Alcohol-related domestic violence and its prevention through the MALVA project

Xavier Ferrer, Psych. D.

Scientific Director, FSC (Foundation Health and Community, Spain) and

Director, Postgraduate Degree in Addictions, Univ. of Barcelona

ALCOHOL ABUSEand domestic violence

(focusing on violence against intimate partner)

(“domestic” or “family” violence includes also violence against

children and older adults, as well as against parents from their offspring)

SUMMARY:• Alcohol abuse is one of the better known and most

relevant risk factors on violence against intimate partner.

• Alcohol facilitates aggression by 3 main ways:– 1) Decreasing self-control (an almost specific effect of alcohol,

and a widely known factor).– 2) Stimulating onset of mental aggressive pathologies

caused by substance abuse (mostly the alcoholic psychotic disorder, ICD-F10.5). This is a common problem with amphetamines, cocaine, and some psychodysleptic drugs (and is widely underestimated).

– 3) Worsening or difficulting to solve other violence-inducing mental disorders: schizophrenia, paranoidism, depression, personality disorders… (also widely underconsidered)

SUMMARY (2)• Besides the support to the victims, a relevant effort is needed in order to:

– 1) Implement measures aimed to reduce high alcohol per capita consumption.

– 2) Implement specific actions addressing the relationship among alcohol abuse, aggressiveness and violence:

• Information and education to the general public about these specific risks of facilitation of aggression, especially when mixed with “macho” attitudes.

• Awareness-raising among possible victims, aggressors and professionals involved, to facilitate early detection and intervention.

• Selective action in the cases found to avoid repetition of the victimisation.

– 3) Given the innovative character of these actions, a strong evaluation effort is needed to improve them and select the most efficient ones.

FSC- FUNDACIÓN SALUD Y COMUNIDADFOUNDATION HEALTH AND COMMUNITY

• FSC is a health and welfare professionals- lead NGO, aiming to promote health and quality of life for all, but especially for those more underprivileged, as the victims of HIV-aids, alcohol and other drugs abuse, violence and social exclusion.

• It runs over 60 centres and projects in several regions of Spain, employing

more than 1400 professionals and relying on the help of more than 500 volunteers. FSC has been involved in many European and international projects. In 2008 there were more than 75000 beneficiaries.

• One of the strengths of FSC is its multi-subject specialisation, which makes us able to adopt and combine different points of view. In this case, for instance, we have the perspective of the organisations helping alcoholics, along with the vision of the NGOs helping battered women and fighting against domestic violence.

What do we do in the field of domestic violence? (some examples, not exhaustive):

* Service for shelter of Women, Children and Families (SADIF) (City of Palma de Mallorca; Balearic Islands, Spain).            

* Centre for Intensive psychosocial care aimed to women victims of violence and their children (CIE) (region of Tarragona, Catalonia, Spain).

* First Contact and care Centre for women victims of violence and their children (EAD) (City Council of Barcelona, Spain)

* Women’s meeting place (Espai de Dones) Municipal Service promoting women’s rights and development , Badalona, Barcelona, Spain

* Promotion of the rights of women, sexual and reproductive health, and education against violence (Projet Repère-Lewhi) (Kabylie region, Algeria). In coop. with the “Ligue de Prévention pour la Jeunesse

et l’Enfance” de Tizi-Ouzou .

* Shelter Home (3-5 month stay) and longer-term stabilisation support for victims of domestic violence and their children. (Casa i pis del Segrià). Lleida, Catalonia, Spain.

•Outpatient centres (Barcelona)

•Day- care centres (L’Hospitalet, Barcelona)

•In-patient facilities for short and medium-term stays (up to 6 months) (Catalonia)

•Protected apartments to support long-term recovery (Catalonia)

•Occupational and rehabilitation workshops (Catalonia)

•Outreach contact and harm-reduction centres and programmes (Castelló, Valencia, Madrid), including drug consumption rooms

•Alcohol and drug Rehabilitation programmes inside 3 prisons (Barcelona, Lleida, Can Brians). Syringe exchange in the prison of Valencia.

•Prevention programmes in communities, schools and aimed to families

•Specific prevention programme addressed to and carried through University students (11 Universities)

What do we do in the field of alcohol and addictions?

Evidence about involvement of alcohol in violent crimes is overwhelming, and just as examples:

From the WHO synopsis “Interpersonal violence and alcohol”, Geneva, 2006:Alcohol has been a factor in about 3/4 homicides in Russia.In the USA, 35% among victims of violence reported that their aggressor/s had been drinking.In England and Wales, the same figure amounts to 50%, in South Africa 44%.

Our own data: among 1070 battered women cared in our Centre at Barcelona (EAD) (2008), 46% said addictions had a relevant role in the aggressor’s behaviour. Alcohol alone amounted to 30%.

According to the “Descriptive Note” of WHO about “Violence inflicted by the intimate partner and alcohol” (Geneva, 2006), alcohol intake is one of the main risk factors for violence among the couple. And this, because:

● Alcohol directly impairs cognitive and physical functioning, and lowers self-control, thus making individuals less able to find non-violent solutions to interpersonal conflicts.● The belief -individual and general – about alcohol generating violence may facilitate violent behaviour after its intake, and also may lead to drink searching an excuse for these behaviours.● Being victim of violence in a relationship may lead to drink as a way of coping or as self-medication.

According to the WHO-sponsored GENACIS Project [1], drinking alcohol is in many cases a determinant factor for violence. Moreover, it exists a negative association between alcohol abuse and the overall quality of the couple relationship.

Around half of the people involved in aggressions had been drinking immediately before these episodes, being

- The aggressor (25% of the cases),- Both aggressor and victim (16,7%)- The victim (3,5%)

[1] Sánchez, L; Navarro, J; Valderrama, JC; (2004) GENder, Alcohol and Culture International Study. Report. Sociedad Española de Toxicomanías: Alicante.

Aspects of the interaction:

1. Elements usually generating aggressiveness among “normal” individuals.

2. Psychopathological states and processes which use to produce aggressiveness.

3. System for inhibition and control of aggressiveness and anger, avoiding it to become aggression.

4. Role of alcohol:* Worsening pre-existing mental disorders* Decreasing self-control over aggressiveness* Generating specific mental disorders which

induce aggressiveness.

5. Violence: as a result a of a failure in the system for inhibition and control to block the aggressive drives (wrath, anger)

6. Mechanisms of feedback maintaining violent behaviour afterwards

OUR UNDERSTANDING: AN INTEGRATIVE MODEL FOR THE RELATIONSHIP ALCOHOL – DOMESTIC VIOLENCE

1. Concepciones y actitudes sociales hacia la violencia

2. Concepciones y actitudes sociales hacia los roles de

género

4. Generación de expectativas de comportamiento propio y ajeno:

Ej. “Yo soy quien lleva los pantalones y quiero que la cena esté hecha cuando llegue a casa”.

Ej. “Si me impongo de forma agresiva se me hará caso y se me tomará más en serio ”.

5. Deseos frustrados

6. Intolerancia la frustración7. Falta de habilidades de

comunicación y solución de problemas.

9. Estados y procesos psicopatológicos:

- Paranoidismo- Manía/ Depresión- Trastorno de personalidad

8. Agresividad/Estado emocional de IRA

3. Aprendizaje escolar, familiar, medios de

comunicación

15. SISTEMA DE FILTRO Y CONTROL DE LA AGRESIVIDAD

16. Deslegitimación cognitivo-moral de

la violencia

18. Consideración de las

consecuencias para el propio

agresor

19. - Respuesta esperada de la víctima (vulnerabilidad percibida)

- Respuesta social e institucional esperada (tolerancia o sanción)

17. Consideración afectiva de las consecuencias para el otro y

terceros (influenciable por evaluación negativa de la

víctima)

20. VIOLENCIA21. Mecanismos de autojustificación y

legitimación a posteriori

22. Obtención de objetivos del agresor

(satisfacción del deseo, poder)

24. Mantenimiento

23. - Legitimación cultural e institucional de la violencia.- Impunidad de los perpetradores.

10. Consumo crónico intenso y/o dependencia

del alcohol

11. Agrava trastornos

mentales previos:(Ver casilla nº 9 del esquema)

12. Provoca trastornos mentales por abuso de

alcohol:- Trastorno psicótico / Celotipia/ Paranoidismo- Trastorno afectivo (Reacción maníaca o depresiva)- Delirium Tremens

13. Consumo puntual de

alcohol suficientemente

intenso

14. Afecta e incluso anula el sistema de filtro y control de la agresividad

Basics about the MALVA PROJECT

It aims to prevent violence against intimate partner linked to alcohol (and other drugs) abuse. Its name is an acronym for

“Machismo plus ALcohol, Violence Assured”, but besides this, the Malva / mallow flower was considered a symbol for female submission, and violet is also the colour symbolizing fight for women’s rights.

The MALVA team is made out of experts in addictions, in domestic violence and in the mass-media.

Their actions are developed in three regions: Madrid, Valencian Community and Catalonia.

It was originally started with support of the European Commission, DAPHNE programme, with a German partner NGO (IFT-Nord, Kiel). Today it runs thanks to the Ministry of Health of Spain (National Plan on Drugs), The autonomous Governments of Catalonia, the Valencian Community and the Anti-drug Agency of Madrid.

MALVA Objectives: Primary prevention

1. Contributing to avoid, even for the first time, episodes of violence against the intimate partner (usually the woman). That is: helping to avoid / identify / manage aggressiveness before it leads to aggression.

- Information and awareness-raising of the general population through the Mass Media.

- Information and awareness-raising aimed to potential victims and aggressors about processes leading to violent behaviour, with especial relevance to the involvement of alcohol.

- Information to the main target groups about the available resources for support and counselling about alcohol abuse and/or violence.

- Awareness raising to professionals from different fields (health services, social services, justice, education…) about strategies of prevention of family violence associated to alcohol abuse.

MALVA Objectives: Early detection

2. Early detection of the already existing violence cases in an early and moderate stage, trying to avoid its consolidation.

-Educate and train the various professional groups in the detection of cases, patterns of action and strategies for prevention of family violence associated with alcohol abuse

-Improve the responsiveness on detection situations, contributing to the unification of criteria between specialized services.

-Help the people involved in a violent relationship (aggressor, victim, surrounding others) to early identify it and to behave efficiently to stop the process, when related to the alcohol abuse.

  

MALVA Objectives: Harm Reduction

3. Contribute to reduce the intensity of the violence in the most difficult-to-solve cases, furnishing to the victims tools and ideas to reduce the negative impact of the situation they go through, provided this is not possible yet to change it in a more substantial way.

- Furnishing the victims with some tools (patterns of behaviour to follow and resources) to reduce the harm associated to family violence.

- Facilitating to the relevant professionals tools and procedures to provide the support the victims do require.

Working areas of the project:1. Continued theoretical analysis on the relationship between domestic

violence and alcohol (and other drugs) abuse.

2. Awareness-raising and training professionals related with this type of violence, i.e., health, social services, justice, police…

3. Workshops with adolescents (in high schools).

4. Training to selected university students.

5. Workshops with women at risk of social exclusion.

6. Awareness raising, dissemination of early detection and intervention messages through the mass media.

7. Information and awareness-raising for the general population about the link between alcohol abuse and domestic violence, and how to avoid both (distribution of leaflets, posters…). Self-detection tests and advice in our website.

Monography: “Abuso de alcohol y violencia doméstica”

Training professionals:

-Training workshops

-Online training (www.fsyc.org/malva)

-Distribution of guidelines for action

-Cooperation in University Master Degrees on addictions and on domestic violence, where lessons about this interaction are included.

Guidelines for professionals

Some actions through the Media

- Informing about the MALVA project and its development.

- Publishing Press releases, opinion articles, human stories with good examples or ideas…

-Giving advice to the screenwriters of TV series to depict this phenomenon (e.g., “Hospital Central”, audience beyond 5.000.000 people)

-Following-up of the published news about domestic violence, trying to highlight the relationship with alcohol abuse, often hidden or distorted.

Some publications at the Media

News and opinion articles

Materials for prevention (adults)

Self-detection test in the web site