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Public health interventions for alcohol-related intimate partner violence Ingrid Wilson PhD Candidate Judith Lumley Centre, La Trobe University 29th June 2015

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Acknowledgements

Funding and Support: Australian Postgraduate Award Judith Lumley scholarship Australian Rechabite Foundation PhD scholarship

Professor Angela Taft Judith Lumley Centre for Mother, Infant and Family Health Research La Trobe University

Dr Kathryn Graham Centre for Mental Health and Addiction (CAMH), Ontario, Canada

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Women’s suffrage: “home protection” from alcohol-related male violence

"Temperance fueled as important a contribution to the women’s movement as abolition. Slavery fueled discussion of the innate equality of humans of all races and sexes; intemperance forced consideration of inequality and abuse within the American family." Catherine Gilbert Murdock (2003) Domesticating Drink: Men, Women and Alcohol in America, 1870-1940

Frances Willard President, Women’s Christian Temperance Union Lived 1839-1898

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Women’s experiences of fear and harm from an alcohol-affected

male partner

“Once he started drinking on a Friday night then Mr Happy would ... Mr Bouncy would come out again. But Mr Happy started turning into Mr Sarcastic and Mr Making Personal Remarks and ... and then being threatening and then, you know, hurting.” (Kath)

“And he would start to put his face right into my face. That was the start of it so just that really intimidating put his face right up to me and talk through his teeth and, you know, be quite verbally aggressive. But with his face probably an inch away from mine which was ... and I would be backed into a corner.” (Kym)

“I will usually wait for that stage when he would be too drunk to do anything, when he’ll be unstable on his feet that was the moment when I knew I was pretty much safe.” (Carla)

Not all partner violence is

alcohol-related

Alcohol is involved

in a substantial proportion

of partner violence

Prevalence

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Indigenous partner homicides

13 times more likely to

involve alcohol than non-

indigenous partner homicides (Dearden & Payne, 2009)

US studies - 25-50%

involve alcohol (Leonard, 2001)

Australian victimisation

survey - 1 in 3 (35%) recent

incidents were alcohol-

related (Mouzos and Makkai, 2004)

50% of partner violence is

alcohol-related; 73% physical

assaults (Laslett et al., 2010) 40% females experienced

alcohol-related physical

violence in intimate

relationship compared

with 11% of males (AIHW, 2011 2010 National Drug Strategy

Household Survey)

Alcohol and IPV: what is the link?

Picture: Alvimann

Strong evidence for association

• Cross-sectional studies (alcoholic males higher IPV)

• Longitudinal studies (drinking in early marriage predicts later IPV)

• Laboratory studies (alcohol and aggression)

• Stronger effect on aggression in males v females

• Theoretical explanations

• Physiological (cognitive functioning)

• Psychological (expectancies/beliefs)

• ‘alcohol myopia’ (Steele & Josephs,1990)

• Social learning/cultural (excusing drunken behaviour)

• ‘responsible disinhibition’ (Galvani, 2004)

• Alcohol an instrument of domination (Room, 1980)

• Heavy and binge drinking increases risk of IPV (Foran & O’Leary, 2008)

• Violence is more severe when one or both partners drink (Abramsky et al., 2011; Graham et al., 2011)

• “Alcohol may not cause partner violence but it seems to make things worse” (Graham et al., 2011)

• Contributing role of alcohol in IPV

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How and where can we intervene in alcohol-related partner violence? An ecological model

WHO Ecological model for understanding violence against women (Krug et al., 2002; Bronfenbrenner, 1979)

Individual Societal

(population)

Community Relationship

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Individual Societal

(population)

Community Relationship

Couples-based treatment

Restrictions on

sale of alcohol Alcohol outlet

density

Review of evidence - alcohol and policy interventions 1992-2013

Alcohol pricing

and taxation

Individual treatment

Interventions +

alcohol-related IPV

= neglected space

Society level – what do we know?

Alcohol-pricing and taxation

Alcohol pricing strategies are generally effective in reducing consumption and related harms

Few studies have looked at taxation and impact on domestic violence

Only one American study found price reduction may reduce partner violence

Limited evidence base

Strategic policy:

We need to know more to target pricing mechanisms

How perpetrators are affected by alcohol price: type of alcohol/drinking patterns/forms of partner violence

Picture: Cohdra

Community level - what do we know?

Alcohol availability

Reducing physical availability decreases consumption and harm by increasing effort to obtain alcohol

Alcohol sales restriction

Reduce hours or days of sale

Study in Brazil – reductions in homicide and non-significant reduction in violence against women

Restrictions in Aboriginal communities - reductions of IPV in some communities but no rigorous or clear evidence

Community level - what do we know?

Alcohol availability

Reducing physical availability decreases consumption and harm by increasing effort to obtain alcohol

Alcohol outlet density

Australian evidence of links between packaged liquor (off-premises) and increase in family violence police incident rates ( 28.6%)

Two other US studies found associations between outlets and police reports of domestic violence (inconsistent about type of outlet)

Evidence is still weak, but worth investigation

Picture: DMedina

Relationship level – what do we know?

Couple-based treatment

Aims to reduce alcohol consumption and improve marital relations in couples where one partner has alcohol problems

Some evidence for brief interventions reducing both problem drinking and aggression in dating university couples (but reductions not linked)

Other uncontrolled studies showed reductions in clinical populations (treatment seeking, middle-aged couples, long-term relationships); effects not often sustained

Increases in violence with relapsed patients

Picture: Penywise

Individual level - what do we know? Individual treatment

Aims to reduce alcohol problems in individuals with diagnosed problems

Standard batterer program compared with batterer and substance use treatment (motivational interview brief intervention) had some effects on IPV but lost over time

The remaining few intervention studies (using CBT and telephone motivational interviewing) showed limited evidence, effects not sustained and unclear if violence reduction mediated by alcohol reduction

Uncontrolled studies found some links between alcohol use and violence outcomes Picture: TerryDick

Picture: Xololounge

Reducing alcohol-related intimate partner violence

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Conclusion

• Evidence for what to do at any level is scarce and limited quality

• We need more strategic research – current research focussing on generalised alcohol policies may not be sensitive enough

• We need:

• Focus on those at risk (young/binge) and heavy drinkers

• Better research quality

• Targeted interventions at all levels of ecological model

• Other approaches e.g., South Dakota criminal justice?

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Better research and evaluation

Improve data collection

• Recording of alcohol-related IPV versus non-alcohol-related IPV

Measure prevalence

• Surveys of populations at risk (young people; heavy drinkers)

• Personal Safety Survey – specifically include alcohol use in domestic violence

• More longitudinal research – alcohol risk and perpetration and victimisation

Research and Evaluation

• Evaluations of alcohol policy interventions should include measures of domestic violence

• Investigate alcohol availability, drinking location and domestic violence

Alcohol use ‘one of the factors most open to

intervention and change’

(Lori Heise in Graham et al., 2008)

Picture: MarcoMaru

“Five years now on, we’ve got a child and I still -- I’m still waiting for the moment when he will become drunk and angry.” “… we are the damaged goods (laughs), you know, me and my other kids” (Carla)

The long term impact

Picture: sideshowmom

Thank you

latrobe.edu.au CRICOS Provider 00115M

Wilson IM, Graham K, Taft AJ. Alcohol interventions, alcohol policy and intimate partner violence: a systematic review. BMC Public Health. 2014;14:881.

http://www.biomedcentral.com/content/pdf/1471-2458-14-881.pdf

imwilson@students.latrobe.edu.au

m. 0433 947 611

http://www.biomedcentral.com/content/pdf/1471-2458-14-881.pdfhttp://www.biomedcentral.com/content/pdf/1471-2458-14-881.pdfhttp://www.biomedcentral.com/content/pdf/1471-2458-14-881.pdfhttp://www.biomedcentral.com/content/pdf/1471-2458-14-881.pdfhttp://www.biomedcentral.com/content/pdf/1471-2458-14-881.pdfhttp://www.biomedcentral.com/content/pdf/1471-2458-14-881.pdfhttp://www.biomedcentral.com/content/pdf/1471-2458-14-881.pdfhttp://www.biomedcentral.com/content/pdf/1471-2458-14-881.pdfmailto:imwilson@students.latrobe.edu.au

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