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. Author manuscript; available in PMC: 2023 Jun 1.
Published in final edited form as: Addict Behav. 2022 Jan 29;129:107262. doi: 10.1016/j.addbeh.2022.107262

A Dyadic Examination of Alcohol Use and Intimate Partner Aggression Among Women in Same-Sex Relationships

Ruschelle M Leone 1,2, Sarah J Ehlke 3, Alyssa Norris 4,5, Cassidy M Sandoval 6, Lauren V Butler 7, Barbara Winstead 6,7, Michelle Kelley 6,7, Robin J Lewis 6,7
PMCID: PMC8957041  NIHMSID: NIHMS1777951  PMID: 35131682

Abstract

Despite considerable evidence linking alcohol use and intimate partner aggression among mixed-sex couples, scant research has examined this association in same-sex couples using a dyadic framework. The aim of the present study was to examine associations between one’s own and their partner’s alcohol use (i.e., drinks per week, hazardous alcohol use) and intimate partner aggression (physical, psychological) perpetration while accounting for the interdependence among partners in alcohol use. Participants were 326 women (M age = 27.57, SD = 3.65) from 163 female-female couples who independently completed measures of drinks per week, hazardous alcohol use, psychological intimate partner aggression victimization and perpetration, and physical intimate partner aggression victimization and perpetration. Actor-partner interdependence structural equation models found that (1) actor drinks per week were positively associated with one’s own physical assault perpetration (2) actor hazardous alcohol use was positively associated with one’s own physical assault and psychological aggression perpetration and (3) partner drinks per week and hazardous alcohol use were positively associated with actor’s psychological aggression perpetration. No other significant effects were detected. Collectively, findings highlight the nuanced relationship between alcohol use and intimate partner aggression among same-sex female couples and suggest that one’s own alcohol use is associated with intimate partner psychological and physical aggression perpetration. In contrast, the only partner effect was partner’s alcohol use in association with actor’s psychological aggression perpetration. These findings differ from prior research with heterosexual couples and underscore the need for future research with same-sex couples rather than attempts to generalize findings across populations.

Keywords: Intimate Partner Violence, Alcohol Use, Same-Sex Couples

Introduction

Intimate partner aggression (IPA) is a significant public health problem resulting in numerous negative health outcomes (Coker, 2007; Kwako et al., 2011; Lagdon et al., 2014). Rates of IPA among sexual minority women (SMW) are similar to or higher than those of heterosexual women (Edwards et al., 2015). Although primarily conducted with mixed-sex couples, research has established that alcohol is a causal factor in IPA (Leonard & Quigley, 2017). Despite fewer studies, similar results have been found for same-sex couples. Cross-sectional studies have shown that alcohol use, particularly heavy alcohol use, is associated with IPA among lesbian women and their same-sex partners (Lewis et al., 2012); however, previous work has been limited by its use of the participant’s report of their own and their partner’s alcohol use and IPA. Capturing reports from both partners allows for analytic frameworks that consider the interdependence between partners (e.g., actor-partner interdependence models; APIM). In the present study, we examined person-level alcohol-related predictors [i.e., drinks per week (DPW), hazardous drinking] of psychological and physical IPA perpetration using a dyadic framework.

1.1. Alcohol Use and IPA

In samples of women in which sexual identity was not specified, alcohol use and IPA were associated (e.g., Devries et al., 2014). Consistent with alcohol myopia theory (Steele & Josephs, 1990), alcohol intoxication lowers processing capacity leaving dominant instigating factors (e.g., relationship conflict) less likely to be effectively countered by inhibitory factors (e.g., empathy for partner), thereby contributing to IPA perpetration. In support of this theory, a meta-analysis and systematic review found a positive association between women’s alcohol use — including problem drinking, binge drinking, and alcohol use over a specified time — and physical IPA, though they also found that few studies examined or accounted for partner characteristics (Devries et al., 2014). Another meta-analysis did not find evidence of an association between past-year IPA and alcohol use (Bacchus et al., 2018). However, the authors suggest this is due to limited research and differences in alcohol measurement. Indeed, a separate meta-analysis indicated that the association between alcohol use and IPA was stronger when problematic alcohol use was assessed, compared to alcohol consumption (Cafferky et al., 2018). Thus, not all research points to an association, and differences may exist based on the measurement and level of alcohol consumption, as well as on partner characteristics.

Despite limited research about SMW, preliminary studies suggest an association between alcohol use – particularly hazardous use – and IPA perpetration. In a cross-sectional study of self-identified lesbian women in same-sex relationships, life stress was associated with hazardous alcohol use, which in turn was associated with reports of physical assault perpetration (Mason et al., 2016). Also, among SMW, hazardous alcohol use (quantity, maximum drinks consumed on a given day, alcohol-related problems) was associated with bidirectional physical IPA (Lewis et al., 2015). Similarly, when physical and psychological IPA were considered together, SMW’s alcohol use in the past three months was associated with bidirectional IPA (Kelly et al., 2011). Finally, in a recent meta-analysis, one’s “alcohol abuse” was among the strongest risk markers for physical IPA for women in same-sex relationships (Kimmes et al., 2019).

1.2. Partners’ Alcohol Use and IPA

Theory and research indicate that a partner’s alcohol use may also contribute to IPA. Consistent with the I3 meta-theory (Finkel & Slotter, 2009; Slotter & Finkel, 2011), partner alcohol use may be an instigating situational factor that triggers aggressive behavior for individuals who (1) have impelling factors, or a predisposition to aggressive behavior in the form of personality traits or life experiences (e.g., IPA victimization) and (2) contend with disinhibiting factors (e.g., alcohol use) that increase the odds of behaving aggressively in the presence of an instigating factor and impelling factors. Indeed, research on mixed-sex couples has found that partner alcohol use is associated with actor IPA (Leone et al., 2016; Shorey et al., 2016; Testa et al., 2003).

There is limited dyadic work with female-female couples. In a longitudinal study discrepant drinking (i.e., the absolute difference in the number of standard drinks per day) was associated with psychological aggression, but not physical aggression, over the course of one year among lesbian women (Lewis et al., 2018). A limitation of this study is that participants reported on their partner’s alcohol use, thus, reports may be bias. More recently, Do et al. (2021) conducted a cross-sectional study that assessed both partners’ reports within female same-sex couples and employed an APIM to account for the interdependent nature of the data. Although actor hazardous alcohol use was not associated with the odds of actor physical IPA perpetration in this sample, greater partner hazardous alcohol use, experienced discrimination, and anxiety were associated with a greater likelihood of actor physical assault perpetration. Collectively, previous research suggests that the alcohol-IPA association is complex and dependent on dyadic processes. Thus, it may be that partner alcohol use is a salient instigating factor that leads to couple conflict and increases IPA, especially in the context of other impelling (e.g., IPA victimization) and disinhibiting factors (e.g., actor alcohol use), but it remains unclear if this association varies based on intensity of alcohol use (i.e., drinks per week, hazardous alcohol use).

1.3. The Present Study

Extant research has found significant dyadic associations between alcohol use and IPA in mixed-sex couples. For example, in a longitudinal study of mixed-sex married or cohabitating couples, partner alcohol use predicted actor physical IPA among partners higher, but not lower, in negative affect (Quigley et al., 2018). However, we know far less about alcohol use and IPA among same-sex couples. Only one prior study has examined actor-partner associations between alcohol use and dichotomized past-year IPA (presence/absence for physical violence and high/low for psychological aggression) among same-sex female couples (Do et al., 2021). The present study builds upon prior research by including a continuous measure of IPA and considering an additional measure of alcohol use (i.e., hazardous alcohol use and typical weekly drinking [DPW]). Although presence of hazardous alcohol use is the more established predictor of IPA, it is important to know if drinking quantity, even if unproblematic, is also a risk factor for IPA among SMW. Consistent with alcohol myopia theory, one’s own drinking may contribute to IPA perpetration as a disinhibiting factor. Conversely, it may be that a partner’s alcohol use, especially hazardous use, instigates IPA (e.g., due to impact on their behavior, couple conflict). The following hypotheses were advanced:

  1. One’s own (i.e., actor) DPW and hazardous alcohol use would be associated with more frequent actor physical and psychological aggression perpetration.

  2. Partner hazardous use would be associated with more frequent actor physical and psychological aggression perpetration.

Although hypotheses were not advanced for DPW partner effects due to limited prior research, we also explored these associations.

1. Materials and Method

2.1. Participants

Data for this study were drawn from a baseline survey completed by women in female-female couples (N = 326 women, 163 couples). Participants were on average 27.57 (SD = 3.65) years old, and the majority were White (n = 233, 71.5%), not Hispanic/Latinx/Spanish origin (n = 288, 88.3%), completed a bachelor’s degree or higher (n = 239, 73.3%), lived with their partner (n = 246, 75.5%), in an exclusive relationship but not married (n = 210, 64.4%), identified as lesbian (n = 274, 84.0%), and were only attracted to women (n = 149, 45.7%) or mostly attracted to women (n = 158, 48.5%). See (Lewis et al. (2021a) for a detailed description of the sample characteristics.

2.2. Procedure

The data for this study were drawn from the baseline survey of a larger study protocol (IRRID: DERR1–10.2196/11718; NIH: R15AA020424). Participants were recruited nationwide using a market research firm and represented all areas of the United States (see Lewis et al., 2021b). Eligibility was determined at the couple level, with eligible couples then referred to the research team for consenting procedures. To be eligible, each partner needed to be: (1) 18–35 years old, (2) identify as a cisgender woman, (3) report dating their current romantic female partner for 3+ months and seeing each other in person at least weekly, and (4) willing to respond to daily surveys every morning for 2 weeks. In addition, one participant of the couple met the following inclusion criteria: (5) identify as “only” or “mostly” attracted to women, (6) drink alcohol 3+ days in the prior 2 weeks, and (7) report heavy episodic drinking (i.e., drink 4+ drinks in a single sitting) in the past 2 weeks. The research team emailed each partner of a couple individually, such that each woman completed her own baseline survey, reporting on alcohol use and experiences with IPA in their current partnership1. Participants were compensated $25 for completing the baseline survey.

2.3. Measures

Alcohol Use and Hazardous Drinking.

Using a 7-day grid, women reported on their “typical drinking” in the last 3 months using the Daily Drinking Questionnaire (DDQ; Collins et al., 1985). Women reported the number of standard drinks they consumed on a typical day. Women’s daily reports over the 7-day period were summed to reflect the typical DPW women consumed in the last 3 months.

Women also completed the 10-item Alcohol Use Disorders Identification Test (AUDIT; Babor et al., 2001), a well-validated and reliable (α=.83; Hays et al., 1995) measure of hazardous drinking (e.g., Conigrave et al., 1995). We used the continuous, summed item scores in analyses (α for the current study =.78).

IPA.

Women completed 34 items of the Conflict Tactics Scale – 2 (CTS-2; Straus et al., 1996), including the full 12-item Physical Assault subscale that assesses victimization and perpetration. Women report on the frequency of each type of aggression using 8-item Likert-type response scales ranging from This never happened to me to More than 20 times in the past year. The CTS-2 was designed to assess both minor (e.g., “Threw something at my partner that could hurt”) and severe (e.g., “Burned or scalded my partner on purpose”) forms of aggression. A sum score of physical assault victimization (α=.82) and perpetration (α=.83) was computed. To account for potential underreporting of perpetration, we used the higher score within couples of actor perpetration or partner victimization. The Physical Assault subscale has demonstrated adequate reliability with adults (α = 0.86) (Straus, 2004; Straus et al., 1996) as well as SMW (e.g., α=.88 for perpetrator and partner physical assault) (Lewis et al., 2017).

To assess for past-year psychological IPA victimization and perpetration, women completed the 28-item short-form version of the Psychological Maltreatment of Women Inventory (PMWI; Tolman, 1999). Women reported on the frequency of each type of psychological aggression in her current partnership using a 5-item Likert-type scale ranging from 0 = Never to 4 = Very Frequently. The full scale was used, that includes two subscales: Emotional/Verbal (e.g., “treated me like an inferior”) and Dominance/Isolation (e.g., “monitored my time and made me account for my whereabouts”). The mean score for psychological IPA victimization (α=.88) and perpetration (α=.85) was computed. We used the higher score within couples of actor perpetration or partner victimization. The PMWI has adequate reliability in prior work with SMW (e.g., α=.87 for perpetrator psychological aggression, α=.89 for partner psychological aggression) (Lewis et al., 2017).

2.4. Data Analysis

Data were inspected for normality and outliers. Three values for DPW and three values for hazardous drinking were outliers and winsorized to the next highest value. There were no missing values. Means, standard deviations, and correlations were examined in SPSS 27. The hypothesized models were examined using an APIM structural equation modeling framework in Mplus 8 (Muthén & Muthén, 2017). APIM models assume that each participant’s responses may be influenced by their own behavior (actor effect), as well as their partner’s behavior (partner effect). Two separate APIM models were run for each behavior (DPW, hazardous drinking) on IPA (physical assault and psychological aggression perpetration). Actor psychological and physical aggression victimization, respectively, and whether couples lived together (yes/no) were included as covariates in both models.

Modeling actor-partner effects within same-sex and mixed-sex (e.g., male-female) couples differs. Within APIM models with male-female couples, gender/sex is typically used as the “distinguishable” factor that allows for the assignment of members of the couple to the “actor” and “partner” roles for statistical purposes. APIM frameworks then allow the researcher to test whether the means, variances, and correlations are equivalent for men and women in the model. In contrast, unless selected a priori on some important factor (e.g., HIV status in serodiscordant male-male couples) same-sex couples are considered “indistinguishable” from a statistical perspective (Kenny et al., 2020), such that there is no meaningful factor that can be used to assign actor status. For this reason, to readers of prior work using APIM, the current results might read differently in that there is only one actor effect and one partner effect, rather than female-to-male and male-to-female actor and partner effects. Because couples were indistinguishable dyads (i.e., same-gender female couples), paths were constrained to equality. Due to non-normal distributions (i.e., high skew and kurtosis) for IPA perpetration, APIM models were estimated using a negative binomial distribution.

2. Results

Descriptive statistics and correlations between variables are displayed in Table 1. All variables were significantly correlated. Two separate APIMs were conducted examining the association of (1) DPW and (2) hazardous alcohol use on IPA (see Figure 1). As shown in Table 2, for the DPW model, actor DPW was significantly and positively associated with their own physical assault aggression perpetration. Additionally, a significant partner effect was found for DPW on psychological aggression perpetration. This finding indicates that greater partner DPW was associated with higher psychological aggression perpetration from the other partner within the couple. For the hazardous alcohol use model, actor hazardous alcohol use was significantly associated with both forms of actor IPA. This finding suggests that actor hazardous alcohol use scores were associated with greater actor physical assault and psychological aggression perpetration. There was also a significant partner effect for actor psychological aggression perpetration, such that partner hazardous alcohol use was associated with higher actor psychological aggression perpetration.

Table 1.

Correlations and Descriptive Statistics for Drinks per Week, Hazardous Alcohol Use, and Intimate Partner Aggression Variables

Variable n (%) Mean SD 1. 2. 3. 4. 5. 6.
1. Drinks per Week 10.48 6.75 --
2. Hazardous Alcohol Use 163 (50.0%) 8.52 4.80 .69*** --
3. Physical Assault Perpetration 72 (22.1%) 0.98 2.74 .16** .17** --
4. Physical Assault Victimization 67 (20.6%) 0.94 2.62 .13* .15** .86*** --
5. Psychological Aggression Perpetration 280 (85.9%) 0.41 0.40 .18** .26*** .50*** .51*** --
6. Psychological Aggression Victimization 266 (81.6%) 0.42 0.44 .18** .24*** .48*** .48*** .85*** --
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Note. Hazardous alcohol use is measured by the Alcohol Use Disorder Identification Test. The n (%) for hazardous alcohol use indicates that number of participants with an AUDIT score of 8 or higher. The n (%) for intimate partner aggression variables indicates that number of participants who reported perpetration and victimization.

†

p < .10

*

p < .05

**

p < .01

***

p < .001.

Figure 1.

Figure 1

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Actor Partner Interdependence Model (APIM) Conceptual Model

Table 2.

Actor Partner Interdependence Model (APIM) Results for Drinks per Week and Hazardous Alcohol on Physical Assault and Psychological Aggression Perpetration

Actor Effects Partner Effects
Variable B SE p B SE p
Predictor: Drinks per Week
 Actor Physical Assault Perpetration 0.80 .11 <.001 −0.01 .13 .938
 Actor Psychological Aggression Perpetration 0.09 .05 .072 0.13 .05 .006
Predictor: Hazardous Alcohol Use
 Actor Physical Assault Perpetration 0.81 .09 <.001 −0.01 .12 .916
 Actor Psychological Aggression Perpetration 0.16 .06 .004 0.18 .06 .001
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Note. Standardized coefficients are presented. Significant values in bold for emphasis. Models controlled for actor reports of victimization and living with partner.

3. Discussion

This study was the first to examine the association between (1) DPW and (2) hazardous alcohol use and IPA among sexual minority female couples using a dyadic framework. Hypotheses were partially supported, as findings indicate that actor DPW and hazardous drinking were associated with one’s own physical IPA perpetration, and actor hazardous drinking was also associated with actor psychological aggression. Conversely, findings demonstrated that one’s partner’s DPW and hazardous use were only associated with one’s own psychological perpetration. These findings differ from those of Do et al. (2021) that found nonsignificant actor effects of alcohol use on physical and psychological perpetration but a significant partner effect of hazardous alcohol use on physical IPA perpetration; however, several key differences between studies may account for disparate findings.

First, we utilized a national sample that (1) was younger (Mage=27.57 vs 33.7), (2) was selected for participation based on heavy alcohol use, and (3) included fewer married couples. Although differences in measurement of IPA preclude us from directly comparing rates between studies, it is important to note that younger women experience greater rates of IPA than older women (Breiding et al., 2014) and married women tend to report lower rates of IPA (Capaldi et al., 2012), suggesting our sample might have been at higher risk for IPA. Second, the present study utilized longer measures of each form of IPA and assessed for both victimization and perpetration by both partners. To control for potential underreporting of perpetration, we also used the higher score at the couple level of actor perpetrator or partner victimization. Finally, we evaluated the frequency of IPA victimization and perpetration rather than only the dichotomous presence of perpetration. It is possible that count, as opposed to dichotomous, measurement affords more statistical variability and greater ability to detect associations between alcohol use and IPA (see Kan & Feinberg, 2010). However, it is also possible that hazardous alcohol use might not be associated simply with the presence of an aggressive act in a relationship (mostly null results in Do et al., 2021), but instead that more hazardous alcohol use is predictive of IPA frequency (current findings).

4.1. Actor Alcohol Use

For women in a same-sex relationship, one’s own DPW and hazardous drinking were associated with more physical IPA perpetration and one’s own hazardous drinking was also associated with more psychological IPA perpetration. This finding is consistent with prior research, based largely on heterosexual participants, documenting the link between alcohol consumption and various forms of IPA (e.g., Devries et al., 2014), as well as research with SMW that has found links between alcohol use and bidirectional IPA (Kelly et al., 2011; Lewis et al., 2015). Importantly, to our knowledge, this is one of the first studies to control for partner effects and one’s own victimization experiences while testing the alcohol-IPA association among same-sex female couples. Thus, the current results provide strong evidence for a relationship between one’s own alcohol use and physical and psychological IPA perpetration above and beyond victimization.

4.2. Partner Alcohol Use

The current data indicate that partner DPW and hazardous use are associated with psychological, but not physical perpetration. In other words, when one person in the couple engages in more alcohol use or hazardous drinking behaviors, the other person’s psychological perpetration is elevated. It may be that, in line with I3 theory (Finkel & Slotter, 2009; Slotter & Finkel, 2011), one’s partner’s alcohol use is an instigating situational factor for psychological perpetration. Individuals may become frustrated by their partner’s alcohol use, including, but not limited to, their decision-making and behavior while intoxicated, and may engage in more psychological perpetration. The lack of finding for physical perpetration is somewhat surprising given prior research with heterosexual couples has found that partner hazardous use was associated with actor physical perpetration (Leone et al., 2016). This disparate finding highlights a potential difference between heterosexual and sexual minority female couples and cautions against generalizing research from heterosexual partnerships to sexual minority populations. Research that includes both mixed- and same-sex couples is needed for a rigorous test of this difference.

4.3. Limitations & Future Directions

This study’s findings may not generalize across all SMW populations. Future research should endeavor to recruit a broader sample of women, because this study, like most research with SMW (Do et al., 2021; Hughes et al., 2020), did not recruit enough racial/ethnic minority women to examine differences as a function of intersectionality. Since the time this study was designed, researchers have documented that social media recruitment results in a significantly greater proportion of White, non-Hispanic respondents than other methods (Guillory et al., 2016; Miller-Perusse et al., 2019), so future research should create an a priori recruitment plan to overcome this limitation. Additionally, the study used a cross-sectional design and relied on retrospective, self-reports of IPA. In addition to potential recall bias, we cannot ascertain the context and situation in which IPA occurred. For example, it is impossible to determine if one or both partners were drinking/under the influence at the time IPA occurred and if IPA was bidirectional at that moment. Studies that assess the proximal effects of alcohol on IPA via intensive longitudinal methods or experimental methods are needed. Importantly, ambulatory assessment methods should be used to determine how concordance in drinking may influence rates of IPA.

Additionally, although the present study asked participants to report on experiences of IPA with their current partner (presumably a participant in this study), approximately 5% of our sample reported being in a non-exclusive relationship. Thus, a small percentage of participants may have been reporting on IPA with more than one partner, and future studies might consider multiple relationship statuses. Factors potentially mediating or moderating the association between alcohol use and IPA warrant further attention, particularly in the context of minority stress (Shorey et al., 2019). In addition to considering individual-level sexual minority stressors (e.g., internalized homophobia), future research should also examine the impact of sexual minority stress at the couple level (e.g., unequal relationship recognition; LeBlanc et al., 2018) and how this may affect associations between alcohol use and IPA.

4.4. Conclusion

Study findings highlight the importance of considering both psychological and physical IPA as well as using multiple methods of assessing alcohol use. Given that IPA may lead to increases in alcohol use (for review, see Devries et al., 2014), future research is needed to explore how alcohol may be both a predictor and outcome of IPA among same-sex couples. It is important to highlight that women in same-sex relationships have been historically underrepresented in empirical research (Rolle et al., 2018). More research is necessary to explore underlying mechanisms and moderators of these dyadic associations and to develop effective interventions to assist SMW in maintaining healthy relationships and lifestyles.

Highlights.

  • APIMs were used to measure dyadic associations between alcohol use and IPA.

  • Actor drinks per week were positively associated with actor physical assault perpetration.

  • Partner drinks per week were associated with actor psychological aggression.

  • Actor hazardous drinking was positively associated with all actor IPA variables.

  • Partner hazardous drinking was associated with actor psychological aggression.

Acknowledgments

Funding Statement: Research reported in this publication was supported by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the National Institutes of Health (NIH) under Award Number R15AA020424 (PI: Lewis), K01AA028844 (PI: Leone), K23AA028513 (PI: Norris). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

International Registered Report Identifier (IRRID): DERR2-10.2196/11718

Footnotes

Declarations of Interest: None

1

Although only one member of each couple was required to meet alcohol use eligibility criteria, 98.2% of the sample reported alcohol use in the past 3 months. At the couple level, the average discrepancy (i.e., absolute value of partner 1 drinks per week – partner 2 drinks per week) between partners’ drinks per week was 1.19 (SD =1.22). Partners’ discrepancy scores for the AUDIT were 4.29 points on average (SD = 4.20).

Author Agreement

We request for this manuscript to be considered under the subscription model, the authors agree to transfer copyright to Elsevier.

Author CRediT statement

The study was conceptualized and designed by RJL, BW, and MK. Funding was acquired by RJL. SJE conducted the statistical analyses. RML wrote the first draft of the manuscript. All authors contributed to writing, reviewing, and have approved the final manuscript.

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