Risk Factors for Alcohol-Related Problems Among Victims of Partner Violence

Abstract

Despite the high prevalence of alcohol-related problems and disorders among women who experience intimate partner violence (IPV), factors related to current alcohol use are understudied. We examined current risk factors for alcohol-related problems among 143 substance-using, IPV-exposed women recruited from an urban community from 2007 to 2010. Posttraumatic stress disorder (PTSD) symptom severity was associated with alcohol-related problems and a positive alcohol screen; physical IPV severity was related to alcohol dependence. Post hoc analyses revealed that PTSD symptom severity mediated relationships between physical IPV severity and hazardous, harmful, and dependent drinking. Focusing on managing PTSD symptoms and physical IPV in community-based interventions may halt the progression from alcohol use to dependence.

RÉSUMÉ

Facteurs de risque des problèmes liés à l'alcool chez les victimes de violence de la part d'un partenaire.

Malgré la prévalence importante des problèmes et troubles liés à l'alcool parmi les femmes victimes de violence de la part d'un partenaire, les facteurs liés à leur consommation d'alcool sont insuffisamment étudiés. Nous avons examiné les facteurs de risque des problèmes actuels d'alcool parmi 143 femmes victimes de violence de la part de leur partenaire et consommant de l'alcool recrutées dans une communauté urbaine entre 2007 et 2010. La sévérité de leurs symptômes de stress post-traumatique était associée avec des problèmes d'alcool et un résultat de dépistage positif; la sévérité de la violence physique du partenaire était associée à la dépendance à l'alcool. Des analyses post-hoc ont révélé que la sévérité des symptômes de stress post-traumatique médiatisait les relations entre la sévérité de la violence physique et, respectivement, la consommation dangereuse, la consommation nuisible et la dépendance à l'alcool. Se concentrer sur la prise en charge des symptômes de stress post-traumatique et de la violence physique entre partenaires dans des interventions de type communautaire pourrait arrêter la progression de la consommation d'alcool à la dépendance.

RESUMEN

Factores de riesgo para problemas de alcohol en las víctimas de violencia de pareja

A pesar de la alta prevalencia de problemas de alcohol y desordenes en las mujeres que sufren violencia de pareja (IPV), los factores relacionados con el consumo actual de alcohol está poco estudiado. Examinamos los factores de riesgo actuales para los problemas de alcohol entre 143 mujeres que usan sustancias y que han sido expuestas a IPV, que fueron reclutadas de una comunidad urbana del 2007–2010. La gravedad de los síntomas de PTSD se asoció con problemas relacionados al y resultados positivos de alcohol; la gravedad de IPV-física estaba relacionada con la dependencia al alcohol. Los análisis post hoc revelaron que la severidad de los síntomas PTSD medida por las relaciones entre la gravedad de IPV-física y el riesgoso, perjudicial y dependiente consumo de alcohol. Enfocándonos en controlar los síntomas de PTSD y IPV-física en las intervenciones comunitarias pueden detener la progresión del consumo de alcohol y la dependencia.

Keywords :

• partner violence
• alcohol disorders
• PTSD symptoms
• depression symptoms
• coping

THE AUTHORS

Tami P. Sullivan, Ph.D., is an assistant professor and Director of Family Violence Research and Programs in the Department of Psychiatry, School of Medicine, Yale University, New Haven, CT. Her program of research focuses on individual- and system-level factors that affect the well-being of women victims of intimate partner violence (IPV). At the individual level, her work focuses on understanding the relationships among IPV, posttraumatic stress, substance use, and sexual risk. She is actively involved in research examining (a) precursors, correlates, and outcomes of women's victimization and their use of aggression in intimate relationships, and (b) the co-occurrence of IPV, posttraumatic stress, and substance use with specific attention to daily processes and microlongitudinal designs. At the systems level, Dr. Sullivan studies the conduct of partner violence research within the criminal justice system as well as the impact of the criminal justice system response on victims’ well-being. She is a licensed psychologist who has extensive clinical experience with victims and offenders of IPV, providing services in a range of settings from inpatient and outpatient units to domestic violence shelters, transitional living programs, and community programs.

Rebecca L. Ashare, Ph.D., is a postdoctoral fellow at the Center for Interdisciplinary Research on Nicotine Addiction (CIRNA) at the Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA. Her research focuses on improving treatments for nicotine dependence by identifying withdrawal-related cognitive deficits that contribute to relapse and translating this information to develop novel treatments that target these factors. She received her Ph.D. in Clinical Psychology from the University at Buffalo where she worked on a variety of research studies including clinical trials for smoking cessation and laboratory studies examining the effects of various pharmacological substances on behavioral and cognitive processes related to smoking behavior. During her predoctoral clinical fellowship at the Division of Substance Use, School of Medicine, Yale University, Dr. Ashare expanded her research to the physiological, cognitive, and behavioral factors related to stress-precipitated relapse as well as the association between intimate partner violence and substance abuse. At the CIRNA, she continues to receive training in pharmacology, cognitive neuroscience, and addiction genetics related to nicotine dependence and plans to apply this training to better understand pharmacogenetic factors related to smoking cessation treatment response.

Véronique Jaquier, Ph.D., is a postdoctoral fellow at Division of Prevention and Community Research, School of Medicine, Yale University, New Haven, CT, and a lecturer at the École des sciences criminelles, University of Lausanne, Lausanne, Switzerland. Trained in social psychology and criminology in Switzerland and the United States, Dr. Jaquier has taught classes in victimology, violence against women, victims’ rights, and counseling. She has worked at a victim's crisis center and in an association striving to prevent sexually transmitted infections and other dangers related to the practice of sex work. Dr. Jaquier's program of research focuses on the interrelations of women's and girls’ victimization and their use of aggression as it impacts mental health, substance use, and social behaviors. This includes, among other issues, the study of the precursors, correlates, and outcomes of women's victimization and use of aggression, with emphasis on understanding how the criminal justice response impacts these different life trajectories. Her current work at Yale is funded by a fellowship from the Swiss National Science Foundation.

Howard Tennen, Ph.D., is a Board of Trustees Distinguished Professor at the University of Connecticut. His research examines stress, coping, and adjustment to threatening encounters, including (a) cognitive adaptation as a predictor of health outcomes in the face of serious illness, (b) the daily dynamics of chronic pain, (c) stress and alcohol use, (d) gene—stress interactions, and (e) the application of daily process methods in clinical trials.

Notes

2 Additional logistic regression analyses were conducted to determine if alternative coding schemes for alcohol disorders impacted results. Two dependent variables were created and tested in separate models that classified women as (1) 0 = no diagnosis and 1 = diagnosis of alcohol dependence (i.e., removing from the dataset those women who met criteria for alcohol abuse); and (2) 0 = no diagnosis and 1 = diagnosis of alcohol abuse or dependence (i.e., collapsing abuse and dependence into one diagnostic category as is being explored for DSM-V). Results of each of the models with alternative coding schemes did not differ from the results noted in Table 3; therefore, the conservative coding scheme proposed was retained.

3 Of note, in initial models, we created and tested interaction terms between PTSD severity and IPV variables (Aiken & West, 1991). No interactions emerged as statistically significant and, therefore, were removed from final models to preserve degrees of freedom and to retain the most parsimonious model.