Substance use is a significant public health problem with an estimated 14 million Americans (approximately 6% of the U.S. population) currently using illicit substances. Marijuana is the most widely used illicit drug in the United States with over 72 million Americans estimated to have tried marijuana at least once; however, 41% of current illicit substance users, or 5.7 million Americans, use illicit drugs other than marijuana. Substance use has been linked to negative physical and mental health outcomes, such as cognitive deficits, paranoid feelings, delirium, depression, and suicide. Substance use has also been associated with psychosocial problems such as employment difficulties and relationship problems. In addition, substance abuse is overrepresented in samples with a history of interpersonal violence.
Theories of the Relationship between Substance Abuse and Interpersonal Violence
Several theoretical models have been advanced to account for the relationship between substance use and interpersonal violence. For example, the tripartite conceptual framework posited three possible links between substance use and violence. The first stems from psychopharmacological effects of drugs, which may contribute to impairment in cognitive abilities and increased arousal and irrational behavior (e.g., violence). This framework is conceptually similar to the proximal effects model and the psychopharmacological model, both of which suggest that violence results from the acute and chronic effects of intoxication. Physiologic effects of drugs are thought to increase the likelihood of violence by inhibiting anxieties regarding perceived punishment. It has also been hypothesized that drugs may increase sensitivity to pain, resulting in an increased risk of reactive aggression. Additionally, drugs may interact with several neurotransmitter systems, including dopamine, serotonin, and gamma-amino butyric acid, but the precise interactions are unknown.
The second component of the tripartite framework involves the hypothesis that violence occurs in the context of criminal behavior, such as in the procurement of drugs for economic gain or to support a drug habit (also described as an economic motivation model). The third component suggests that violence occurs within the broader system of substance use (e.g., fights over failing to pay debts) and that violence may be used to uphold rules associated with the drug market. These latter components may also be helpful in explaining intimate partner violence. For example, trying to obtain drugs (e.g., forcing a partner to obtain drugs) and supporting a drug habit (e.g., stealing money from a partner to pay for drugs, leading to financial difficulties) could place intimate partners at risk for aggression.
Another theoretical model used to explain the relationship between substance use and violence is general deviance theory. This theory hypothesizes that substance use may not cause violence and that violence may not lead to substance use, but rather individuals more apt to be involved in one type of deviant behavior are also at risk for other types of deviant behavior. This theory is consistent with the spurious model, which proposes that violent behavior and substance use are not causally linked but, rather, both are by-products of a common third variable, such as antisocial personality disorder or child abuse victimization. Thus, violence and substance use may be viewed as deviant behaviors within the spectrum of a general deviance syndrome. An advantage of this theory is the emphasis placed on the role of environmental influences in the onset of both behaviors. For example, it is possible that cultural norms may support both violence and substance use as evidence or proof of masculinity, which may inadvertently increase the strength of the relationship between aggression and substance use.
Finally, the biopsychosocial model posits that distal influences (e.g., childhood abuse, family history of substance abuse, norms regarding aggression, psychopathology) in conjunction with proximal factors (e.g., acute intoxication, impulsivity, the milieu of the current situation) increase the risk for violence in the context of conflictual interactions. It has been suggested that distal factors may exert their effects on proximal variables and vice versa, ultimately leading to violence. The biopsychosocial model is a relatively broad model that incorporates components of numerous related theories. The etiology of violence and substance abuse are multifactorial, and no singular theory is likely to explain the relationship between all forms of aggression and substance abuse.
Empirical Data Regarding the Relationship between Substance Abuse and General Violence
Although most substance use occurs among people who are nonviolent, there is substantial evidence that substance abuse is overrepresented in violent populations and vice versa. For example, one study found that the prevalence of violence in people diagnosed with substance abuse was 16 times that of people with no diagnosis. Similarly, violent individuals typically meet the diagnostic criteria for one or more substance use disorders. In fact, the majority of arrested violent offenders have a history of regular substance use, with many testing positive for an illicit substance following the violent incident. Drug-abusing criminals have been shown to commit more crimes against other people directly, such as robberies and assaults, than nondrug-using criminals.
Much of the research on the association between violence and illicit substance use has grouped all illicit substances together. Thus, relatively little is known about the relationship between violence and specific substances. Although few empirical studies exist and a direct link has yet to be unequivocally established, amphetamine-methamphetamine and cocaine use are frequently implicated as being related to violent behavior. Across multiple studies, 24% to 54% of methamphetamine users reported committing a violent act due to their substance use. Similarly, cocaine users (especially crack cocaine users) often report an increase in anger, irritability, and violent behavior shortly after using. It should be noted that chronic methamphetamine use and high doses of cocaine seem to be especially associated with violence. Marijuana, another commonly studied substance, is generally found to be unrelated or to have a negative relationship to general violence. However, some animal and human studies have revealed an association between small doses of marijuana and aggression.
Empirical Data Regarding the Relationship between Substance Abuse and Intimate Partner Violence
Substance abuse is strongly related to both perpetration and victimization in intimate partner violence (IPV). One analysis of battered women revealed that, across four studies examining the prevalence of drug abuse or dependence, battered women were over 5 times more likely to report drug abuse or dependence compared to nationally representative samples. Of course, these data do not imply that battered women are to blame for their victimization, but they do suggest that substance use may be a consequence of IPV victimization or that it interferes with the ability to avoid or escape a dangerous partner. Several studies have documented a strong relationship between illicit drug use and IPV, particularly among male perpetrators, even after controlling for antisocial personality and alcohol use. Reviews of five studies examining the association between men’s substance use and male-to-female IPV found moderately large effect sizes, all in the direction of increased drug use being associated with greater risk of IPV.
As with general violence, relatively few studies have been conducted on the relationship between IPV and specific illicit drugs. Research on marijuana use and IPV shows a strong positive association within cross-sectional and longitudinal survey studies among intimate partners. Similarly, the majority of studies on cocaine use and IPV have found a strong positive relationship for perpetration and victimization of IPV in both genders. When examining the temporal relationship between cocaine use and IPV, one researcher found the likelihood of male-to-female IPV to be 3 times greater on a day when the male partner used cocaine compared to a nonuse day, after controlling for antisocial personality and relationship discord. Other studies have shown that combinations of alcohol and drugs, especially cocaine, may be particularly related to IPV.
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