Introduction to the Special Issue: Examining the Relationship Between Violence and Addiction

Violence and addiction are widespread and interrelated problems that affect the health and well-being of individuals, families, and communities. Researchers from social work and other disciplines have used a range of methodological approaches to document multiple connections between violence and substance use. Women seeking treatment for substance use problems experience physical or sexual victimization at rates higher than those for the general population (Greenfield, Back, Lawson, & Brady, 2010; Najavits, Weiss, & Shaw, 1997). High rates of violence are found among adult (Chermack et al., 2010) and adolescent (Perron, Gotham, & Cho, 2008; Sabri, Williams, Smith, Jang, & Hall, 2010) substance use treatment samples. Aggressive and violent behaviors are more common among adolescents who use alcohol and illicit drugs than among nonusers, although not necessarily while they are under the influence of drugs or alcohol (Pinchevsky, Wright, & Fagan, 2013; Swahn & Donovan, 2004). Victimization by an intimate partner places women at significantly higher risk for substance abuse, whether or not they have suffered physical injury (Bonomi et al., 2006; Howard et al., 2010; Rodríguez, Valentine, Son, & Muhammad, 2009). Recent studies suggest that acute substance use confers increased risk for partner violence at the level of day-to-day events and conflict situations (Chermack et al., 2010; Friend, Langhinrichsen-Rohling, & Eichold, 2011). Substance abuse treatment dropout rates are also higher for persons with a history of physical or sexual abuse (Claus & Kindleberger, 2002; Resko & Mendoza, 2012).

Despite this evidence, much remains to be learned about the intersections between substance use and interpersonal violence. Achieving a more comprehensive understanding of these issues will require new research that explores the links between particular substances and forms of violence and explains how they influence each other across the life span. This special collection of articles in the Journal of Social Work Practice in the Addictions enriches our understanding of the overlap between violence and substance use and addictions. This special issue features nine original articles on substance use and violence-related topics, an informative dialogue with former police lieutenant Ruben Burgos, and Suzanne Brown’s insightful endpage article that highlights importance of social supports and social network change.

Much of the early research on the relationship between violence and substance use focused on violence perpetration and alcohol use. Scholars have more recently broadened their work to examine this relationship for a wider variety of substances (e.g., cocaine and marijuana), and violence perpetration and victimization. Articles in this current issue bring attention to other substances, including marijuana and tobacco, and address multiple forms of violence victimization and perpetration (e.g., intimate partner violence, childhood abuse, cyberbullying). In these contributions, the authors move us toward increased specification and clarification of the dynamic interactions between types of substances and types of violence perpetration/exposure over time.

This collection begins and ends with articles that address the importance of context (neighborhood, poverty, and experiences of marginalization) as a contributor to substance use and violence, and a barrier to treatment and recovery. In the first article, Matto and Cleaveland present a unique theoretical perspective by using a “social-spatial lens” to analyze the impact of contextual dynamics of poverty, oppression, and privilege on substance use, violence, and recovery support. The authors offer a framework for understanding violence and addiction as consequences of social spaces. Case examples and descriptions illustrate the ways in which poverty and inequality are embodied in geographic place and space, and influence experiences of violence, addiction, and recovery.

Levenson and Grady’s article, “Childhood Adversity, Substance Abuse, and Violence: Implications for Trauma-Informed Social Work Practice,” examines the relationship among adverse childhood experiences (e.g., abuse, neglect, and domestic violence), substance abuse, and violence perpetration among adults involved in the criminal justice system. This article offers a developmental perspective on the relationships between violence experienced in childhood and adult outcomes in a group for which violence and addiction are ubiquitous. Using the model first introduced in the original Adverse Childhood Experiences (ACE) study (Felitti et al., 1998) the authors confirm similar findings on the enduring impact of adverse events among a sample of adults distinctly different from the original ACE study.

Next, Kobulsky, Minnes, Min, and Singer’s article, “Violence Exposure and Early Substance Use in High-Risk Adolescents,” presents a longitudinal study of violence exposure and early alcohol, tobacco, and illicit drug use among adolescents (by age 12). The majority of youth in this high-risk sample were exposed to drugs, alcohol, or both in utero. This article describes relationships between violence exposure and substance use and considers the mediating pathways of depression, anxiety, and anger among young adolescents. Information on this age group is frequently absent from the substance abuse literature. However, understanding use among younger adolescents could offer greater opportunities for prevention and intervention.

In “Longitudinal Associations Between Substance Use and Violence in Adolescence Through Adulthood,” Lim and Lui examine the transition from adolescence to adulthood in their study of associations between substance use and violence. Analyzing data from the National Longitudinal Study of Adolescent to Adult Health, the authors consider whether heavy drinking and marijuana use increase the likelihood of later violence exposure. They also examine whether violence exposure sets the stage for later substance use and abuse. Their findings reflect the complexity of the relationship between violence exposure and substance use and the uniqueness of this relationship both within and across developmental stages.

Cybervictimization and bullying have burst into our cultural awareness in recent years, and parents and treatment providers have struggled to understand, prevent, and intervene, but with little empirical knowledge to guide us. Wright’s examination of the relationships between cybervictimization, social support, and substance use (“Cybervictimization and Substance Use Among Adolescents: The Moderation of Perceived Social Support”) among middle school students leads us closer to the possibility of an evidence-informed intervention. Using a longitudinal study design, the author analyzes the impact of cybervictimization on substance use in a large cohort of students across the sixth, seventh, and eighth grades. The finding on the important buffering effect of social support offers an avenue for prevention and intervention to mitigate the impact of cybervictimization on substance use. An additional strength of this article is that Wright separates the data analyses to examine the unique impact of victimization on alcohol, marijuana, tobacco, and illicit drug use.

Next, Shpiegel, Lister, and Isralowitz take a closer look at the relationship between caregiver abuse, delinquency, and substance use among adolescents transitioning out of foster care. Recent research (Lee, Courtney, & Hook, 2012) has identified this population of transition age adolescents leaving foster care as highly vulnerable to substance abuse, violence, and incarceration. Focusing on a diverse sample of youth, this study examines the temporal relationship between alcohol, tobacco, and marijuana use and delinquent behaviors, such as fighting and weapon carrying. This work underscores the vulnerability of youth who have experienced abuse and are in foster care.

Further refining our insight into the violence–substance abuse relationship is the investigation by Kristman-Valente and colleagues entitled “The Relationship Between Interpersonal Violence and Smoking Behavior Across Time and By Gender.” Research, to date, on violence and substance use is usually focused on alcohol and to a lesser extent illicit drugs (Atkinson et al., 2009). This work expands our focus to examine smoking behaviors and interpersonal violence. The authors of this study identified relationships among childhood physical abuse, adult smoking, and partner violence, reminding us of the importance of childhood violence exposure in its effect on lifespan trajectories of substance use and violence exposure.

In the article “Alcohol Use & Latent Profiles of Intimate Partner Violence,” Messing, Mendoza, and Campbell extend our understanding of intimate partner violence by exploring how patterns of partner violence perpetration are related to alcohol misuse. This study presents a unique perspective as it draws on data from female victim-survivors interviewed after police-involved partner violence incidents. The authors consider whether more frequent and more severe alcohol use are associated with different patterns of partner violence perpetration. These findings highlight the importance of addressing substance use in police-involved intimate partner violence situations and addressing partner violence in substance use treatment settings.

The final two articles, “Violent Victimization and Substance Dependency: Comparing Rural Incarcerated Heterosexual and Sexual Minority Women” by Otis, Oser, and Staton-Tindall, and “Health Care Experiences of Rural Women Experiencing Intimate Partner Violence and Substance Abuse” by Bender, bring attention to vulnerable and understudied populations by focusing on rural women and sexual minority women. Otis and her colleagues present data on the substance use and violence experiences of women incarcerated in rural Appalachia, a population rarely examined in the substance abuse and violence literatures. Comparing heterosexual and sexual minority (lesbian and bisexual) women, the authors examine the association of violent victimization experiences (e.g., physical assault, sexual assault) with drug overdoses and other substance use problems. This study highlights how sexual identity interacts with violence exposure and influences substance abuse and substance-related problems. Bender uses qualitative methods to explore the health care experiences of rural women with histories of substance abuse and exposure to interpersonal violence. Bender considers the views of women with current or past experiences of substance abuse and intimate partner violence as well as health care providers who serve similar women. These participants offer stark examples of the barriers to health care and substance abuse treatment for women in a rural community with limited numbers of providers and resources. Both of these articles remind us that the individual cannot be separated from his or her social milieu and that substance abuse and violence occur within sociocultural contexts of oppression, stigma, and marginalization that affect exposure to substance abuse and violence as well as opportunities and barriers to treatment services.

Taken together, this collection of articles sheds new light on the complexity of the substance use–violence relationship and brings attention to how these problems influence one another. Involvement in substance use can increase the risks of being both a victim and perpetrator of violence (Atkinson et al., 2009). Experiencing violent victimization can increase the risks of initiating drug and alcohol use (Patrick, Schulenberg, O’Malley, Johnston, & Bachman, 2011). Several of the articles in this collection further our understanding of whether the relationship between substance use and violence is causal or an association linked through shared risk factors. Using longitudinal analyses helps these authors (Kobulsky, Minnes, Min, & Singer; Lim & Lui; Wright; Kristman-Valente et al.) provide insight on the temporal relationship of these behaviors that span across multiple developmental periods. The focus on vulnerable populations, including incarcerated adults, rural women, bisexual women, and lesbians, is a notable strength of this collection.

Recognizing the interconnections between substance use and violence has substantial implications for research and practice. For etiological models to be accurate, it will be important to understand which forms of violence and substance use are most closely linked and why. Understanding this etiology can help social workers and other health professionals prevent the initiation and escalation of these behaviors. Substance-abusing clients who engage in violent behaviors or have a history of victimization pose an additional level of complexity for treatment providers who already work with a challenging and heterogeneous population (Sabri et al., 2010). Recognizing that many substance use clients are victims and perpetrators of interpersonal violence will help us to develop and improve prevention and treatment services.