB, and days during which IPV perpetration and victimization occurred are entered on the calendar. Participants were given a list of possible types of IPV, derived from the violence items on the Revised Conflict Tactics Scale(Straus, Hamby, Boney-McCoy, & Sugarman, 1996; Straus, Hamby, & Warren, 2003) and the Sexual Experiences Survey (Koss, Gidycz, & Wisniewski, 1987). When handing participants the list of types of IPV, the research assistant said to the participant, “Now I’m going to show you a list of things that can happen between couples in a relationship no matter how well they get along. Take your time and read through the list. If any of them have happened between you and your partner since [date] please say the number of the item and whether it was you to that person, that person to you, or both of you to one another.” At the top of the page containing the list of types of IPV that is handed to participants, the instructions (derived from the CTS2; Straus et al., 1996; 2003) read, “No matter how well a couple gets along, there are times when they disagree on major decisions, get annoyed about something the other person does, or have spats or fights because they’re in a bad mood, or tired, or for some other reason. A couple may also use many different ways to settle their differences. Listed below are some things that you or your partner may have done when you had a dispute. Please keep in mind that everything you tell us is strictly confidential and will not be reported to your partner, your treatment coordinator, or anyone else.” Examples of physical violence items include, “pushed, grabbed, or shoved” and “kicked, bit, punched, or hit with a fist.” Examples of sexual coercion items include, “used some degree of physical force to try to obtain any sexual act when the other did not want to, whether or not the act occurred” and “had sex when you didn’t want to because you felt pressured.” When violence is reported, the type(s) of violence is also recorded on the calendar.

Physical violence was categorized as either minor or severe, based on potential of the behavior to cause injury. Sexual IPV was not categorized as minor or severe since there is no standardized definition of minor and severe sexual IPV based on the items employed in the current study. Days of face-to-face contact between partners were also coded, since physical and sexual aggression cannot occur on days of no contact. Women were not required to be with the same intimate partner throughout the six months assessed. During the assessment period, 70% of the women had face-to-face contact with a current relationship partner only; 19% of the women had face-to-face contact with both a current and an ex-partner; and 11% of the women had face-to-face contact with an ex-partner only. Violence was coded dichotomously for each day (present versus absent). As with the TLFB, the TLFB-SV interview covered the six month period prior to the interview date. The order of administration of the TLFB and TLFB-SV was counterbalanced. On days that substance use and IPV were both reported, participants indicated which behavior occurred first.

Results

Data Analytic Method

Given that daily reports of substance use and IPV are nested within individuals, these data violate the assumptions of ordinary least squares regression analyses. Therefore, all analyses estimated two-level models using HLM6 (Raudenbush, Bryk, & Congdon, 2004), which controls for the autocorrelation between individuals’ daily reports in the second level of the model. By regressing daily IPV onto daily substance use, we calculated odds ratios (ORs) indicating the extent to which alcohol and drug use on a given day was associated with IPV later that same day, relative to days in which participants refrained from using substances. Because IPV is measured dichotomously (no IPV vs. IPV), a Bernoulli sampling distribution and logit link function were specified in all analyses. Substance use and IPV were temporally linked only if the substance use preceded IPV on each day. Days in which participants reported using a substance only after IPV occurred were recoded as non-use days to avoid artificially inflating the results, given our focus on substances as potential contributing factors to the onset of violence. All analyses controlled for the variance shared with other drugs used that day by entering all classes of drugs in each model, and all variables were entered into the model as uncentered due to their dichotomous nature. Three separate models were tested to accommodate examining the link between alcohol and IPV: 1) drinking versus no drinking, 2) heavy drinking (i.e., 4 or more standard drinks) versus no drinking, and 3) number of drinks on a drinking day. Each other drug was simultaneously entered into all models as “did not use” or “used.” Effects were allowed to vary across individuals in all analyses.

Descriptive Statistics

During the six month assessment period, participants reported a mean of 123.9 days of face-to-face contact with their partners (SD = 65.1 days), which amounted to face-to-face contact on 68.1% of the 182 days assessed. These data were used in all HLM analyses since physical and sexual violence cannot occur on days in which partners do not see each other. All women included in the analyses had at least one day of face-to-face contact with a partner. Seventy-five percent of the participants reported perpetrating at least one act of physical violence across the previous six months, 66% reported perpetrating at least one act of minor physical violence, and 55% reported perpetrating at least one act of severe physical violence. Participants reported perpetrating a mean of 7.9 acts of any physical violence (SD=22.4), 7.3 acts of minor physical violence (SD=20.8), and 3.8 acts of severe physical violence (SD=11.8). Only 15% of the sample reported perpetrating at least one act of sexual coercion. Many models examining the temporal relationship between substance use and sexual coercion perpetration would not run due to limited variability and the low prevalence of endorsement, and, therefore, we omit reporting the few models that did run. In regard to violence victimization, 73% of the participants reported being victimized by at least one act of any physical violence across the six months, 68% reported victimization of at least one act of minor physical violence, 53% reported victimization of at least one act of severe physical violence, and 29% reported victimization of at least one act of sexual coercion. Participants reported being victimized by a mean of 7.5 acts of any physical violence (SD=15.5), 6.1 acts of minor physical violence (SD=14.2), 5.9 acts of severe physical violence (SD=14.5), and 7.1 acts of sexual coercion (SD=27.5).

Participants reported drinking on 41.3% of face-to-face contact days, using cannabis on 23.6% of contact days, using opiates on 6.0% of contact days, and using cocaine on 4.4% of contact days. Other established classes of drugs were combined (e.g., benzodiazepines, hallucinogens) and were reported on approximately 2% of face-to-face contact days. These drugs were not analyzed independently, given the lack of sufficient power to detect effects; however, they were included as covariates to ensure that any significant effects were not artificially inflated by use of other substances.

Temporal Relationship between Substance Use and IPV

The primary analyses examined the extent to which daily reports of IPV were associated with daily reports of substance use. Results for violence perpetration are presented in Table 1. Relative to days of no drinking, days of drinking were associated with a significantly greater odds of perpetrating any physical violence (OR = 10.58), minor violence (OR = 14.03), and severe violence (OR = 8.48). Similarly, relative to days of no drinking, days of heavy drinking were associated with a significantly greater odds of perpetrating any physical violence (OR = 12.81), minor violence (OR = 16.49), and severe violence (OR = 9.32). Results also showed that the number of drinks consumed on a given day was associated with a significantly greater odds of perpetrating any physical violence (OR = 1.20), minor violence (OR = 1.17), and severe violence (OR = 1.19). Specifically, women were 17–20% more likely to engage in each type of physical violence with each additional drink consumed. Cocaine use was not temporally associated with IPV perpetration. However, marijuana use days were associated with a significantly lower odds of perpetrating any physical violence (OR = −2.80) relative to non-marijuana use days. Additionally, opiate use days were associated with a lower odds of perpetrating severe violence (OR = −2.26) relative to non-opiate use days. Sexual perpetration models would not run due to the low base-rate of female perpetrated sexual aggression.

Table 1.

Temporal Association between Substance Use and IPV Perpetration.

t β SE OR CI
Any Physical Violence
 Alcohol (yes/no) 6.95*** 2.36 .34 10.58 5.38 – 20.79
 Heavy Drinking 7.40*** 2.55 .34 12.81 6.45 – 25.44
 Number of Drinks 6.57*** .18 .03 1.20 1.14 – 1.27
 Marijuana −2.31* −1.03 .45 −2.80 (−6.80) – (−1.15)
 Opiates −1.79 −.47 .26 −1.60 (−2.70) – 1.05
 Cocaine 1.42 .70 .49 2.02 (−1.32) – 5.39
Minor Physical Violence
 Alcohol (yes/no) 7.53*** 2.64 .35 14.03 6.98 – 28.22
 Heavy Drinking 7.85*** 2.80 .36 16.59 8.10 – 33.57
 Number of Drinks 6.33*** .16 .02 1.17 1.11 – 1.23
 Marijuana −1.90 −.90 .47 −2.46 (−6.29) – 1.04
 Opiates −1.59 −.43 .27 −1.54 (−2.63) – 1.11
 Cocaine 1.88 .89 .47 2.44 (−1.05) – 6.26
Severe Physical Violence
 Alcohol (yes/no) 5.80*** 2.14 .37 8.48 4.07 – 17.66
 Heavy Drinking 6.10*** 2.23 .37 9.32 4.50 – 19.32
 Number of Drinks 5.59*** .17 .03 1.19 1.12 – 1.27
 Marijuana −1.75 −.90 .52 −2.47 (−6.90) – 1.14
 Opiates −2.65** −.81 .31 −2.26 (−4.15) – (−1.23)
 Cocaine −.17 −.10 .59 −1.10 (−3.57) – 2.94
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Note: All analyses controlled for the presence of other substances; SE = Standard error; OR = Odds ratio; CI = Confidence interval

N = 105.

*

p< .05,

**

p < .01,

***

p < .001

In regard to violence victimization (see Table 2), days of drinking were associated with a significantly greater odds of being victimized by any physical violence (OR = 5.22), minor violence (OR = 4.92), and severe violence (OR = 5.46) relative to days of no drinking. Similarly, days of heavy drinking were associated with a significantly greater odds of being victimized by any physical violence (OR = 6.16), minor violence (OR = 5.77), and severe violence (OR = 6.68) relative to days of no drinking. Results also showed that the number of drinks consumed on a given day was associated with a significantly greater odds of being victimized by any physical violence (OR = 1.13), minor violence (OR = 1.13) and severe violence (OR = 1.15). Specifically, women were 13–15% more likely to be victims of one or more types of physical violence with each additional drink consumed. None of the indices of alcohol use were temporally associated with sexual coercion victimization. In regard to other drugs, results revealed that days of cocaine use were associated with a 6.06 greater odds of sexual coercion victimization relative to days of no cocaine use. Days of opiate use were associated with a lower odds of being victimized by any physical violence (OR = −2.87), minor physical violence (OR = −2.02), severe physical violence (OR = −2.82), and sexual coercion (OR = −12.76) relative to days of no opiate use. Days of marijuana use were associated with a 4.13 lower odds of sexual coercion victimization.

Table 2.

Temporal Association between Substance Use and IPV Victimization.

t β SE OR CI
Any Physical Violence
 Alcohol (yes/no) 5.24*** 1.65 .32 5.22 2.79 – 9.777
 Heavy Drinking 5.65*** 1.82 .32 6.16 3.25 – 11.68
 Number of Drinks 4.05*** .12 .03 1.13 1.06 – 1.20
 Marijuana −1.77 −.79 .44 −2.20 (−5.32) – 1.10
 Opiates −2.75** 1.06 .38 −2.87 (−6.17) – (−1.34)
 Cocaine 1.71 1.00 .59 2.72 (−1.18) – 8.73
Minor Physical Violence
 Alcohol (yes/no) 5.21*** 1.59 .31 4.92 2.68 – 9.05
 Heavy Drinking 5.75*** 1.75 .30 5.77 3.15 – 10.58
 Number of Drinks 4.33*** .12 .03 1.13 1.07 – 1.20
 Marijuana −1.28 −.57 .44 −1.76 (−4.27) – 1.37
 Opiates −2.11* −.70 .33 −2.02 (−3.91) – (−1.04)
 Cocaine 1.93 1.05 .54 2.85 (−1.03) – 8.40
Severe Physical Violence
 Alcohol (yes/no) 4.54*** 1.70 .37 5.46 2.59 – 11.49
 Heavy Drinking 4.95*** 1.90 .38 6.68 3.11 – 14.32
 Number of Drinks 4.52*** .14 .03 1.15 1.08 – 1.22
 Marijuana −.12 −.05 .42 −1.05 (−2.44) – 2.20
 Opiates −2.71** −1.04 .38 −2.82 (−6.06) – (−1.32)
 Cocaine 1.50 .88 .59 2.42 (−1.33) – 7.79
Sexual Coercion
 Alcohol (yes/no) .53 .27 .51 1.13 (−2.10) – 3.58
 Heavy Drinking 1.05 .53 .50 1.70 (−1.60) – 4.63
 Number of Drinks −.08 .00 .04 −1.00 (−1.09) – 1.09
 Marijuana −3.52*** −1.42 .40 −4.13 (−9.26) – (−1.85)
 Opiates −5.16*** −2.55 .49 −12.76 (−34.48) – (−4.78)
 Cocaine 2.21* 1.80 .82 6.06 1.19 – 30.80
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Note: All analyses controlled for the presence of other substances; SE = Standard error; OR = Odds ratio; CI = Confidence interval.

N = 105

*

p< .05,

**

p < .01,

***

p < .001

Discussion

These findings suggest that hazardously drinking women who are arrested for domestic violence and court-referred to batterer intervention programs are substantially more likely to perpetrate and be victimized by IPV on days that they consume alcohol relative to days that they do not drink. This study is among the first to demonstrate a temporal relationship between substance use and IPV in general and is the first study to report this link among women court-referred to batterer intervention programs. Specifically, compared to non-drinking days, physical IPV perpetration was over 10 times more likely to occur on drinking days, and over 12 times more likely to occur on heavy drinking days. Similarly, compared to non-drinking days, being victimized by physical IPV was approximately five times more likely on drinking days and six times more likely on heavy drinking days. Further, there appears to be a dose-response effect, where a woman’s odds of IPV perpetration and victimization are increased with each additional drink consumed. Each drink increased the odds of IPV perpetration by 17%–20% and IPV victimization by 13%–15%.

The strong temporal relationship identified between alcohol and physical IPV emphasizes the importance of alcohol as a potential contributor to individual incidents of IPV. This appears to be the case with minor and severe physical IPV, even when moderate amounts of alcohol are consumed. We improved on previous research with women (Parks et al., 2004; 2008)by controlling for all other substances used in the analyses. Thus, the importance of alcohol as a precursor to physical IPV is particularly significant given that its influence was above and beyond the influence of other drugs. These findings lend further support to other researchers’ assertion that alcohol use can be considered a contributing cause of IPV (Leonard, 2005; Moore et al, 2011). Our study was also the first to examine the temporal association between IPV victimization and drug use. Cocaine use, which was temporally associated with sexual aggression victimization, was the only other substance positively related to IPV (after controlling for alcohol and other substances). Specifically, women were approximately six times more likely to be victims of sexual coercion on cocaine use days, relative to days of no use. This finding is consistent with the Moore et al. (2008) meta-analysis, which showed a large effect size for the link between women’s cocaine use and sexual coercion victimization.

It is notable that we found a dose-response relationship between drinking and IPV perpetration and victimization after controlling for drug use. In addition to the findings that any drinking and heavy drinking significantly increased the odds of violence, so did each individual drink consumed. These data are consistent with the results of a recent methodologically rigorous alcohol administration experiment in a sample of male and female social drinkers recruited from the community (Duke et al., 2011). This study found a highly significant positive linear trend for the relationship between dose of alcohol administered and perpetration of aggression by both sexes.

Several theories have been posited to account for the relationship between alcohol use and IPV. For example, use of alcohol could result in information processing problems, the narrowing of attention, misinterpretation of social cues, reduced ability to manage stressful situations, increased acceptance of using violent behavior to solve problems, and other cognitive deficits (Giancola, 2000, 2001; Klostermann et al., 2006; Leonard, 1993; Steele & Josephs, 1990). Further, most violent relationships are characterized by mutual violence (Leonard, 2005; Temple, Weston, & Marshall, 2005); therefore, it may also be that intoxicated women who are victimized by physical or sexual IPV are more likely to respond by perpetrating violence themselves. Regardless of the reason behind the association, it is clear from this and other studies (Stuart et al., 2009; Temple, Stuart, & O’Farrell, 2009) that addressing alcohol use as a means to prevent or reduce incidents of IPV perpetration is warranted. Batterer intervention programs have demonstrated minimal success at reducing IPV(Babcock, Green, & Robie, 2004; Feder & Wilson, 2005), and researchers have previously arguedthat the ineffectiveness of these programs may be partially attributed to the lack of focused attention on individuals’ substance use (Stuart, Temple, & Moore, 2007). Indeed, numerous studies of male and female alcoholics have shown that a variety of treatments for substance abuse are associated with significant reductions in physical IPV perpetration and victimization (Stuart et al., 2009). Thus, research is needed that examines whether modifying batterer intervention programs for women by specifically focusing on concurrent substance use problems results in improved violence outcomes. A number of approaches could be implemented with this population, including brief motivational interventions, mindfulness-based approaches, self-help involvement, and/or individual counseling for substance use. At a minimum, it is important for women in these programs to be educated on their substantially elevated risk for perpetrating and being victimized by IPV on alcohol and cocaine use days. Since any drinking and heavy drinking were associated with 8–17 times greater likelihood of perpetration of various forms of violence, and each individual drink was associated with significantly greater odds of aggression (i.e., a dose-response effect), one implication is that any reduction in drinking may lead to reduced violence. Thus, interventions that focus on total abstinence from alcohol or those that employ harm reduction approaches may be beneficial in decreasing aggression.

These findings also hold important ramifications for programs intending to help victims of IPV. As implied in previous cross-sectional and longitudinal studies, women who refrain from using alcohol may decrease their risk of physical IPV victimization (Caetano, Cunradi, Clark, & Schafer, 2000; Chase, O’Farrell, Murphy, Fals-Stewart, & Murphy, 2003; Temple, Weston, Stuart, & Marshall, 2008). Further, our finding that women’s cocaine use appeared to increase their odds of sexual aggression victimization suggests that preventing certain forms of substance use may be an important avenue to aid in the prevention of sexual assault. It is important to note that while women are never to blame for victimization of any form of IPV, these findings suggest a potentially important vulnerability to being abused that is associated with substance use. For example, if a woman has prior knowledge of her increased risk of being abused after drinking alcohol or using cocaine, she may refrain from using these substances around her abusive partner or modify her environment to minimize the risk. To be clear, victims of IPV should not be blamed for any abuse. However, our data do suggest that women’s drinking and cocaine use may put them at increased risk for any number of possible reasons, and reducing use of these substances may lower this risk.

It is noteworthy that both opiate use and marijuana use were associated with reduced odds of perpetrating and being victimized by IPV compared to days of no opiate or marijuana use. Specifically, marijuana use was associated with lower odds of perpetrating physical IPV and being victimized by sexual coercion; opiate use was associated with lower odds of being victimized by all forms of IPV. Because this is the first known study to demonstrate such temporal associations between these specific substances and IPV, these findings should be considered preliminary until they have been replicated. Still, there are a number of potential explanations for these results. Researchers have hypothesized that potential withdrawal symptoms associated with marijuana use and opiate use, and not their acute intoxicating effects, may increase one’s risk for aggression perpetration(Moore et al., 2008) since the acute effects may produce feelings of euphoria, calmness, and behavioral inhibition. This would be consistent with other studies demonstrating no temporal relation between marijuana use, opiate use, and IPV perpetration (Moore et al., 2011). Indeed, laboratory studies with animals suggest that opiates temporarily reduce aggressive behavior(Espert, Navarro, Salvador, & Simon, 1993). In addition, the decreased risk of IPV victimization on opiate and marijuana use days may be partially explained by both members of the dyad consuming these substances, thus reducing the likelihood that either partner will aggress against the other. Indeed, research demonstrates that couples often consume the same substance together(Simmons & Singer, 2006), and this could help to partially explain why cocaine and alcohol use, but not opiates or marijuana, increase one’s risk for IPV victimization. Clearly, continued research is needed to elucidate the mechanisms underlying the specific substances and risk for IPV perpetration and victimization.

Limitations

There are several limitations of the present study that could be addressed in future research. First, although use of the structured TLFB allowed us to examine the temporal association between substance use and IPV, a prospective study that involved daily assessments could reduce problems associated with retrospective reporting. Daily measurement of the temporal relationship between substance use and violence could be assessed with online surveys, interactive voice response systems, or with mobile phone applications and other forms of ecological momentary assessment devices. Second, obtaining corroborating reports of partners’ violence and substance use could increase the accuracy of the data and allow for the examination of the interactive effects of both partners’ substance use and IPV. We did not ask the women to report on their partners’ substance use every day because we were concerned that they would not know and thus would not be able to provide accurate information. It is possible that substance use by both partners would have a synergistic effect that further increases the relative risk of IPV occurring on substance use days. Third, additional research is needed to understand the relationship of some specific drugs to IPV. For example, our finding that opiate and marijuana use were associated with decreased odds of IPV perpetration and victimization has not been previously indentified in temporal association studies. Future research could more thoroughly examine the influence of specific drugs and consider potential mechanisms for their influence on IPV. Fourth, on days in which women both perpetrate and are victimized by violence, future research should assess whether women initiated violence or were first victimized by violence prior to their perpetration. This will allow for a more in-depth investigation of the behavior of both partners in the dyad on the temporal relation between substance use and IPV. Finally, although our findings are consistent with data from other populations, the results may be generalizable only to women of similar age, education, socioeconomic status, and racial backgrounds who were arrested for domestic violence and court-referred to batterer intervention programs. Seventeen percent of the women in our sample were racial minorities, which is slightly higher than the racial minority population in the state of Rhode Island. Nonetheless, future work should be conducted in populations with greater diversity.

Despite these limitations, this study fills a gap in the literature by demonstrating the temporal relationship between alcohol use and physical IPV perpetration and victimization, and between cocaine use and sexual coercion victimization. Women entering batterer intervention programs should be screened for alcohol and drug use, and those with substance use problems should be encouraged to obtain treatment prior to or concurrent with their violence intervention. Research on men in batterer intervention programs demonstrated that subsequent to attending a batter program, violence recidivism was reduced by 30%–40% for men who obtained treatment for substance abuse (Jones & Gondolf, 2001). The effectiveness of such programs is yet to be tested in women. Given the evidence from the present study and previous research with other samples of women (i.e., college women, adolescents), programs aimed at IPV prevention might stress that even moderate amounts of alcohol use may increase the risk of IPV perpetration and victimization.

Acknowledgments

This work was supported, in part, by grants from the National Institute on Alcohol Abuse and Alcoholism (R01AA016315; K24AA019707; Dr. Stuart, Principal Investigator) and by the Department of Veteran Affairs (Dr. O’Farrell).

NIAAA played no role in the design and conduct of the study, in the collection, management, analysis, and interpretation of the data, or in the preparation, review, or approval of the manuscript.

We are grateful to research assistants paid by the aforementioned NIAAA grants for collecting the data.

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