Correlates of partner and non-partner aggression among patients with substance use disorders in an urban ED

Abstract

Introduction: Violence is a leading cause of morbidity and mortality among patients seeking care in urban emergency departments (EDs). Few studies have examined the relationship between substance use and violence among ED patients with substance use disorders. The urban ED is a critical location for intervening with patients with substance use disorders and violence. This study examined correlates of violence by patients with substance use disorders.

Method: For this cross-sectional study, 1215 patients (64.7% males, average age 34.1 years, SD = 10.58) in an ED, with substance use disorder, completed Substance Abuse Outcome Module (Smith et al., 1996, Psychiatric outcomes module: Substance Abuse Outcomes Module (SOAM). Baltimore, MD: Williams & Wilkins), Addiction Severity Index (McLellan et al., 2006, The Addiction Severity Index at 25: Origins, contributions and transitions. American Journal on Addictions, 15(2), 113–124), Conflict Tactics Scale (Straus, 1979, Measuring intrafamily conflict and violence: The conflict tactics (CT) scales. Journal of Marriage and Family, 41(1), 75–88) and Social Support Scale (Smith et al., 2006, Reliability and validity of the substance abuse outcomes module. Psychiatric Services, 57(10), 1452–1460). Participants were coded into groups based on aggression: participants who are not aggressive (n = 675), participants aggressive towards a partner (n = 249) and participants aggressive towards a non-partner (n = 291).

Results: Logistic regression analysis examined variables associated with participants aggressive towards a partner and participants aggressive towards a non-partner with participants who are not aggressive as the reference group. Participants aggressive towards a partner were related to female gender, antisocial traits and lower level of social support; participants aggressive towards a non-partner were related to younger age, male gender, history of physical abuse, alcohol intoxication, drug problems and antisocial traits.

Conclusion: Screening and brief intervention in urban EDs should focus on substance use and aggression, with tailoring needed to address the unique factors associated with partner and non-partner aggression.

• Substance use
• aggression
• emergency department

Acknowledgements

We thank the project staff, especially Lynn Massey, for their work on the project and Peter De Chavez for assistance with data analyses. Finally, special thanks to the patients and medical staff at Hurley Medical Center for their support of this project.

Declaration of interest

This work was supported by grants from the NIAAA (#AA014665) and the NIDA (#DA 016591). This work was supported in part by a training grant from the National Institute on Drug Abuse and the Fogarty International Center (TW005818) to the University of Michigan Addiction Research Center and Department of Psychiatry Substance Abuse Section.