Alcohol-Related Violence

Prevention and Treatment

Mary McMurran, Mary McMurran

• Publisher: Wiley-Blackwell
• Year: 2012
• ISBN:
  9781118411070
• Edition: 1
• Topic: Psychologie
• Subtopic: Psychologie légale

New in the Wiley Series in Forensic Clinical Psychology, Alcohol-Related Violence: Prevention and Treatment presents an authoritative collection of the most recent assessment and treatment strategies for alcohol-related aggression and violence.

• Features contributions from leading international academics and practitioners
• Offers invaluable guidance for practitioners regarding intervention to reduce alcohol-related aggression and violence
• Describes evidence-based interventions at a number of levels, including populations, bar room, families, couples, and individuals

PART I
THE EXTENT OF THE PROBLEM

Chapter 1

THE PROBLEM OF ALCOHOL-RELATED VIOLENCE: AN EPIDEMIOLOGICAL AND PUBLIC HEALTH PERSPECTIVE

INGEBORG ROSSOW AND ELIN K. BYE

SIRUS, the Norwegian Institute for Alcohol and Drug Research, Oslo, Norway

INTRODUCTION

An Epidemiological and Public Health Perspective

Violence constitutes a significant health problem globally (Krug et al., 2002). It is widely recognized that alcohol consumption is a significant risk factor for violent perpetration and violence victimization (Abbey, 2011; Chermack and Giancola, 1997; Leonard, 2008; Lipsey et al., 1997; Roizen, 1997). We will in this chapter present an overview of research evidence on how and to what extent alcohol consumption is related to violence within an epidemiological and public health perspective. More specifically, we will show that alcohol use is a common ingredient in violent acts, that the risk of being involved in a violent act is higher among those who consume alcohol frequently and in large quantities, that the amount of violent acts in a society varies systematically with the overall alcohol consumption in that population and with the drinking pattern in that population.

Defining the Problem

What do we mean by ‘violence’? While self-inflicted injuries and collective violence (e.g., riots or acts of war) are often included in the term violence (Krug et al., 2002), we have limited the focus here to that of interpersonal violence. According to the World Health Organization, interpersonal violence can be divided into the following subcategories: family and intimate partner violence (between family members and intimate partners, usually taking place in the home) and community violence (between individuals who are unrelated and who may or may not know each other, generally taking place outside the home) (Krug et al., 2002). These subcategories are again divided by the nature of violent acts: physical, sexual, psychological and involving deprivation or neglect. We will in this review address only the former two (physical and sexual violence) in relation to alcohol use.

This leads us to the question of what we mean by alcohol use in relation violence. The term ‘alcohol use’ covers a wide range of behaviours and is assessed by different types of measures across studies. Examples of the latter are presence of alcohol at the time of the event as measured by breathalyzer or blood sample analysis; self-report in surveys or clinical interviews; assessment of alcohol intoxication by health personnel, police officers and so on; and aggregate measures of alcohol consumption such as sales figures. The various types of behaviour comprise, for instance, any drinking in the few hours prior to the violent event; annual alcohol consumption; frequency of intoxication; and indicators of alcohol dependence or abuse.

Alcohol-related violence is not only a problem for those who suffer violent injuries in terms of health and economic costs, but it has also a wide range of consequences at the societal level, for instance, in terms of its burden on health services, police forces and economic costs to society, and by generating fear and insecurity in the family, neighbourhood and community. While these consequences of alcohol-related violence are indeed part of the problem, a societal analysis is beyond the scope of this review.

THE EVIDENCE OF AN ASSOCIATION BETWEEN ALCOHOL CONSUMPTION AND INTERPERSONAL VIOLENCE

The scientific literature on the alcohol–violence association is overwhelming. A quick search in various literature databases reveals thousands of publications that – based on the title only – address this topic. We will therefore provide a review partly drawing on previous, preferably recent, review studies but also refer to primary studies, when no fairly recent reviews are available or when primary studies add to previous reviews. Given the epidemiological and public health perspective, the literature review mainly covers studies that refer to the general population and that are of relevance to public health strategies.

Numerous studies have demonstrated some kind of statistical association between alcohol consumption and interpersonal violence. These studies have addressed the association between alcohol consumption and interpersonal violence in various ways by examining different aspects of the association and by applying different types of research designs and methods and different types of data. For instance, Roizen (1997) distinguished between event-based research, that is, samples of people to whom a serious event has occurred, and studies of the general population. We have in the following sections briefly summarized broad categories of studies that have demonstrated some kind of association between alcohol consumption and violence.

Those Involved in Violence Have Often Been Drinking

There is a large research literature from event-based research which has demonstrated that alcohol often has been consumed by one or more of those involved in a violent act. Studies of perpetrators of violent crimes (suspected, arrested or convicted) have revealed that these offenders had often consumed alcohol shortly before the violent act (Chermack and Giancola, 1997; Graham et al., 1998; Pernanen, 1991; Roizen, 1997). Yet, it should be noted that the proportion of offenders with alcohol present at the time of the event varies significantly across studies, from around 15% to some 60–85% of offenders (see Roizen, 1997 for a review). Correspondingly, studies of victims of violence have also shown that these had often been drinking prior to the violent act and, yet again, that the proportion of victims that had been drinking varies across studies, ranging from 5% to 85% (Roizen, 1997). The research literature that addresses domestic violence and intimate partner violence specifically has shown that partner-violent men are often heavy drinkers and heavy drinking often accompanies the violence (Leonard, 2001, 2005; Lipsey et al., 1997). Correspondingly, reviews of the literature on alcohol consumption and sexual violence also show that in about half of all sexual assaults, alcohol had been consumed by the victim, the perpetrator or both (Abbey, 2011; Abbey et al., 2004).

A significant part of the event-based research comprises studies of patients admitted to emergency rooms after injuries from violent acts. These have shown that these patients often have a blood alcohol concentration (BAC) above 0.05%, 0.08% or 0.10% (as measured in blood or breath) and/or they often report that they consumed alcohol within 6 hours prior to the injury (Cherpitel, 1997, 2007). Again, the prevalence of alcohol involvement in violent injuries varies significantly across studies, ranging between 22% and 84% in Cherpitel’s recent review (2007). It is also evident from these studies that alcohol involvement occurs more frequently among patients with violence-related injury compared with other injured patients in the emergency room (Cherpitel, 2007).

Whether alcohol involvement varies by type and severity of the violent act has been addressed in some studies. Felson, Burchfield, and Teasdale (2007) noted that, as most research on alcohol and violence focuses on specific types of violence or examines violence generally, there is little evidence on whether alcohol intoxication is a greater risk factor for some types of violence than for others. In their study from a general population survey, perpetrators of physical assaults were just as likely as those of sexual assaults to have been intoxicated (Felson et al., 2007). Correspondingly, in a large population-based survey in New Zealand, self-reported events of physical assaults and sexual assaults were compared with respect to the role of alcohol, and for both types of assaults, a little more than half of the victims reported that the perpetrator was affected by alcohol (Connor, You, and Casswell, 2009).

Several studies have, in various ways, addressed whether alcohol involvement varies with the severity of aggressive behaviour. In his classic study, Pernanen (1991) found no increase in the severity of violence when the assailants had been drinking. However, Leonard and colleagues found that a higher level of alcohol consumption was associated with more severe aggression among males (Leonard, Collins, and Quigley, 2003), and similarly, Graham and co-workers found that greater intoxication of those involved in aggressive incidents was related to greater severity of aggression (Graham et al., 2006). In a recent study, Wells and co-workers also found that drinking at the time may contribute to severity of aggression (Wells et al., 2011).

Whereas alcohol involvement in the perpetrator and/or the victim is extensively studied, there are also a few studies that have addressed the role of alcohol in the drinking environment and among bystanders. These studies suggest that the overall level of intoxication of patrons in drinking establishments independently contributes to the frequency and severity of aggression by patrons (Graham and Homel, 2008).

Violence Is More Likely at Times and Places with Heavy Drinking

The distribution of violent events over days of the week and hours of the day tends to display a similar pattern to that of drinking occasions, and, in particular, heavy drinking occasions. Thus, violent events are more likely to occur at nighttime on weekends (Borges, Cherpitel, and Rosovsky, 1998; Briscoe and Donnell, 2003; Engeland and Kopjar, 2000; Pridemore, 2004) as are heavy drinking occasions (Demers, 1997; Mäkelä, Martikainen, and Nihtilä, 2005; Pridemore, 2004). In a similar vein, it is also shown that bars, pubs and clubs, which are often attended by heavy drinkers, are ‘hot spots’ for violent events (Graham and Homel, 2008).

Those Who Drink Heavily Are at Higher Risk of Being Involved in Violence

Another type of study is surveys of general population samples in which respondents have been asked about their behaviour (for instance, in the past 12 months) and whether they have been involved in violent behaviour. These studies have generally shown that those who report a relatively high alcohol intake and/or frequent heavy drinking occasions are more likely to have been involved in violent acts (Rossow, 1996, 2000; Wells and Graham, 2003; Wells et al., 2005), and it seems that it is, in particular, heavy drinking occasions that account for this association (Bye and Rossow, 2010; Dawson, 1997; Hope and Mongan, 2011; Leonard, 2008; Room and Rossow, 2001; Rossow, 1996; Rossow, Pape, and Wichstrøm, 1999). Thus, with increasing alcohol consumption, and particularly with increasing frequency of heavy drinking occasions, the risk of committing a violent act increases as does the risk of being a victim of violent assault. This has been shown with respect to physical violence, irrespective of subcategory (Room and Rossow, 2001), and with respect to domestic violence and intimate partner violence (Foran and O’Leary, 2008; Leonard, 2001). In a longitudinal cohort study, Boden and co-workers found that young adults with alcohol abuse/dependence symptoms had 4–12 times higher risk than others to be involved in violence, whether as offender or as victim (Boden, Fergusson, and Horwood, 2012). Also, studies of clinical population samples have shown that the prevalence of violence perpetration and victimization is elevated among heavy drinkers (Leonard, 2008).

Heaviest Drinkers Account for a Minor Fraction of Alcohol-Related Violence

Although the risk of violence involvement is highest among those with high consumption and heavy drinking frequency, it should also be noted that these drinkers constitute a relatively small fraction of all drinkers at risk. Thus, the heaviest drinkers in a population contribute to a disproportionately larger fraction of the overall amount of violence. Yet, studies have demonstrated that their share of all violent incidents is less than half and – more or less – it is the moderate drinkers, who constitute the vast majority of all drinkers, who also contribute to the majority of all alcohol-related violence (Poikolainen, Paljärvi, and Mäkelä, 2007; Rossow and Romelsjö, 2006). More specifically, Rossow and Romelsjö (2006) found that, of all self-reported events of alcohol-related quarrels and fights, less than half could be attributed to the 10% of the drinkers who drank the most. Moreover, of all hospital admissions for violent injuries (whether alcohol-related or not), 14% could be attributed to the upper 10% of the drinkers. Correspondingly, Poikolainen and co-workers (2007) found that 25% of all self-reported events of quarrels and arguments and 31% of all scuffles and fights could be ascribed to the upper 10% of the drinkers.

This implies that, from a public health perspective, preventive strategies directed at all drinkers (i.e., population strategies) may be more effective in reducing the overall amount of violent events in a population rather than strategies aimed at the small fraction of heavy drinkers (high-risk strategies). This is what is often referred to as the prevention paradox (Kreitman, 1986; Rossow and Romelsjö, 2006; Skog, 1999).

ACTORS, CONTEXT AND CULTURE

While it is clear that a signific...