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As a disturbing sign of the times, perhaps, or because of a search for clarity, the term "domestic violence" no longer means - as it was first coined 30 years ago - husband-to-wife violence. The term now encompasses all types of violence in the home, including spousal violence, elder abuse, and parent-to-child violence. Intimate Partner Violence (IPV) has become the subset of domestic violence that refers specifically to the verbal, psychological, and especially physical violence between two members of an intimately involved couple, married or unmarried. While research indicates that female IPV (where the woman is the perpetrator) occurs as often or even more often than male IPV (where the man is the perpetrator), women are more likely than men to sustain injuries and need medical care as a result of IPV. A study in the April issue of Alcoholism: Clinical & Experimental Research examines associations among male and female alcohol problems, drug use, and risk of IPV in a general household population sample.
"Our key findings were that female and male alcohol-related problems, and female drug use, were associated with an increased risk of moderate and severe male IPV," said Carol B. Cunradi, epidemiologist, associate research scientist at the Pacific Institute for Research and Evaluation, and lead author of the study. "In addition, couples living in high-unemployment neighborhoods are at increased risk for severe IPV compared to couples living in low-unemployment neighborhoods, even after statistical adjustment for other factors."
"Not surprisingly," added Roland S. Moore, a research anthropologist at the Pacific Institute for Research and Evaluation, "men and women who had been victims of childhood violence were more likely to be involved in severe male-to-female partner violence. In contrast, and similar to those couples who lived in neighborhoods with low unemployment, White and Hispanic couples were also less likely to engage in male-to-female IPV."
Researchers examined a multiethnic sample of 1,615 married or cohabiting couples from the 1995 National Study of Couples, a cross-sectional study of alcohol and IPV that was part of the ninth National Alcohol Survey. The sample included 555 white couples, 527 Hispanic couples, 358 black couples, and 173 couples of "mixed" ethnicity. Participants were asked about sociodemographic and psychosocial variables, as well as alcohol problems, drug use and IPV during the 12 months prior to the interview. In addition, neighborhood unemployment data were collected for each couple from the 1990 census.
Although alcohol-related problems and, to a lesser degree, drug use were associated with an increased risk of male IPV, this does not necessarily mean that high levels of alcohol consumption will cause more IPV. In fact, alcohol-related problems (such as withdrawal or negative social consequences) rather than heavy alcohol use might prove more relevant when examining IPV.
"Alcohol-related problems indicate a loss of control over drinking that mirrors loss of control in other aspects of life," said Moore. "Such loss of control in relationships can lead to more unstable situations in which intimate partner violence is more likely." In other words, lack of restraint regarding alcohol may be part of a larger problem that includes aggressive or violent interpersonal exchanges, which can collectively lead to discord and/or fighting.
"The neighborhood unemployment association that we found," said Cunradi, "is part of a growing body of literature examining the association between neighborhood factors or characteristics and various health outcomes or behaviors. We don't know why characteristics of the neighborhood are associated with greater risk for severe male IPV. One can certainly speculate on the emotional/psychological sequelae of residing in a high-unemployment neighborhood. Given that men are still expected to be the household breadwinners, living in such a neighborhood may be associated with feelings of depression, powerlessness, stress, etc. These factors, in turn, may provide a toxic atmosphere for the resolution of conflict between the couple; violence may ensue."
Moore concurs. "In a society where status and self-worth have been closely tied to one's work, people with fewer opportunities for work face frustration and depression, not to mention stress over providing basic resources for the household. These negative emotions probably foster conflict, including a greater likelihood that violence will ensue."
Both Cunradi and Moore said that although this study finds an association between IPV and substance use or abuse, it does not clarify which comes first.
"A person engaging in heavy drinking or other forms of intoxication certainly increases their odds of being victimized," said Moore. "And 'self-medication' through heavy alcohol or drug use may be a response to the traumatic experience of being victimized. The direction of causality in some of the associations discussed in this paper could be better established with longitudinal studies: an expensive but worthwhile goal."
Cunradi said this was next. "Although the National Study of Couples was originally conceived as a cross-sectional study," she said, "additional funds were obtained to re-interview the participating couples during the year 2000. The data obtained from those interviews are currently being analyzed and may provide insight into which factors may be causally related to IPV, and predict its occurrence over time."
"It's important to remember that IPV is a difficult topic to study because it usually takes place behind closed doors," said Moore. "Moreover, it is not an easy topic to talk about. The association between alcohol and other drug use and IPV is common knowledge, but there are relatively few studies examining the links between them in a sophisticated way. Certainly detailed analyses of intimate partner violence and substance use such as this are relatively rare."
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