Kick Your Habit!
The Link between Gender Based Violence and Substance Abuse
Intimate Partner Violence and Substance Abuse
(World Health Organization, http://www.who.int/substance_abuse/terminology/ who_lexicon/en/).
Intimate partner violence refers to any behaviour within an intimate relationship that causes physical, psychological or sexual harm to those in that relationship. It includes acts of physical aggression (slapping, hitting, kicking or beating), psychological abuse (intimidation, constant belittling or humiliation), forced sexual inter- course or any other controlling behaviour (isolating a person from family and friends, monitoring their movements and restricting access to information or assistance).
Alcohol consumption, especially at harmful and hazardous levels is a major contributor to the occurrence of intimate partner violence and links between the two are manifold. Harmful use is defined as a pattern of alcohol use that causes damage to health. Hazardous use is defined as a pattern of alcohol use that increases the risk of harmful consequences for the user.
Strong links have been found between alcohol use and the occurrence of intimate partner violence in many countries. Evidence suggests that alcohol use increases the occurrence and severity of domestic violence. Alcohol consumption as a direct cause of intimate partner violence has often been contested either on the basis of additional factors (e.g. low socio-economic status, impulsive personality) accounting for the presence of both, or because frequent heavy drinking can create an unhappy, stressful partnership that increases the risk of conflict and violence.
However, evidence is available to support relationships between alcohol and intimate partner violence that include:
Alcohol use directly affects cognitive and physical function, reducing self-control and leaving individuals less capable of negotiating a non-violent resolution to conflicts within relationships
Excessive drinking by one partner can exacerbate financial difficulties, childcare problems, infidelity or other family stressors. This can create marital tension and conflict, increasing the risk of violence occurring between partners
Individual and societal beliefs that alcohol causes aggression can encourage violent behaviour after drinking and the use of alcohol as an excuse for violent behaviour
Experiencing violence within a relationship can lead to alcohol consumption as a method of coping or self-medicating
Children who witnesses violence or threats of violence between parents are more likely to display harmful drinking patterns later in life.
Risk factors for alcohol-related intimate partner violence
A number of individual, relationship and societal factors can exacerbate the association between alcohol use and violence. For perpetrators, heavier, more frequent drinking increases the risk of violence, and there is some evidence that problem drinkers are at increased risk of victimization. Having only fair or poor mental health has been found to co-occur with problematic alcohol use as a risk factor for violent offending, and heavy drinking is more strongly associated with severe intimate partner violence among men with antisocial personality disorder. Having an expectation that drinking alcohol will lead to aggressive behaviour increases the risk of committing violence towards a partner, while relationship dissatisfaction can strengthen the links between problem drinking and partner violence. Some evidence suggests that differences in alcohol consumption between partners are also important and couples where only one partner drinks excessively are more likely to experience alcohol-related arguments and physical violence. Societal beliefs about alcohol consumption, gender roles and violent behaviour can also affect the risk of alcohol-related partner violence. For instance, in some societies, both heavy drinking and violent behaviours towards female partners are associated with masculinity. Moreover, in South Africa, beliefs that alcohol facilitates aggression have led to drinking so that individuals can carry out violence perceived to be socially expected. Equally, societal beliefs that a victim’s drinking is a cause of violence may in some cultures be seen as a mitigating factor, while in others alcohol-related violence can increase the blame and punishment metered out to the offender.
Research focusing on the prevention of alcohol-related intimate partner violence is scarce. However, generic strategies that tackle intimate partner violence and those that aim to reduce harmful use of alcohol in the population both play important roles in prevention. Successful strategies for tackling intimate partner violence in general have been reviewed elsewhere. Such measures should include addressing societal tolerance towards intimate partner violence, acceptance of excessive drinking as a mitigating factor, and normative beliefs about masculinity and heavy drinking. Intimate partner violence may also be reduced through interventions to moderate alcohol consumption which include:
Reducing alcohol availability: In Australia, a community intervention that included restricting the hours of sale of alcohol within one town reduced the number of domestic violence victims presenting to hospital. In Greenland, a coupon-based alcohol rationing system implemented in the 1980s that entitled adults to the equivalent of 72 beers-worth of alcohol per month saw a subsequent 58% reduction in the number of police call outs for domestic quarrels.
Regulating alcohol prices: Increasing the price of alcohol is an effective means of reducing alcohol-related violence in general. Although research evaluating the effectiveness specifically for intimate partner violence is scarce, in the USA it has been estimated that a 1% increase in the price of alcohol will decrease the probability of intimate partner violence towards women by about 5%.
Treatment for alcohol use disorders: In the USA, treatment for alcohol dependence among males significantly decreased husband-to-wife physical and psychological violence, and wifeto-husband marital violence six and 12 months later.
Screening and Brief Interventions: Alcohol screening (such as AUDIT ) and brief interventions in primary health care set- tings have proven effective in reducing levels and intensity of consumption in low- to middle-income and high-income societies; although their direct effect on alcohol-related intimate partner violence has not been measured.
The Role of Public Health
Public health has a central role to play in the prevention of intimate partner violence including addressing its relationships with alcohol use.
Key responsibilities include to:
Collect and disseminate information on the prevalence of intimate partner violence, alcohol consumption levels and drinking patterns in the population.
Promote, conduct and evaluate research on the links between alcohol consumption and intimate partner violence, both by victims and perpetrators, that improves understanding of risk and protective factors.
Increase awareness and routine enquiry regarding intimate partner violence in services addressing alcohol abuse.
Measure and disseminate information about the health, social and wider economic costs associated with alcohol related intimate partner violence.
Evaluate and promote effective and cost-effective prevention strategies for reducing levels of alcohol-related intimate partner violence.
Promote multi-agency partnerships to tackle intimate partner violence by raising awareness of the links between alcohol consumption and intimate partner violence.
Advocate for policy and legal changes to protect victims of inti- mate partner violence, to reduce problematic drinking, and to exclude alcohol as a mitigating factor for violent acts.
Ensure close links between intimate partner violence and alcohol support services, allowing those presenting at one to receive screening and referral to the other. Implementing such measures is often dependent on having established and accessible health and criminal justice services and the capacity to record and monitor alcohol use and violence.
SANCA Horizon challenges South Africa to stop alcohol-related intimate partner violence by Kicking the Habit of Alcohol Abuse as part of SANCA National’s 2020 Kick the Habit Campaign.