Alcohol Use and Predictors of Intimate

Partner Violence: A framework for

understanding moderation in the alcohol-

aggression relationship. Addressing intimate partner violence among substance

misusers: advancing aetiologies and treatment approaches

Conference sponsored by the Economic and Social

Research Council. Rochester, New York

July 21, 2014

Kenneth Leonard

Research Institute on Addictions and

The Department of Psychiatry

University of Buffalo

Goals of this talk

• Review key aspects of alcohol-violence

relationship.

• Discuss the challenges of studying moderation

Key aspects of the alcohol/

domestic violence relationship. • The relationship between excessive alcohol use and

domestic violence

– has been observed in many different cultural

contexts

Netzahualcoyotl of Texcoco

• “It [alcohol] is like a tornado

that destroys everything in its

path. It is like a hellish

tempest that brings with it all

evils. Drunkenness … causes

violence among kinfolks.

Yelling and brawls are

caused by octli and its

accompanying drunkenness (Soustelle, 1955 cited in Paredes, 1975

Countries with at least one controlled study finding an association

between partner drinking and domestic violence

Key aspects of the alcohol/

domestic violence relationship. • The relationship between excessive alcohol use and

domestic violence

– has been observed in many different cultural

contexts

– has been found across many different kinds of

samples

Samples / representative studies supporting alcohol/ domestic

Violence association.

• Alcoholic/substance abuse samples

– O’Farrell, T.J., Fals-Stewart, W., Murphy, M., & Murphy, C.M.

(2003). Journal of Consulting & Clinical Psychology, 71, 92-102.

• Batterers

– Stuart, G.L . , Meehan, J.C., Moore, T.M., Morean, M. ,Hellmuth, J.,

& Follansbee., K. Journal of Studies on Alcohol. Jan 2006 v67 i1

p102(11).

• Emergency Room

– Kyriacou, D.N., McCabe, F., Anglin, D., Lapesarde, K., & Winer,

M.R. (1998). Annals of Emergency Medicine, 31, 502-506.

Samples / representative studies supporting alcohol/ domestic

Violence association.

• Prenatal and Antenatal Clinics

– Muhajarine, N., & D’Arcy, C. (1999). Canadian Medical Association

Journal, 160, 1007-1011.

• Primary Care Settings

– Coker, A.L., Smith, P.H., McKeown, R.E., & King, M.J. (2000).

American Journal of Public Health, 90, 553-559.

• Community and representative samples

– Kaufman Kantor, G., & Straus, M.A. (1990).. In M.A. Straus & R.J.

Gelles (Eds.), Physical violence in American families: Risk factors and

adaptations to violence in 8,145 families (pp. 203-224). New

Brunswick, NJ: Transaction Publishers.

– Arseneault, L., Moffitt, T.E., Caspi, A., Taylor, P.J., & Silva, P.A.

(2000). Archives of General Psychiatry, 57, 979-986.

Key aspects of the alcohol/

domestic violence relationship. • The relationship between excessive alcohol use and

domestic violence

– has been observed in many different cultural

contexts

– has been found across many different kinds of

samples

– represents an association of at least moderate

strength

Meta-analyses across cross-sectional studies

show that the relationship largely consistent.

Lipsey, Wilson, Cohen, and Derzon (1997)

N=67 N=29 N=34

Strength of cross-sectional associations

• Lipsey,Wilson, Cohen, and Derzon 1997

– 34 studies of domestic violence including child abuse

– Effect size .22

• Stith, Smith, Penn, Ward, & Tritt, 2004

– 22 studies of partner violence and alcohol use

– Effect size .24

• Foran and O’Leary, 2008

– 50 studies of partner violence and alcohol

– Effect size .23

Key aspects of the alcohol/

domestic violence relationship. • The relationship between excessive alcohol use and

domestic violence

– has been observed in many different cultural

contexts

– has been found across many different kinds of

samples

– represents an association of at least moderate

strength

– the acute effects of alcohol contribute to the

violence, even in chronic heavy drinker

Husband and wife alcohol use in conflict

episodes

Husband alcohol use Wife alcohol use Leonard, K.E., & Quigley, B.M. (1999). Drinking and marital aggression in newlyweds: An event-based analysis of

drinking and the occurrence of husband marital aggression. Journal of Studies on Alcohol, 60(4), 537-545. Reproduced

with permission of the publisher

Comparing conflict episodes with and

without violence

0

0.02

0.04

0.06

0.08

0.1

0.12

0.14

0.16

0.18

0.2

absent present

HBAC

WBAC

0

0.02

0.04

0.06

0.08

0.1

0.12

0.14

0.16

absent present

HBAC

WBAC

Murphy, C.M., Winters, J., O’Farrell, T.J., Fals-Stewart, W., & Murphy, M. (2005).

Psychology of Addictive Behaviors, 19(1), 35-42. . Published by the American

Psychological Association and adapted with permission.

Alcohol involvement in Police-Citizen

Encounters

Crime Type Percent Alcohol

involved

Odds Ratio N

Violent crime/sexual assault 43.3 2.5 250

Spousal Assault 43.4 2.5 103

Robbery 39.1 2.1 ns 36

Public order, vandalism 46.1 2.8 250

Nonviolent crimes 23.4 597

McClelland & Teplin, Alcohol intoxication and violent crime: Implications for public health policy

The American journal on addictions, 10 (supplement), 70-85, 2001

Experimental Studies of Alcohol and

Physical Aggression

• General Methodological Approach

– Random Assignment to alcohol versus control,

which is sometimes no alcohol, sometimes

placebo, sometimes both.

– Experimental Context is which mild aggressive

behavior (usually shock or noise) is enabled.

– Often the context includes manipulation of other

variables.

Meta-analyses of Experimental Studies of Alcohol and

Physical Aggression

Ito, Miller, & Pollock, 1996

Bushman, 1997

Effect sizes compared to no alcohol control

Alc. w/out aware -0.01

Placebo 0.1

Alcohol 0.43

Effect sizes of different alcohol levels

compared to no alcohol controls.

Low BAC .35

High BAC .53

Experimental Studies of Alcohol and

Aversive Verbal Behavior

• Seen as more ecologically valid than other

aggression paradigms

– Less artificial than reaction time or teacher learner.

– Verbal aggression more natural response than

setting shock

– Links between verbal aggression and physical

aggression

– Primarily has been used in studies of intimate

partners.

*

Negativity as a function of alcohol

condition and time Husband Wife

Leonard, K.E., & Roberts, L.J. (1998). The effects of alcohol on the marital interactions of aggressive

and nonaggressive husbands and their wives. Journal of Abnormal Psychology, 107(4), 602-615. .

Published by the American Psychological Association and adapted with permission.

Key aspects of the alcohol/

domestic violence relationship. • Alcohol does not increase violence for everyone,

there are numerous factors that moderate the

relationship.

Challenges to understanding moderation

• Virtually unlimited number of moderators

Moderators of the alcohol/violence

relationship

• Hostility (Leonard & Blane, 1992)

• Marital satisfaction (Leonard & Blane, 1992)

• Verbal aggression (Quigley and Leonard,1999 )

• Life stress (Margolin, John ,& Foo,1998)

• Negative affect (Leonard & Blane, 1992)

• Social Support (Caldeira and Woodin, 2012)

• Mindfulness (Gallagher, Hudepohl, & Parrott, 2010)

• Cognitive Reappraisal Ability (Stappenback & Fromme, 2013)

• Locus of Control (Gallagher & Parrott, 2010)

• Jealousy (Foran & O’Leary, 2008)

• Impulse Control (Watkins, Maldonado, & DiLillo 2014)

• Trait Displaced Aggression (Denson, White, & Warburton, 2009)

Alcohol, Hostility, and Escape Coping

Schumacher, Homish, Leonard, Quigley & Kearns-Bodkin , Longitudinal Moderators of the Relationship Between Excessive

Drinking and Intimate Partner Violence in the Early Years of Marriage, Journal of Family Psychology

2008, Vol. 22, No. 6, 894–904. Published by the American Psychological Association and adapted with permission

Low hostility High hostility

Alcohol should be most strongly associated with aggression when

there are strong aggression facilitating and weak inhibitory

factors.

Parrot and Giancola (2004) conducted an experimental study

and found that alcohol led to the largest increase in aggression

relative to placebo for participants who were high in trait

anger and low in anger control.

Interaction of husband alcohol use and husband executive

cognitive functioning predicting husband ->wife aggression

Interaction of male alcohol use and executive cognitive

functioning predicting shock settings.

Giancola, PR (2004) Executive functioning and alcohol-related aggression. Journal of Abnormal

Psychology, 114(4), 541-555. Published by the American Psychological Association and adapted

with permission.

Interaction of husband alcohol use and husband perceived

emotional support predicting husband ->wife aggression

Caldeira and Woodin, (2012) found that high alcohol use

was associated with husband to wife aggression only among

those in low perceived emotional support.

Alcohol should be most strongly associated with aggression when

there are strong aggression facilitating and weak inhibitory

factors.

Low provocation High Provocation

Challenges to understanding moderation

• Virtually unlimited number of moderators

• The potential for interactions to involve two or

more moderators.

Prediction of Marital Aggression from Marital

Satisfaction, Hostility, and Alcohol Dependence scores

0

0.1

0.2

0.3

0.4

0.5

0.6

Low ADS High ADS

L MS

H MS

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

Low ADS High ADS

L MS

H MS

Leonard, K.E., & Blane, H.T. (1992). Alcohol and marital aggression in a national sample of

young men. Journal of Interpersonal Violence, 7(1), 19-30.

Low Hostility High Hostility

Challenges to understanding moderation

• Virtually unlimited number of moderators

• The potential for interactions to involve two or

more moderators.

• Counterintuitive findings

Low Alc Problems High Alc Problems

Current alcohol problems

1

1.5

2

2.5

3

3.5

4

Pa

role

e t

o S

po

us

e V

iole

nc

e Low Criminal Violence

High Criminal Violence

Parolee to spouse violence by Parolee to spouse violence by self reported criminal violence self reported criminal violence and current alcohol problemsand current alcohol problems

Blane, Miller, Leonard, Nochajski,

Bowers, & Gondoli, 1988

Interaction of Jealousy and Anger Control

Foran & O’Leary (2008)

Males with high jealousy and problems with anger

control were aggressive irrespective of alcohol use.

Males who were low in jealousy were low in

aggression irrespective of alcohol use.

Males who were jealous, but who had good anger

control, were more aggressive if they were also

problem drinkers.

Addressing these challenges

• A consideration of outcomes, occurrence vs

severity vs frequency.

Husband and Wife Alcohol Dependence scores as

predictors of occurrence vs frequency of H->W violence

Probability of Occurrence Frequency

Testa, M., Kubiak, A., Quigley, B.M., Houston, R.J., Derrick J.L., Levitt, A., Homish, G.G., & Leonard, K.E. (2012). Husband and wife alcohol use as

independent or interactive predictors of intimate partner violence. Journal of Studies on Alcohol and Drugs, 73(2), 268-276.

Addressing these challenges

• A consideration of outcomes, occurrence vs

severity vs frequency.

• A consideration of cognitive neuroscience

observations into our approaches.

Threat sensitivity

(Amygdala)

Poor Decision making

Poor Inhibitory control

(PFC)

Empathy Attachment

(Amygdala) Instrumental

aggression

Under-regulated

response to social

provocation

Threat-based

reactive aggression

Conceptual linkage between cognitive processes and violence

Blair, R. J. R. (2013). The neurobiology of psychopathic traits in youths. Nature Reviews:Neuroscience, 786-799.

Published by Macmillan Publishers Limited

Threat sensitivity

(Amygdala)

Poor Decision making

Poor Inhibitory control

(PFC)

Empathy Attachment

(Amygdala)

Some moderators are directly related to these systems, others are

combinations of these systems, others may be outgrowths of

these systems

Marital satisfaction

History of Aggression

Threat sensitivity

(Amygdala)

Poor Decision making

Poor Inhibitory control

(PFC)

Empathy Attachment

(Amygdala)

Some moderators are directly related to these systems, others are

combinations of these systems, others may be outgrowths of

these systems

(Blair, 2013)

Angry expression

Emotion Regulation

Threat sensitivity

(Amygdala)

Poor Decision making

Poor Inhibitory control

(PFC)

Empathy Attachment

(Amygdala)

Some moderators are directly related to these systems, others are

combinations of these systems, others may be outgrowths of

these systems

Social support

Addressing these challenges

• A consideration of outcomes, occurrence vs

severity vs frequency.

• A consideration of cognitive neuroscience

observations into our approaches.

• A consideration of dyadic factors

Interaction of wife alcohol use and husband negative affect

predicting husband ->wife aggression

Addressing these challenges

• A consideration of outcomes, occurrence vs

severity vs frequency.

• A consideration of cognitive neuroscience

observations into our approaches.

• A consideration of dyadic factors

• A consideration of the total load of instigatory

and inhibitory factors

Multiple Thresholds Model

• Aggression occurs as a function of external provocations, aggressive

motivations, and inhibitory processes.

• Provocation increases aggressive motivations and decreases aggressive

inhibitions.

• The model assumes IPV occurs when an individual’s aggression threshold

is exceeded; that is, when the strength of the aggressive motivations

exceeds the strength of the inhibitions.

• There may be multiple thresholds, e.g. moderate and severe aggression,

or a threshold and then a linear effect.

• Intoxication is hypothesized to lower these aggression thresholds by

impairing inhibitions through its effect on cognitive functioning

One unit provocation

Aggression Curve For Individuals with Weak

Aggressive Motivations and Strong Aggressive Inhibitions

Aggressive Motivations Aggressive Inhibitions

Aggressive

threshold

Provocation

Two unit provocation

Inhibition reduced

by drinking

One unit provocation

Aggression Curve For Individuals with Moderate

Aggressive Motivations and Moderate Inhibitions

Aggressive Motivations Aggressive Inhibitions

Aggressive

threshold

Provocation

Two unit provocation

Inhibition reduced

by drinking

One unit provocation

Aggression Curve For Individuals with Strong

Aggressive Motivations and Low Inhibitions

Aggressive Motivations

Aggressive Inhibitions

Aggressive

threshold

Provocation

Two unit provocation

Inhibition reduced

by drinking

One unit provocation

Aggression Curve For Individuals with Strong

Aggressive Motivations and Low Inhibitions for Severe Violence

Aggressive Motivations

Aggressive Inhibitions

Aggressive

threshold

Provocation

Two unit provocation

Inhibition reduced

by drinking

Clinical implications