Elsevier

Addictive Behaviors

Volume 28, Issue 9, December 2003, Pages 1587-1602
Addictive Behaviors

Perpetration of partner violence: Effects of cocaine and alcohol dependence and posttraumatic stress disorder

https://doi.org/10.1016/j.addbeh.2003.08.036Get rights and content

Abstract

The present study examined the effects of substance dependence and posttraumatic stress disorder (PTSD) on perpetration of partner violence. Participants were 72 men and 124 women diagnosed with and/or without PTSD and cocaine or alcohol dependence. Participants were interviewed with the Structured Clinical Interview for the DSM-IV (SCID-IV) and completed the Conflict Tactics Scale-2 (CTS-2). Analyses indicated that participants with comorbid cocaine dependence and PTSD reported the highest frequency of partner violence relative to all other groups. Main effects were also detected for drug dependence and PTSD. Results suggest that substance dependence and PTSD alone are associated with increased violence in couples, and most importantly, the presence of PTSD serves to further potentiate the perpetration of partner violence among cocaine-dependent individuals.

Introduction

A body of research evidence links alcohol and drug use to perpetration of violence. Reviews in this area indicate that acute effects of alcohol and illicit drugs increase the expression of physical aggression Taylor & Chermack, 1993, Taylor & Hulsizer, 1998 and that a positive relationship exists between substance use disorders and perpetration of violence (Friedman, 1998). Although a substantial amount of data support the aggression-promoting effects of alcohol and drug use, some investigators (Friedman, 1998) contend that “additional research is needed on violent behavior that occurs within the family” (pp. 352). Indeed, alcohol and drug abuse problems, among numerous other factors, have been identified as unique predictors of partner violence perpetration (for a review, see Gortner et al., 1997, Holtzworth-Munroe et al., 1997). However, additional research on factors that further potentiate partner violence among individuals with substance use disorders is still needed.

Of particular interest is the perpetration of intimate violence among alcohol and cocaine-dependent individuals, as alcohol and cocaine use have consistently been linked to increased rates of violence in general (Denison, Paredes, & Booth, 1997). Studies indicate that problematic drinking and alcohol abuse are related to increased physical aggression towards one's partner Julian & McKenry, 1993, Leonard et al., 1985, Leonard & Senchak, 1993. Research also demonstrates a positive relationship between alcoholism and partner violence Leonard & Jacob, 1988, Van Hasselt et al., 1985 and suggests that the 1-year prevalence of partner violence for alcoholic men entering treatment is nearly six times higher than it is among nonalcoholic men (O'Farrell & Murphy, 1995). Moreover, recent evidence shows that alcoholic men who successfully quit drinking report levels of partner abuse comparable to demographically similar nonalcoholic men (O'Farrell, Van Hutton, & Murphy, 1999). Collectively, these studies indicate that individuals who abuse alcohol or are alcohol dependent are more likely to physically and emotionally abuse their intimate partners.

In comparison, relatively few studies have examined the relationship between cocaine abuse or dependence and perpetration of violence against one's partner. One pertinent study examined this relationship in a sample of incarcerated men (Logan, Walker, Staton, & Leukefeld, 2001). Findings indicated that cocaine use was positively related to perpetration of intimate violence. Another investigation of individuals in an inpatient substance use treatment facility found that frequency of cocaine use was related to increased physical and psychological abuse of one's partner (Bennett, Tolman, Rogalski, & Srinivasaraghavan, 1994). Consistent with these studies, extant literature supports a relationship between cocaine use, especially crack cocaine, and perpetration of violence in general Denison et al., 1997, Miller et al., 1990, and evidence has been reported that supports the aggression-promoting pharmacological effects of the drug (Davis, 1996). Indeed, laboratory evidence has demonstrated that individuals who ingested a high dose of cocaine displayed higher levels of physical aggression than participants in a placebo condition (Licata, Taylor, Berman, & Cranston, 1993). One additional factor relative to pharmacological effects that may help explain a potential cocaine–violence link is the associated “drug lifestyle” of crack cocaine users (Inciardi, 1990). This lifestyle includes a “normalization” of violence, as aggressive behaviors may be utilized frequently by crack cocaine users in dealing and obtaining the drug (Miczek et al., 1994). Certainly, crack cocaine users who behave aggressively in interpersonal interactions may also be likely to use similar tactics in intimate relationships, although evidence supporting this notion has yet to be reported. Despite these findings, however, the relatively limited research linking acute and chronic cocaine use to any type of violence precludes any definitive conclusions about this association.

While research indicates that alcohol and cocaine use may potentiate the perpetration of partner violence, additional variables that may augment this relationship remain unclear. Men and women diagnosed with both a substance use disorder and another Axis I psychiatric disorder are more likely to perpetrate violent acts than those with nonsubstance use Axis I disorders alone Boles & Johnson, 2001, Friedman, 1996, Mulvey, 1994, Steadman et al., 1998. Pertinently, cumulative evidence demonstrates a positive relationship between psychopathology and an increased risk of intimate violence Gortner et al., 1997, Holtzworth-Munroe et al., 1997. However, relatively few studies examined the interaction of substance use disorders and other psychiatric disorders on partner violence (Friedman, 1998). Hence, one important issue that needs to be addressed is identification of specific psychiatric disorders that may augment the catalytic relationship between substance use disorders and partner violence.

Posttraumatic stress disorder (PTSD) may be one such psychiatric condition that potentiates the expression of partner violence among substance abusers. Cumulative evidence indicates that a history of trauma is strongly associated with perpetration of intimate violence Dutton, 1998, Dutton, 1999. Moreover, in a recent study of Vietnam veterans, a significant relationship between PTSD hyperarousal symptoms and partner violence was found (Savarese, Suvak, King, & King, 2001). In addition, numerous investigators reported high comorbidity rates between PTSD and substance use disorders Brady, 2001, Dansky et al., 1994, Jacobson et al., 2001, especially among alcohol- and cocaine-dependent individuals Back et al., 2000, Stewart, 1996. Not surprisingly, individuals diagnosed with a substance use disorder report more traumatic events and have higher rates of PTSD than individuals without a substance use disorder (Cottler, Compton, Mager, Spitznagel, & Janca, 1992). Thus, it appears that PTSD may be a risk factor for partner violence and is highly prevalent among persons with substance use disorders, a factor that has also been clearly linked to violence. As such, it is plausible that PTSD may potentiate the expression of partner violence among individuals with problematic alcohol or cocaine use.

Other comorbid disorders, such as mood or other anxiety disorders, may also exacerbate the relationship between substance use and partner violence. For example, individuals who report depressive symptomatology are also at an increased risk for substance use (Kessler et al., 1996) and for perpetration of partner violence (Gortner et al., 1997). However, relative to other mood and anxiety disorders, the interaction between alcohol and cocaine dependence and PTSD may be especially potent. Research suggests that among alcohol- and cocaine-dependent individuals with PTSD, trauma cues elicit craving for an individual's substance of choice (Coffey et al., 2002). Thus, these substance use disorders not only appear to be associated with PTSD, but the existence of PTSD symptomatology may in fact aid in the maintenance of alcohol or cocaine dependence. Though tentative, this finding may help to explain the tendency for individuals with PTSD to “self medicate” their trauma symptoms with alcohol or cocaine. As a result of the potentially strong interaction between these disorders, subsequent violent behavior among these individuals may be especially likely.

Much of the literature on intimate violence has focused on male-to-female aggression, and without question, these cases represent a significant societal problem. Research suggests that women are more frequently the victims of partner violence Browne, 1993, Follingstad et al., 1991, Tontodonato & Crew, 1992, and that relative to men, females sustain more severe injuries from violent altercations with their intimate partner (Makepeace, 1988). Certainly, the context of partner violence and the associated consequences may vary by gender (Jackson, 1999), and severe acts of partner violence are typically perpetrated by men against their female partners (Fagan & Browne, 1994). Indeed, men and women differ in their use of particular types of physically aggressive acts, with women more likely to throw objects, slap, kick, bite, punch, or hit their partner with an object and men more likely to beat up, choke, or strangle their partner (Archer, 2002). However, research indicates that women engage in partner violence at rates comparable to men Archer, 2000, Bookwala et al., 1992, White & Koss, 1991. Moreover, although these data imply gender inequality in one's expression of aggression, all of these acts may be construed as “physical aggression” and all are potentially harmful to the intended victim. Relatedly, regardless of the perpetrator's gender, violent domestic disputes result in negative consequences for the couple's children, support system, and extended family Dube et al., 2002, Riger et al., 2002. Therefore, it was deemed pertinent to examine partner violence perpetration among both men and women in this report.

The purpose of the present investigation was to examine the independent and interactive effects of a substance dependence diagnosis (alcohol dependence, cocaine dependence) and PTSD on partner violence. A structured clinical interview was administered to 233 men and women to assess cocaine dependence, alcohol dependence, and PTSD. The Conflict Tactics Scale-2 (CTS-2) (Straus, Hamby, Bony-McCoy, & Sugarman, 1996) was used to assess the frequency of partner violence during the past year. Based on the reviewed literature, the following hypotheses were made: (1) Participants with comorbid substance dependence and PTSD would report higher levels of partner violence relative to participants with only one or no psychiatric diagnoses; (2) participants with a diagnosis of substance dependence would report more violence against their intimate partner than non-substance-dependent participants; and (3) participants diagnosed with PTSD would report increased levels of violence toward their partner than participants not diagnosed with PTSD.

Section snippets

Participants

Participants were 233 men and women recruited from inpatient and outpatient substance use treatment programs at the Medical University of South Carolina, local treatment facilities in the Charleston, SC area, and the community at large. All participants were screened either in person or over the telephone for the possible presence of either cocaine or alcohol dependence, the presence of a PTSD Criterion A event, and the lack of current PTSD-related treatment. For example, respondents who had

Preliminary analyses

The pertinent literature indicates that age and socioeconomic status are related to perpetration of partner violence (Schumacher, Feldbau-Kohn, Slep, & Heyman, 2001). To evaluate potential group differences for these variables, separate 3 (dependent substance: cocaine, alcohol, and control)×2 (PTSD Diagnosis: yes, no) ANOVAs were performed, with age and yearly income as dependent variables. A significant group difference for age was not detected. However, a main effect of dependent substance

Discussion

The present study is the first to examine the relationship between substance dependence, PTSD, and partner violence. We observed that relative to all other groups, individuals diagnosed with cocaine dependence and PTSD reported perpetrating the most acts of PA and PSA toward their intimate partners. This finding is consistent with research suggesting an increased risk of violence among individuals diagnosed with comorbid substance problems and psychopathology, relative to those diagnosed with

Acknowledgements

This research was supported by National Institute on Drug Abuse grant DA 10595. We wish to thank Susan Montgomery for her valuable contribution to this project.

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