Bob Pihl and Rachael Sutton say the following in the beginning of their article in this special issue of Substance Use and Misuse:
The evidence is clear and substantial. The acute use of alcohol/drugs and interpersonal aggression readily mix. Many drugs are related to violent behavior and some provide insight into possible mechanisms. The list of drugs implicated is very inclusive and if case reports are considered, even some anti anxiety drugs list relevant pharmacopia warnings of increased aggression. (Pihl & Sutton, 2009, p. 1188)
So, the editors have attempted to bring together a number of articles by distinguished and experienced scientists working in this area of investigation that address this relationship from various perspectives. Their charge was not only to report some of the best works being done but also to point the way toward better avenues of investigation or intervention. The works of the authors have more than met the highest expectations of the editors and we believe that this special issue makes a significant contribution to the field. So well wrought and comprehensive are the works of the authors that the editors are at a loss as to how to best introduce this special issue for fear of not doing their work justice. However, an introduction is required, so asking the authors' indulgence, the editors will make the effort.
In their article, “Drug Use and Aggression Readily Mix; So What Now?,” R.O. Pihl and Rachael Sutton explore the relationship between substance use and aggression. They then focus on what is known about other factors, both sociocultural and individual, that seem to strengthen the correlation. Using this as their empirical base, they then discuss the possibilities and perils of public policy interventions. They end by exploring individual interventions that target anger and problems in executive cognitive functioning. In taking the approach they do, these authors create a theme of translational research, of using what is empirically known about a problem as the guide to developing effective interventions that will run through all the articles in this issue in one form or another.
Diana Fishbein and Ralph Tarter are clearly in line with the theme of translational work in their article, “Infusing Neuroscience Into the Study and Prevention of Drug Misuse and Co-Occurring Aggressive Behavior.” In their far-reaching and very comprehensive article they discuss what is known about neural functioning and increased risk of substance use and aggression. They point out that risky behaviors may be the result of genetic and environmental factors that bias the phenotype in the direction of dysregulation. They then point out that the developmental trajectory can be changed and dysregulation avoided by appropriate social and environmental interactions that are appropriately timed. What they call for is preventive approaches that take into account what has been learned in neuroscience about human development. They end with suggesting a number of important questions that neuroscientists might address because their answers have direct bearing on improving the effectiveness and timing of prevention efforts.
It would seem that from the strong correlation between substance misuse and aggression, substance misuse treatment programs would be primary venues to identify and intervene in cases of violent behavior, especially violent behavior directed toward intimate partners. Stephen T. Chermack, Regan L. Murray, Jamie J. Winters, Maureen A. Walton, Brenda M. Booth, and Frederic C. Blow in their article, “Treatment Needs of Men and Women With Violence Problems in Substance Use Disorder Treatment” begin by saying the following:
Despite high rates of violence among people in SUD treatment, there is very little information regarding treatment approaches that impact violence with this population. Further, there is some evidence that SUD settings do not employ systematic assessment of interpersonal violence, that relatively few individuals in SUD settings are referred for domestic violence prevention interventions. (Chermack, et al., 2009)
After reviewing the literature, they report their own findings on prevalence of violent behavior in a sizable sample of individuals in substance misuser treatment. Less than half have no history of violence while the majority of cases have histories of violence against partners only, or against nonpartners only, or both partners and nonpartners. They explore differences among these groups and conclude with an extensive and thoughtful discussion of a conceptual model for intervention based on the identified differences.
In a similar vein, Gregory L. Stuart, Timothy J. O'Farrell, and Jeff R. Temple in their article, “Review of the Association Between Treatment for Substance Misuse and Reductions in Intimate Partner Violence,” review extensively the literature on the relationship between substance use and intimate partner violence and on the effect of substance misuse treatment on subsequent intimate partner violence. They find that substance misuser treatment reduces the incidents of intimate partner violence for those who successfully remain abstinent after treatment. They also review the literature on the effectiveness of structural behavioral couples therapy and find that this approach appears to be effective if there is a history of low to moderate levels of IPV, if both the partners independently agree to participate and do not express fear of negative consequences for doing so, and if they firmly commit to nonviolence. They end by making a strong case for the integration of screening for intimate partner violence into substance misuser treatment and screening for substance misuse into batterer intervention programs. Further, they recommend that the availability of intervention for intimate partner violence be integrated into substance misuser treatment and point the way to valuable future clinical research.
Jeff R. Temple, Gregory L. Stuart, and Timothy J. O'Farrell in their article, “Prevention of Intimate Partner Violence in Substance Using Populations,” review the literature on the nature of the relationship between substance misuse and intimate violence in both adults and adolescents. They then reason, given what is known, that all forms of intimate violence prevention (universal, selective, and indicated) could and should be used with substance-using individuals. They argue that substance users are the ideal candidates for such prevention efforts.
Peter R. Giancola, Robert A. Josephs, C. Nathan DeWall, and Rachel L. Gunn do exactly as their title indicates in their article, “Applying the Attention–Allocation Model to the Explanation of Alcohol-Related Aggression: Implications for Prevention.” The Attention–Allocation Model posits that alcohol intoxications creates a condition best described as a cognitive myopia—a state of awareness in which the individual only attends to the most salient and often most provocative aspects of immediate experience. The more provocative the stimuli, the greater the likelihood of aggression even when there are other factors in the environment that might indicate that aggression is not a good idea. The authors present good evidence for the viability of this model. They then suggest a number of possible prevention strategies based on the model to prevent intoxicated violence. These suggestions are eminently practical and testable.
Among all the forms of violence and resulting injuries, that form least studied is violence directed against the self in the form of self-injurious behavior. Mitchell E. Berman, Tiffany P. Bradley, Jennifer R. Fanning, and Michael S. McCloskey in their article, “Self-Focused Attention Reduces Self-Injurious Behavior In Alcohol-Intoxicated Men,” report a series of well-structured experiments that demonstrate that alcohol intoxication is causally related to self-injurious behavior in men and that enhancing self-awareness decreases that risk even in intoxicated individuals. Such findings are of considerable significance because they point the way toward viable forms of intervention.
Among the varieties of coercive violent behaviors, sexual coercion is of special concern. Antonia Abbey, Michele R. Parkhill, Angela J. Jacques-Tiura, and Christopher Saenz in their article, “Alcohol's Role in Men's Use of Coercion to Obtain Unprotected Sex,” report the results of their well-designed experiment with male college students, identifying the role played by alcohol intoxication and other factors in coercive sexual behavior. They begin by providing a fine review of the literature on the relationship between substance use and sexual coercion. They then report on their own work which found that previous sexually coercive behavior is the strongest predictor of affirmation of coercive sexual behavior so that men who had previously committed sexual assault felt more justified using coercive strategies to obtain unprotected sex than did nonperpetrators. Acute alcohol consumption did not have a main effect; however, it interacted with hostility and misperception. Among participants who consumed alcohol prior to watching the video, the greater their preexisting hostility, the more justified they felt in using coercion. Similarly, the more frequently drinkers had misperceived women's sexual intentions in the past, the more justified they felt in using coercion. Based on these findings, the authors make a number of very salient recommendations for potentially effective intervention/prevention.
Turning from the effect of intoxication on perpetrators to its effect on victims, Maria Testa and Jennifer A. Livingston in their article, “Alcohol Use and Women's Vulnerability to Sexual Victimization,” focus primarily on the effects of acute intoxication on young women and increased risk for sexual victimization. They do an extensive review of the literature and find that the principle association between intoxication and sexual victimization is found in young women, especially college women. They note that despite the fact that there is a clear correlation between rape of young women and their heavy episodic drinking, there are no rape-prevention programs that identify heavy drinking as a risk factor. They posit that prevention programs that target heavy alcohol consumption may be more effective than programs that target other factors and make a number of recommendations about how that might be done.
Anne D. Bartolucci, Amos Zeichner, and Joshua D. Miller report the results of a well-designed study in which subjects were chosen for being either very high or very low on measures of masculinity or femininity were randomly assigned to an alcohol or nonalcohol condition. They were then shown a video of an ambiguous heterosexual scenario and asked questions to assess the accuracy of their perceptions of cues in the video, any positive bias in their recall of cues from the video, further, they were asked to predict whether the couple would have sexual intercourse, and whether they would have sexual intercourse in a similiar situation. They use their findings to discuss possible modifications in intervention to prevent sexual aggression.
Focusing on a relatively unstudied area of aggression, Dominic J. Parrott and Cameron A. Miller explore the issue of substance use and bias-based aggression, specifically aggression against non-heterosexuals in their article, “Alcohol-Related Antigay Aggression: Theoretical Considerations for Individual- and Societal-Level Interventions.” In very methodical and scholarly fashion, they first identify from the existent literature the risk factors and mechanisms that are relevant to alcohol-related anti-gay aggression. They then advance a number of hypotheses, predicting how alcohol intoxication might increase anti-gay aggression. Finally, they suggest possible interventions based on their predictions that are likely to be effective in reducing the risk of alcohol consumption-related anti-gay aggression. Their work sets a solid foundation for future empirical and clinical research in this area.
There is certainly a literature that links substance misuse and violence with antisocial personality. Additionally, there is a good deal of pessimism about the chances of individuals with antisocial personality disorder and substance dependence to have a successful treatment outcome. However, Lauren C. Gudonis, Karen Derefinko, and Peter R. Giancola challenge this assumption in their article, “The Treatment of Substance Misuse in Psychopathic Individuals: Why Heterogeneity Matters.” They posit that the pessimistic attitude toward individuals manifesting an antisocial personality disorder comes from a mistaken notion that the disorder is homogeneous. Using the literature, they argue that antisocial personality disorder is heterogeneous with at least two subtypes. Further, they marshal a strong argument that negative emotionality seems to be a critical feature in distinguishing the two. Finally, they suggest that treatment interventions based on the heterogeneous characteristics of individuals with antisocial personality disorder and substance misuse-related problems are likely to have better outcomes than those based on the homogeneity of their substance misuse.
Samantha Wells, Kathryn Graham, and Paul F. Tremblay report on a qualitative inquiry into the reasons that young males may find aggression against peers an appropriate behavior in bars in their article, “‘Every Male in There is Your Competition’: Young Men's Perceptions Regarding the Role of the Drinking Setting in Male-To-Male Barroom Aggression.” Using focus-group discussions with males 18 to 25 years of age they identify eight themes young males use to explain such aggression. After exploring each of these themes in detail, they offer a number of suggestions, based on their research, which would stand a good chance of decreasing aggression in bar environments. Their recommendations are especially valuable because they address both changes that can be made in the environment to decrease the likelihood of aggression as well as specific interventions that might be made in the decisional process leading up to aggression.
The editors would like to thank, again, the authors for the exceptionally fine work that they have done in their contributions to this special issue. We would also like to thank the Senior Editor of Substance Use and Misuse, Dr. Stanley Einstein, for his invaluable assistance and support.
THE AUTHORS
Theodore M. Godlaski is an Associate Professor of Social Work at the University of Kentucky where he teaches and does evaluative research. He has long experience in treatment development, implementation, and delivery in both the public and private sector and is an editor for Substance Use and Misuse.
Peter R. Giancola is a Professor of Clinical Psychology at the University of Kentucky. He received his doctorate in 1996 from the University of Georgia. His research is focused on identifying risk factors and underlying mechanisms for the relation between acute alcohol consumption and aggressive behavior. Dr. Giancola is an associate editor for the journal Aggressive Behavior and also serves as a consulting editor for other journals and reviewer for a number of national institutes of health grant panels. He has authored nearly 100 scholarly publications.