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Women's substance use and experiences of intimate partner violence: A longitudinal investigation among a community sample
Addictive Behaviors 28 (2003) 1649 – 1664
Women’s substance use and experiences of intimate partner violence: A longitudinal investigation among a community sample Maria Testa*, Jennifer A. Livingston, Kenneth E. Leonard Research Institute on Addictions, University at Buffalo, State University of New York, 1021 Main Street, Buffalo, NY 14203, USA
Abstract Although cross-sectional studies reveal an association between women’s substance use and experiencing physical violence from one’s intimate partner, the temporal ordering of these variables is not clearly established. The current study involved longitudinal examination of the association of women’s substance use with subsequent experiences of intimate partner violence as well as the association between women’s experiences of intimate partner violence and their subsequent substance use. Women ages 18 – 30 who were in heterosexual relationships (n = 724) were recruited through random digit dialing in the Buffalo, NY, area. Within ongoing relationships, women’s use of hard drugs was associated with increased odds of experiencing intimate partner violence over the next 12 months. Both marijuana and hard drug use were associated with increased likelihood of experiencing violence in new relationships. Women’s heavy episodic drinking did not predict subsequent experiences of partner violence in ongoing or new relationships. Experiences of intimate partner violence had a significant effect on subsequent relationship satisfaction, which was modestly associated with subsequent heavy episodic drinking but not with subsequent drug use. D 2003 Elsevier Ltd. All rights reserved. Keywords: Alcohol drinking patterns; Drugs; Partner abuse; Family violence; Victimization
1. Introduction The association between substance use and intimate partner violence (IPV) has long been recognized. The bulk of literature addressing this association has focused on the link between * Corresponding author. Tel.: +1-716-887-2560; fax: +1-716-887-2215. E-mail address: [email protected] (M. Testa). 0306-4603/$ – see front matter D 2003 Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2003.08.040
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substance use and perpetration of partner violence, primarily by men toward their female partners (for reviews, see Lipsey, Wilson, Cohen, & Derzon, 1997; Schumacher, FeldbauKohn, Slep, & Heyman, 2001). However, there is also some evidence that women who report higher levels of substance use or abuse are more likely to report experiencing IPV. For example, among adolescent girls, substance use is associated with experiencing dating violence (Malik, Sorenson, & Aneshensel, 1997; Silverman, Raj, Mucci, & Hathaway, 2001). Studies of married and cohabitating couples reveal similar findings. Using data from the 1985 National Family Violence Survey, Kantor and Straus (1989) found that wives who reported minor physical violence from a spouse in the past year were three times more likely to have been high on drugs and twice as likely to have been drunk in the past year compared to women not reporting violence. Neither women’s drinking nor drug use was related to experiences of severe assault, a finding the authors attribute to the low baserate of severe violence. Kantor and Jasinski (1995) found similar results using 1990 National Family Violence Survey data, which included more sophisticated measures of alcohol and drug use. Using data from a multiwave telephone survey of adolescents and young adults in New Jersey, White and Chen (2002) also found evidence for an association between problem drinking and experiencing IPV among young married or cohabitating women. This relationship was obtained after controlling for several risk factors, including experiencing violence as a child and negative affect, which were assessed in earlier waves of the survey. However, because partner violence and problem drinking were assessed at the same data collection point, the temporal ordering of these variables cannot be determined. Using data from the National Survey of Families and Households, a large national telephone survey, Anderson (2002) also found an association between reporting an alcohol or drug problem and experiencing IPV but not between substance abuse and perpetration of partner violence. The association between violence victimization and substance abuse was stronger for women than for men. Although the association between women’s substance use or abuse and intimate partner victimization appears relatively robust, interpretation of this finding is more complicated. In their review of the literature regarding the association between women’s substance use and their experiences of IPV, Kantor and Asdigian (1997) discuss several mechanisms by which a woman’s intoxication or problem drinking may contribute to increased likelihood of her experiencing violence from her male partner. For example, an intoxicated or alcoholic woman may be victimized because of negative views of substance abusing women. Evidence for this mechanism is generally absent, however. Kantor and Asdigian conclude that the relationship between women’s substance use and victimization is likely to be spurious, reflecting the association of women’s substance use with her partner’s substance use or the association of both substance use and partner violence with common third variables such as violence in the family of origin. Understanding the temporal or causal ordering of women’s substance use and their experiences of intimate partner victimization is greatly aided by prospective studies; however, few such studies have been conducted. Quigley and Leonard (2000) found no evidence for a main effect of women’s drinking on subsequent male-to-female violence in a longitudinal study of newlywed couples. Rather, violence was elevated in couples in which husbands were
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heavy drinkers but wives were light drinkers or abstainers. Use of substances other than alcohol was not considered. Using data from the Dunedin birth cohort, Magdol, Moffitt, Caspi, and Silva, (1998a) found that problem behaviors at age 15, including substance abuse, were predictive of female reports of partner violence perpetration and victimization at age 21 in multivariate analyses. Given the long time lag between measurement of substance use and measurement of partner violence, the finding is probably best interpreted as reflecting the role of social deviance on later violence, rather than indicating the substance use within relationships exacerbates conflict and contributes to violence. It is also possible that the observed association between women’s experiences of partner violence and substance use reflects the use of substances as a means of selfmedication following victimization. Such an association is consistent with studies showing increased substance abuse following trauma such as physical or sexual assault (e.g., Kilpatrick, Acierno, Resnick, Saunders, & Best, 1997) and with studies showing increased depression and decreased marital satisfaction resulting from IPV (e.g., Heyman, O’Leary, & Jouriles, 1995; Stets & Straus, 1990). A recent study by Anderson (2002) revealed associations between one’s own alcohol problems and both IPV victimization and mutual IPV but no association between alcohol problems and IPV perpetration, a pattern that was stronger for women than for men. The author interpreted these crosssectional findings as evidence that IPV contributes to problem drinking rather than the reverse; however, it is also possible that the findings reflect a contribution of victim problem drinking to subsequent victimization. Stronger evidence that experiencing IPV influences subsequent alcohol use is provided by a longitudinal study by Testa and Leonard (2001) showing that women’s experiences of IPV in the first year of marriage were positively associated with greater stress, lower marital satisfaction, and increased occasions of heavy episodic drinking at the first wedding anniversary. Although effects of IPV on subsequent drinking were modest, the study provides some support for the notion that the association between women’s alcohol problems and victimization found in crosssectional studies may reflect the use of alcohol as a reaction to victimization. In another longitudinal study, Salomon, Bassuk, and Huntington (2002) found that experiences of partner violence predicted subsequent onset of drug use among a sample of low-income mothers, although violence was not associated with subsequent problem alcohol use. The goal of the current study was to examine evidence for effects of women’s substance use on their subsequent experiences of IPV as well as for effects of IPV on women’s subsequent substance use. Evidence for these bidirectional effects was examined in a longitudinal study involving a community sample of young women. We considered women’s illicit drug use as well as alcohol use. It is possible that because of its illicit nature and association with deviance and criminal activity, women’s drug use is more strongly associated with violent victimization than is alcohol use (Kilpatrick et al., 1997). The sample was diverse in terms of women’s relationship status and included single, cohabitating, and married women. While many intimate relationships were maintained over the course of the study, a significant number ended, allowing us to examine the role of women’s substance use on subsequent partner violence both within enduring relationships as well as across relationships.
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2. Method 2.1. Participants Participants consisted of a subsample of the 1014 women, ages 18–30, who participated in the ‘‘Women 2000’’ study, a three-wave longitudinal study of substance use and victimization experiences. Women 18–30 years of age living in Buffalo, NY, and its immediate suburbs were identified using random digit dialing between May 2000 and April 2002. In-person interviews were completed with 61% of eligible women identified, a rate that is comparable or superior to completion rates for surveys that were conducted solely by telephone (Greenfield, Graves, & Kaskutas, 1999; Welte, Barnes, Wieczorek, Tidwell, & Parker, 2001). The sample matched closely the characteristics of the local population. For example, 75% of the sample were White and 17% were African American, compared to 72% and 21%, respectively, for the geographic area from which the sample was drawn. Median household income for the sample was between US$30,000 and 40,000, which also matches the median household income for metropolitan area. Of the 964 women who had completed the first two waves of data collection as of May 2003, 724 reported a current heterosexual relationship at Wave 1 and were included in the analyses. Women who were not in a relationship (n = 229) or who were in a lesbian relationship (n = 11) at Wave 1 were not included in analyses. Average age was 24.06 years (S.D. = 3.70) and average relationship length at Wave 1 was 3.96 years (S.D. = 3.96). 2.2. Procedure Eligible women were recruited to participate in an initial interview, to take place at the Research Institute on Addictions, University at Buffalo, State University of New York (RIA) and to complete follow-up mail questionnaires at 12 months (Wave 2) and 24 months (Wave 3) postbaseline. They were told that the initial session would include computer-administered questionnaires and a face-to-face confidential interview involving personality, alcohol and drug use, and sexual experiences. Upon arrival at RIA, study procedures were explained and informed consent was obtained. The majority of questionnaire data were collected using a computer-assisted format (CASI) because studies suggest that participants are more willing to report on sensitive behaviors using this mode of administration (Gribble, Miller, Rogers, & Turner, 1999). However, other information, including alcohol consumption, was collected via personal interview. Women were paid US$50 for participation. Wave 2 data were collected using paper-and-pencil questionnaires that were similar to measures used in the Wave 1 CASI interview but focused on the past 12 months. After confirming addresses by telephone, these questionnaires were sent 2 weeks before the 1-year anniversary date of the Wave 1 interview and returned by postage-paid envelope. Women were sent a US$50 check upon receipt of the questionnaire booklets. Most booklets (94%) were returned within 1 month of the anniversary date.
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2.3. Measures 2.3.1. Partner violence Women’s experiences of IPV were assessed using the minor violence (five items), severe violence (seven items), and severe psychological aggression (four items) subscales from the CTS-2 (Straus, Hamby, Boney-McCoy, & Sugarman, 1996). We assessed whether or not each item had occurred, rather than the frequency of occurrence. Instructions preceding the items were as follows: ‘‘Following is a list of behaviors that sometime happen in relationships. Please indicate whether or not a boyfriend or dating partner ever did any of these things to you in your lifetime. Consider experiences you may have had with any sexual or romantic partner, not just your current partner.’’ If a woman responded positively to at least one item on a subscale, she was subsequently asked, via computer, how old she was the first time any of these experiences had occurred, whether these experiences had occurred in the past 12 months, and whether her current partner had done any of these things to her. Thus, we were able to determine whether a woman had experienced minor violence, severe violence, or psychological aggression in her lifetime, in the past 12 months, or from her current partner. At Wave 2, the same CTS subscales were included in the questionnaire booklets immediately following the section on intimate partner relationships and were assessed specific to each heterosexual partner identified. Women who had reported a current partner at Wave 1 were first asked to report whether or not they had experienced any violent acts from this partner in the past 12 months. All women provided this information, regardless of whether they still considered this man to be their current partner. For women who reported a new partner(s) at Wave 2 or at some point in the past year, they were also asked about the occurrence of any violent acts from these partners in the past 12 months. 2.3.2. Relationship satisfaction For each identified heterosexual relationship women were asked ‘‘How emotionally satisfying do you find your relationship?’’ and ‘‘Overall, how satisfied are you with your relationship?’’ Items were rated on five-point scales, ranging from 1 (not at all satisfied) to 5 (extremely satisfied). Because these items were highly correlated (r=.86), they were combined into a single mean satisfaction score (M = 4.03, S.D.=.96). 2.3.3. Substance use Women completed a battery of questions regarding their alcohol consumption, including current quantity and frequency of consumption. For purposes of this study, we created a variable to indicate the frequency of heavy episodic drinking. This variable consisted of the mean response to two questions, the first assessing the frequency of consuming five or more drinks in a single day in the past 12 months, the second assessing the frequency of drinking until drunk or intoxicated in the past 12 months. Both items were assessed on a six-point scale ranging from 0 (never) to 5 (5 or more days per week) and were highly correlated at Wave 1 (r=.67) and at Wave 2 (r=.71). The majority reported at least one occasion of heavy episodic
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drinking in the past year (75.5% at Wave 1, 60.7% at Wave 2). At Wave 1, the mean response was 0.91 (S.D. = 0.79) and the median was 1, roughly corresponding to a frequency of less than once a month. Mean at Wave 2 was 0.82 (S.D. = 0.88). The correlation between Wave 1 and Wave 2 was .65. Use of drugs other than alcohol was assessed using a series of separate questions regarding frequency of use of marijuana, cocaine, opiates, psychedelics, club drugs, barbiturates, amphetamines, inhalants, and nonprescribed prescription drugs. Use of one or more drugs during the past year was reported by 33.7% at Wave 1 and 35.6% at Wave 2. The most commonly used drug was marijuana (30.1% at Wave 1, 29.0% at Wave 2), with cocaine a distant second (5.3% at Wave 1, 6.1% at Wave 2). Using Wave 1 drug use data, women were assigned a score from 0 to 2 corresponding to no drug use (n = 479), marijuana use only (n = 149), or hard drug use, with or without marijuana (n = 96). In addition, women were assigned a frequency of use score based upon the drug used most frequently in the past 12 months. Scores ranged from 0 (no use in the past 12 months) to 6 (used every day or nearly every day). Mean frequency of drug use was at 1.22 (S.D. = 1.96) at Wave 1 and 1.11 (S.D. = 1.86) at Wave 2, corresponding to about two or three times per year. Correlation between Wave 1 and Wave 2 drug use frequency was .69. 2.3.4. Demographics Age, ethnicity, marital status, and living arrangements were assessed. Although we included questions about education, employment, and income, we did not use these demographic variables. Given the young age of the sample, these did not appear to be reliable indicators of socioeconomic status.
3. Results 3.1. Prevalence of intimate partner violence Upon entry into the study, 56.1% reported experiencing minor violence and 30.8% reported experiencing severe violence from an intimate partner at some point in their lives. Average age at which violence first occurred was 19.11 (S.D. = 3.13). At Wave 1, 26.4% reported experiencing minor violence from their current partner and 11.7% reported experiencing severe violence. In addition, 20.6% reported experiencing minor violence and 9.1% reported experiencing severe violence in the past 12 months. At Wave 2, 26.9% reported minor violence and 12.2% reported severe violence in the past 12 months. The prevalence of current relationship violence is comparable to other studies of young adult samples (e.g., Capaldi & Crosby, 1997; Magdol et al., 1997; McLaughlin, Leonard, & Senchak, 1992). Of the 724 women who reported a current male partner at Wave 1, 196 were married, 163 were cohabitating, and 365 were single and not living with their partners. There were significant differences among these three groups on all variables depicted in Table 1. Consistent with previous research (Magdol, Moffitt, Caspi, & Silva, 1998b), cohabitating
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Table 1 Intimate partner violence prevalence and risk factors: married, cohabitating and single women Age Percent white Wave 1 heavy episodic drinking frequency Wave 1 drug use level (0 – 2) Lifetime minor violence Lifetime severe violence Wave 1 current relationship: minor violence Wave 1 current relationship: severe violence Wave 2 minor violence, same partner Wave 2 severe violence, same partner Wave 2 violence, new partnera
Married (n = 196)
Cohabitating (n = 163)
Single (n = 365)
27.09 (2.52) 85.6% .63 (.61) .18 (.50) 52.6% 29.6% 27.6% 11.2% 18.4% 4.6% 0%
23.74 (3.24) 70.6% .92 (.76) .60 (.76) 70.6% 42.3% 41.7% 20.3% 40.5% 17.1% 22.5%
22.57 (3.46) 73.9% 1.05 (.86) .57 (.75) 51.5% 26.3% 18.9% 8.2% 22.5% 11.2% 8.6%
a
Percentages based on 16 married women, 40 cohabitating women and 162 single women who reported a new partner at Wave 2.
women are more likely than married or single women to report experiencing lifetime and current relationship IPV. Married women were older, more likely to be White, and reported less substance use compared to cohabitating or single women. Because previous studies have shown IPV to occur more frequently among younger, minority and cohabitating couples (Heyman & Neidig, 1999; Magdol et al., 1998b), we controlled for age, race, and married and cohabitating status in all subsequent analyses. Table 2 presents the zero-order correlations among violence and substance use variables for the full sample. Wave 1 drug use level was positively and significantly correlated with most Wave 1 and Wave 2 IPV variables. Although Wave 1 heavy episodic drinking was positively correlated with drug use, it was generally not correlated with either Wave 1 or Wave 2 IPV. 3.2. Does women’s substance use predict intimate partner violence within ongoing relationships? We examined the impact of women’s Wave 1 substance use on their experiences of IPV within ongoing relationships, as reported at Wave 2. Two separate hierarchical logistic regressions were performed, the first predicting minor violence reported at Wave 2 and the second predicting severe violence at Wave 2. These analyses considered experiences of Wave 2 violence that were perpetrated by the man identified as the current partner at Wave 1, that is, within ongoing relationships. On the first step, race, age, married (yes/no), and cohabitating (yes/no) status at Wave 1 were entered. On the second step, we entered Wave 1 severe psychological aggression, as well as Wave 1 minor violence (in the equation predicting minor violence) or severe violence (in the equation predicting severe violence). Psychological aggression has been identified as a predictor of subsequent IPV within existing relationships (Quigley & Leonard, 2000). On the last step we entered Wave 1 substance use variables: frequency of heavy episodic drinking in the past 12 months and
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Table 2 Intercorrelations among Wave 1 and Wave 2 violence and substance use variables 1 1. W1 psychological aggression 2. W1 minor physical violence 3. W1 severe physical violence 4. W1 heavy episodic drinking frequency 5. W1 drug use (0 = none, 1 = marijuana, 2 = hard drugs) 6. W2 minor physical violence 7. W2 severe physical violence 8. W2 violence—new partnera 9. W2 heavy episodic drinking frequency 10. W2 drug use frequency
2
3
4
5
6
7
8
9
.55*** .52***
.56***
.01
.02
.01
.07
.15***
.11**
.39***
.39***
.37***
.32***
.08*
.19***
.30***
.27***
.33***
.05
.18*** .57***
.02
.16
.17*
.03
.20**
.01
.01
.02
.65*** .32*** .11**
.10**
.09*
.13**
.30*** .57*** .17*** .21***
.12
.05 .08*
.08 .05 .27***
a
Correlations involving Wave 2 violence based on n = 218. All other correlations based on n = 724. * P < .05. ** P < .01. *** P < .001.
level of illicit drug use in the past 12 months. So that we could distinguish between the effects of marijuana use and hard drug use relative to no drug use, we performed an indicator contrast for this categorical variable, using no drug use as the reference category. As shown in Table 3, the addition of the substance use variables substantially improved prediction of Wave 2 minor violence beyond the contribution of Wave 1 violence. This increase in predictive power was due to significantly increased odds of experiencing Wave 2 violence associated with hard drug use; neither heavy episodic drinking nor marijuana use alone were significant independent predictors of Wave 2 minor violence. The pattern of results was identical for prediction of severe violence. In sum, increased odds of experiencing Wave 2 violence within ongoing relationships were associated with being younger, cohabitating, experiencing Wave 1 psychological aggression and violence, and Wave 1 hard drug use. 3.3. Does women’s substance use predict intimate partner violence in new relationships? Although most Wave 1 partners were still classified by the women as current partners at Wave 2, 193 (26.7%) reported that these relationships had ended by Wave 2 and 218 women (30.1%) reported a new heterosexual partner at some point in the preceding 12
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Table 3 Hierarchical logistic regression predicting Wave 2 minor and severe violence from same partner v2 Minor violence Step 1 Racea Age Cohabitating Married Step 2 W1 psychological aggression W1 minor violence Step 3 Heavy episodic drinking Marijuana use only Hard drug use Severe violence Step 1 Race1 Age Cohabitating Married Step 2 W1 psychological aggression W1 severe violence Step 3 Heavy episodic drinking Marijuana use only Hard drug use
Step OR
Step 95% CI
Final OR
Final 95% CI
0.66* 0.93 2.57*** 1.13
0.45 – 0.98 0.88 – 0.98 1.69 – 3.88 0.67 – 1.89
0.68 0.91** 2.04** 1.12
0.44 – 1.07 0.86 – 0.97 1.27 – 3.29 0.62 – 2.02
3.83*** 3.22***
2.39 – 6.13 2.05 – 5.06
3.94*** 3.05***
2.44 – 6.36 1.91 – 4.85
1.20 0.98 2.41**
0.93 – 1.56 0.59 – 1.64 1.36 – 4.26
1.20 0.98 2.41**
0.93 – 1.56 0.59 – 1.64 1.36 – 4.26
0.58* 0.96 1.71* 0.50
0.35 – 0.97 0.89 – 1.03 1.00 – 2.92 0.22 – 1.13
0.68 0.91** 2.04** 1.12
0.44 – 1.07 0.86 – 0.97 1.27 – 3.29 0.62 – 2.02
3.63*** 3.92***
1.98 – 6.67 2.01 – 7.64
3.94*** 3.05***
2.44 – 6.36 1.91 – 4.85
1.00 1.78 2.87**
0.71 – 1.40 0.92 – 3.44 1.39 – 5.92
1.00 1.78 2.87**
0.71 – 1.40 0.92 – 3.44 1.39 – 5.92
36.29***
115.49***
16.71**
21.42***
67.80***
9.69*
a Odds ratio less than 1 indicates that White women are at decreased risk. * P < .05. ** P < .01. *** P < .001.
months. To examine whether Wave 1 substance use was associated with the likelihood of having a new partner by Wave 2, hierarchical logistic regression was performed. Demographic variables were entered on the first step, followed by Wave 1 psychological aggression, minor violence, and severe violence on the second step, and substance use variables on the third step. Women were less likely to enter a new relationship if they were White, older, married, and cohabitating, and more likely if they experienced minor violence. After controlling for these variables, substance use improved prediction of entering a new relationship (v2 = 48.27, P < .001). Heavy episodic drinking (OR = 1.76, CI 1.38–2.26), use of marijuana (OR = 2.03, 95% CI = 1.30–3.15), and use of hard drugs (OR = 1.79, 95% CI = 1.04 –3.07) all increased the odds of entering a new relationship.
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Table 4 Hierarchical logistic regression predicting Wave 2 violence from a new partner v2 Step 1 Racea Age Cohabitating Step 2 W1 minor violence Step 3 Heavy episodic drinking Marijuana use only Hard drug use
Initial OR
CI
Final OR
Final CI
16.26** 0.34* 0.83* 3.48*
0.14 – 0.86 0.70 – 0.98 1.27 – 9.55
0.25* 0.77** 3.59*
0.09 – 0.73 0.64 – 0.93 1.17 – 10.97
3.64*
1.11 – 11.87
4.11*
1.14 – 14.86
0.69 5.90* 15.57**
0.36 – 1.31 1.50 – 23.84 3.03 – 80.08
0.69 5.90* 15.57**
0.36 – 1.31 1.50 – 23.84 3.03 – 80.08
5.43* 14.74**
a
Odds ratio less than 1 indicates that White women are at decreased risk. *P < .05. **P < .01.
Hierarchical logistic regression was used to examine whether Wave 1 substance use was associated with increased odds of experiencing any Wave 2 violence from a new partner.1 Because only 16 married women reported a new partner at Wave 2, they were omitted from this analysis, resulting in n = 202. Demographic variables were entered on the first step, followed by lifetime history of minor IPV on the second step, and Wave 1 substance use variables on the third step. As shown in Table 4, after controlling for demographics and history of minor violence, the addition of Wave 1 substance use substantially improved prediction of violence from a new partner. The indicator contrast, comparing marijuana use only to no drug use and hard drug use to no drug use, revealed that both types of drug use resulted in increased odds of experiencing Wave 2 violence from a new partner relative to women who did not use drugs. Heavy episodic drinking did not predict violence from a new partner. 3.4. Do women’s experiences of intimate partner violence predict subsequent substance use? The relationship between women’s substance use and experiences of IPV may be bidirectional. That is, women may increase their frequency of substance use in response to experiencing partner violence. To determine whether experiencing IPV contributes to subsequent substance use, we conducted two separate hierarchical multiple regressions, the first predicting frequency of Wave 2 heavy episodic drinking, the second predicting frequency of Wave 2 drug use. We used frequency of drug use, rather than drug use level as the
1
Few women reported experiencing severe violence from a new partner (n = 15) and all of these also reported experiencing minor violence from a new partner. Given the modest sample size and exploratory nature of the analyses, we restricted the equation to prediction of any Wave 2 violence from a new partner, which is equivalent to prediction of minor violence from a new partner.
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dependent variable because we believed that frequency of drug use would be more sensitive to change as a result of experiencing violence. In each of these equations, we entered demographic variables and Wave 1 substance use on the first step. On the second step, Wave 1 psychological aggression, minor violence, and severe violence were included. Wave 1 IPV did not improve prediction of Wave 2 heavy episodic drinking, DR2=.000, P=.93, which was predicted by being White and by Wave 1 drinking. Wave 1 drug use frequency was a significant and strong predictor of Wave 2 drug use frequency; however, Wave 1 violence variables contributed only marginally to prediction of Wave 2 drug use, DR2=.005, P=.07. We speculated that the relationship between experiences of IPV and subsequent substance use may not be direct but rather may be mediated by relationship satisfaction. Path analysis was used to test this notion. As shown in Fig. 1, Wave 1 psychological
Fig. 1. Path analysis: Indirect effects of partner violence on subsequent heavy episodic drinking. All paths shown are significant at P < .05 level or greater. The path coefficients are standardized betas from multiple regression analysis.
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aggression and minor violence (but not severe violence) from the current partner predicted Wave 1 relationship satisfaction, which was in turn negatively associated with Wave 2 heavy episodic drinking. A similar path analysis predicting Wave 2 drug use revealed a nonsignificant negative path from Wave 1 relationship satisfaction to subsequent frequency of drug use (r = .03). A recent study found that increased drug use following partner violence was observed primarily among women who did not initially use drugs at baseline (Salomon et al., 2002). To explore this possibility, we examined whether women who did not use drugs at Wave 1 were more likely to initiate drug use at Wave 2 if they experienced partner violence. We found no differential initiation of drug use at Wave 2 according to whether the woman had experienced Wave 1 minor violence [v2(1) < 1] or severe violence [v2(1) < 1].
4. Discussion The study provides evidence that women who use drugs are at increased risk of experiencing subsequent partner violence, even after controlling for previous IPV experiences and known risk factors such as young age, cohabitation, and previous IPV victimization. Within ongoing relationships, hard drug use, but not marijuana use alone, predicted subsequent minor and severe IPV. One possible explanation for this pattern of results is that drug use itself increases the likelihood that violence will occur in a relationships. Although we did not assess partner drug use, it is likely that drug using women were in partnerships with drug using men. Use of drugs by the woman or her partner may have increased irritability and volatility, impaired social interaction and ability to handle conflict, and thus increased the likelihood of violence. The fact that marijuana use alone was not associated with experiencing violence in ongoing relationships is consistent with research suggesting that marijuana may suppress aggressive responding (Myerscough & Taylor, 1985). Conflicts specifically related to drug use, such as disagreements over sharing available drugs and conflict over spending household resources on drugs may also have contributed to partner violence (Gilbert, El-Bassel, Rajah, Foleno, & Frye, 2001). These types of conflict illustrate both the systemic and economic compulsive violence associated with drug use as described in Goldstein’s (1985) tripartite model. Women in the study of Gilbert et al. (2001) also indicated that they were verbally abused by their partners as a result of their low status as drug-using women. Psychological abuse has been linked to subsequent violence (Quigley & Leonard, 2000). Although it is tempting to conclude that drug use itself led to violence, we have no event-level data linking use of drugs with violent episodes. Hence, an equally plausible explanation for our findings is that it is not women’s drug use per se that increases vulnerability to subsequent violence. Rather, because drug use is illegal and socially deviant, the association between drug use and IPV may reflect the influence of a third variable, such as antisocial behavior, difficulty managing stress or conflict, or risky lifestyle, that is common both to drug users and to women in violent relationships.
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Kilpatrick et al. (1997) also found a prospective relationship between women’s drug use, but not alcohol use, and subsequent experiences of physical and sexual violence from all sources, not limited to intimate partners. These authors explained their results as reflecting the influence of the risky lifestyle associated with drug use on exposure to violence. We believe that our findings regarding drug use and new relationships support this notion. First, drug users are more likely to enter new relationships, thereby increasing their potential exposure to partner violence over time. Further, women who use drugs are more likely to experience violence in these new relationships. This finding is consistent with the suggestion of Kilpatrick et al. that drug users are involved in an illegal and socially deviant subculture that includes violent men. It is likely that drug using women choose their sexual partners from this riskier pool of men. It is noteworthy that women’s heavy episodic drinking did not emerge as a predictor of violent victimization either within ongoing or new relationships. The failure to observe an effect of women’s drinking on subsequent violence within ongoing relationships is consistent with recent evidence suggesting that mutual drinking within couples is associated with higher perceived marital quality (Roberts & Leonard, 1998) and less violence (Quigley & Leonard, 2000) than marriages in which the husband drinks but the wife does not. However, among this sample, heavy episodic drinking was not completely benign but rather was associated with relationship instability. The failure to observe an association between heavy episodic drinking and violence in subsequent relationships may reflect the fact that unlike drug use, alcohol use, even heavy episodic use, is legal, normative, and socially sanctioned among young people. Hence, women who engage in heavy episodic drinking may not be restricted to socializing within deviant social groups or limited to these groups when choosing partners. Although we did not observe a direct effect of violence on subsequent substance use, consistent with Testa and Leonard (2001), experiences of psychological aggression and minor violence were negatively associated with relationship satisfaction. In turn, satisfaction had a modest negative effect on subsequent heavy episodic drinking. We did not find evidence for either a direct or indirect effect of violence on frequency of drug usage or that violence increased the likelihood of initiating drug use. The modest effects of violence on subsequent drinking and the nonsignificant effects on drug use likely reflect the fact that not all women turn to substance use as a way of coping with unhappy relationships. Changes in drug use are likely to be very difficult to detect due to the fact that only about half as many women used drugs as used alcohol. Although the effects of women’s drug use on subsequent experiences of IPV were relatively strong, the interpretation of these effects is not unambiguous. Because the larger study focused on women’s substance use and experiences of victimization, we examined experiences of partner violence solely from the woman’s perspective and did not obtain information the woman’s own perpetration of violence or on the partner’s substance use. Because we did not assess women’s perpetration of IPV, it is plausible that the effect of women’s drug use on her subsequent experiences of partner violence actually reflects the impact of her drug use on her own perpetration of violence toward her partner, and the subsequent impact of her perpetration on her partner’s perpetration toward her. A number
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of studies have demonstrated that women’s perpetration of violence is very highly correlated with men’s perpetration of violence, however, we are not aware of any published studies suggesting that women’s violent behavior is causally linked to male partner’s violent behavior. In the context of longitudinal survey data, it is often impossible to delineate the temporal relationship between these two types of violence. It is also possible that the apparent effects of women’s drug use on subsequent IPV actually reflect effects of male partner’s drug use on his perpetration of violence. As with IPV, women’s drug use is often highly correlated with her partner’s drug use, and distinguishing the independent and interactive effects is often difficult because of the relatively fewer couples in which wives have used drugs but their partners have not (Mudar, Leonard, & Soltysinki, 2001). The use of a large community sample of young women who are involved in various types of relationships of varying length is a strength of the study. Results may not generalize to older women or to high-risk samples, however. Moreover, we caution that our findings regarding the impact of women’s drug use on violence in new relationships, while intriguing, should be considered exploratory given the relatively low number of new relationships and their short duration, resulting in low levels of violence. The availability of Wave 3 data will better enable us to explore the role of women’s substance use on violence as new relationships develop, an area which has received very little research attention. Despite these limitations, this study appears to be the first to establish a temporal relationship between women’s drug use and subsequent experiences of violence. As such, it is an important first step in understanding the role of women’s substance use in their experiences of IPV.
Acknowledgements This research was supported by Grants R01 AA12013 from the National Institute on Alcohol Abuse and Alcoholism and NIH Director’s Office of Research on Women’s Health and K02 AA00284 from the National Institute on Alcohol Abuse and Alcoholism (MT).
References Anderson, K. L. (2002). Perpetrator or victim? Relationships between intimate partner violence and well-being. Journal of Marriage and the Family, 64, 851 – 863. Capaldi, D. M., & Crosby, L. (1997). Observed and reported psychological and physical aggression in young, atrisk couples. Social Development, 6, 184 – 206. Gilbert, L., El-Bassel, N., Rajah, V., Foleno, A., & Frye, V. (2001). Linking drug-related activities with experiences of partner violence: A focus group study of women in methadone treatment. Violence and Victims, 16, 517 – 536. Goldstein, P. J. (1985). The drug/violence nexus: A tripartite conceptual framework. Journal of Drug Issues, 15, 493 – 506. Greenfield, T. K., Graves, K. L., & Kaskutas, L. A. (1999). Long-term effects of alcohol warning labels: Findings from a comparison of the United States and Ontario, Canada. Psychology & Marketing, 16, 261 – 282.
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Gribble, J. N., Miller, H. G., Rogers, S. M., & Turner, C. F. (1999). Interview mode and measurement of sexual behaviors: Methodological issues. Journal of Sex Research, 36, 16 – 24. Heyman, R. E., & Neidig, P. H. (1999). A comparison of spousal aggression prevalence rates in the U.S. army and civilian representative samples. Journal of Consulting and Clinical Psychology, 67, 239 – 242. Heyman, R. E., O’Leary, K. D., & Jouriles, E. N. (1995). Alcohol and aggressive personality styles: Potentiators of serious physical aggression against wives? Journal of Family Psychology, 9, 44 – 57. Kantor, G. K., & Asdigian, N. (1997). When women are under the influence. Does drinking or drug use by women provoke beatings by men. Recent Developments in Alcoholism, 13, 315 – 336. Kantor, G. K., & Jasinski, J. (1995). Prevention of teen violence: Evaluation of a multidimensional model. Paper Presented at the 4th International Family Violence Conference, Durham, NH. Kantor, G. K., & Straus, M. A. (1989). Substance abuse as a precipitant of wife abuse victimizations. American Journal of Drug and Alcohol Abuse, 15, 173 – 189. Kilpatrick, D. G., Acierno, R., Resnick, H. S., Saunders, B. E., & Best, C. L. (1997). A two-year longitudinal analysis of the relationships between violent assault and alcohol and drug use in women. Journal of Consulting and Clinical Psychology, 65, 834 – 847. Lipsey, M. W., Wilson, D. B., Cohen, M. A., & Derzon, J. H. (1997). Is there a causal relationship between alcohol use and violence? A synthesis of evidence. In M. Galanter (Ed.), Recent developments in alcoholism ( pp. 245 – 282). New York: Plenum. Magdol, L., Moffitt, T. E., Caspi, A., Newman, D. L., Fagan, J., & Silva, P. A. (1997). Gender differences in partner violence in a birth cohort of 21-year-olds: Bridging the gap between clinical and epidemiological approaches. Journal of Consulting and Clinical Psychology, 65, 68 – 78. Magdol, L., Moffitt, T. E., Caspi, A., & Silva, P. A. (1998a). Developmental antecedents of partner abuse: A prospective-longitudinal study. Journal of Abnormal Psychology, 107, 375 – 389. Magdol, L., Moffitt, T., Caspi, A., & Silva, P. A. (1998b). Hitting without a license: Testing explanations for differences in partner abuse between young adult daters and cohabitors. Journal of Marriage and the Family, 60, 41 – 55. Malik, S., Sorenson, S. B., & Aneshensel, C. S. (1997). Community and dating violence among adolescents: Perpetration and victimization. Journal of Adolescent Health, 21, 291 – 302. McLaughlin, I. G., Leonard, K. E., & Senchak, M. (1992). Prevalence and distribution of premarital aggression among couple applying for a marriage license. Journal of Family Violence, 7, 309 – 319. Mudar, P., Leonard, K. E., & Soltysinki, K. (2001). Discrepant substance use and marital functioning in newlywed couples. Journal of Consulting and Clinical Psychology, 69, 130 – 134. Myerscough, R., & Taylor, S. P. (1985). The effects of marijuana on human physical aggression. Journal of Personality and Social Psychology, 49, 1541 – 1546. Quigley, B. M., & Leonard, K. E. (2000). Alcohol and the continuation of early marital aggression. Alcoholism, Clinical and Experimental Research, 24, 1003 – 1010. Roberts, L. J., & Leonard, K. E. (1998). An empirical typology of drinking partnerships and their relationship to marital functioning and drinking consequences. Journal of Marriage and the Family, 60, 515 – 526. Salomon, A., Bassuk, S. S., & Huntington, N. (2002). The relationship between intimate partner violence and the use of addictive substances in poor and homeless single mothers. Violence Against Women, 8, 785 – 815. Schumacher, J. A., Feldbau-Kohn, S., Slep, A. M. S., & Heyman, R. E. (2001). Risk factors for male-to-female partner physical abuse. Aggression and Violent Behavior, 6, 281 – 352. Silverman, J. G., Raj, A., Mucci, L. A., & Hathaway, J. E. (2001). Dating violence against adolescent girls and associated substance use, unhealthy weight control, sexual risk behavior, pregnancy, and suicidality. JAMA: Journal of the American Medical Association, 286, 572 – 579. Stets, J. E., & Straus, M. A. (1990). Gender differences in reporting marital violence and its medical and psychological consequences. In M. A. Straus, & R. J. Gelles (Eds.), Physical violence in American families ( pp. 151 – 165). New Brunswick, NJ: Transaction. Straus, M. A., Hamby, S. L., Boney-McCoy, S., & Sugarman, D. B. (1996). The Revised Conflict Tactics Scales (CTS2): Development and preliminary psychometric data. Journal of Family Issues, 17, 283 – 316.
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Testa, M., & Leonard, K. E. (2001). The impact of marital aggression on women’s psychological and marital functioning in a newlywed sample. Journal of Family Violence, 16, 115 – 130. Welte, J., Barnes, G., Wieczorek, W., Tidwell, M. -C. O., & Parker, J. (2001). Alcohol and gambling pathology among U. S. adults: Prevalence, demographic patterns and comorbidity. Journal of Studies on Alcohol, 62, 706 – 712. White, H. R., & Chen, P. -H. (2002). Problem drinking and intimate partner violence. Journal of Studies on Alcohol, 63, 205 – 214.
Women’s substance use and experiences of intimate partner violence: A longitudinal investigation among a community sample Maria Testa*, Jennifer A. Livingston, Kenneth E. Leonard Research Institute on Addictions, University at Buffalo, State University of New York, 1021 Main Street, Buffalo, NY 14203, USA
Abstract Although cross-sectional studies reveal an association between women’s substance use and experiencing physical violence from one’s intimate partner, the temporal ordering of these variables is not clearly established. The current study involved longitudinal examination of the association of women’s substance use with subsequent experiences of intimate partner violence as well as the association between women’s experiences of intimate partner violence and their subsequent substance use. Women ages 18 – 30 who were in heterosexual relationships (n = 724) were recruited through random digit dialing in the Buffalo, NY, area. Within ongoing relationships, women’s use of hard drugs was associated with increased odds of experiencing intimate partner violence over the next 12 months. Both marijuana and hard drug use were associated with increased likelihood of experiencing violence in new relationships. Women’s heavy episodic drinking did not predict subsequent experiences of partner violence in ongoing or new relationships. Experiences of intimate partner violence had a significant effect on subsequent relationship satisfaction, which was modestly associated with subsequent heavy episodic drinking but not with subsequent drug use. D 2003 Elsevier Ltd. All rights reserved. Keywords: Alcohol drinking patterns; Drugs; Partner abuse; Family violence; Victimization
1. Introduction The association between substance use and intimate partner violence (IPV) has long been recognized. The bulk of literature addressing this association has focused on the link between * Corresponding author. Tel.: +1-716-887-2560; fax: +1-716-887-2215. E-mail address: [email protected] (M. Testa). 0306-4603/$ – see front matter D 2003 Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2003.08.040
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substance use and perpetration of partner violence, primarily by men toward their female partners (for reviews, see Lipsey, Wilson, Cohen, & Derzon, 1997; Schumacher, FeldbauKohn, Slep, & Heyman, 2001). However, there is also some evidence that women who report higher levels of substance use or abuse are more likely to report experiencing IPV. For example, among adolescent girls, substance use is associated with experiencing dating violence (Malik, Sorenson, & Aneshensel, 1997; Silverman, Raj, Mucci, & Hathaway, 2001). Studies of married and cohabitating couples reveal similar findings. Using data from the 1985 National Family Violence Survey, Kantor and Straus (1989) found that wives who reported minor physical violence from a spouse in the past year were three times more likely to have been high on drugs and twice as likely to have been drunk in the past year compared to women not reporting violence. Neither women’s drinking nor drug use was related to experiences of severe assault, a finding the authors attribute to the low baserate of severe violence. Kantor and Jasinski (1995) found similar results using 1990 National Family Violence Survey data, which included more sophisticated measures of alcohol and drug use. Using data from a multiwave telephone survey of adolescents and young adults in New Jersey, White and Chen (2002) also found evidence for an association between problem drinking and experiencing IPV among young married or cohabitating women. This relationship was obtained after controlling for several risk factors, including experiencing violence as a child and negative affect, which were assessed in earlier waves of the survey. However, because partner violence and problem drinking were assessed at the same data collection point, the temporal ordering of these variables cannot be determined. Using data from the National Survey of Families and Households, a large national telephone survey, Anderson (2002) also found an association between reporting an alcohol or drug problem and experiencing IPV but not between substance abuse and perpetration of partner violence. The association between violence victimization and substance abuse was stronger for women than for men. Although the association between women’s substance use or abuse and intimate partner victimization appears relatively robust, interpretation of this finding is more complicated. In their review of the literature regarding the association between women’s substance use and their experiences of IPV, Kantor and Asdigian (1997) discuss several mechanisms by which a woman’s intoxication or problem drinking may contribute to increased likelihood of her experiencing violence from her male partner. For example, an intoxicated or alcoholic woman may be victimized because of negative views of substance abusing women. Evidence for this mechanism is generally absent, however. Kantor and Asdigian conclude that the relationship between women’s substance use and victimization is likely to be spurious, reflecting the association of women’s substance use with her partner’s substance use or the association of both substance use and partner violence with common third variables such as violence in the family of origin. Understanding the temporal or causal ordering of women’s substance use and their experiences of intimate partner victimization is greatly aided by prospective studies; however, few such studies have been conducted. Quigley and Leonard (2000) found no evidence for a main effect of women’s drinking on subsequent male-to-female violence in a longitudinal study of newlywed couples. Rather, violence was elevated in couples in which husbands were
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heavy drinkers but wives were light drinkers or abstainers. Use of substances other than alcohol was not considered. Using data from the Dunedin birth cohort, Magdol, Moffitt, Caspi, and Silva, (1998a) found that problem behaviors at age 15, including substance abuse, were predictive of female reports of partner violence perpetration and victimization at age 21 in multivariate analyses. Given the long time lag between measurement of substance use and measurement of partner violence, the finding is probably best interpreted as reflecting the role of social deviance on later violence, rather than indicating the substance use within relationships exacerbates conflict and contributes to violence. It is also possible that the observed association between women’s experiences of partner violence and substance use reflects the use of substances as a means of selfmedication following victimization. Such an association is consistent with studies showing increased substance abuse following trauma such as physical or sexual assault (e.g., Kilpatrick, Acierno, Resnick, Saunders, & Best, 1997) and with studies showing increased depression and decreased marital satisfaction resulting from IPV (e.g., Heyman, O’Leary, & Jouriles, 1995; Stets & Straus, 1990). A recent study by Anderson (2002) revealed associations between one’s own alcohol problems and both IPV victimization and mutual IPV but no association between alcohol problems and IPV perpetration, a pattern that was stronger for women than for men. The author interpreted these crosssectional findings as evidence that IPV contributes to problem drinking rather than the reverse; however, it is also possible that the findings reflect a contribution of victim problem drinking to subsequent victimization. Stronger evidence that experiencing IPV influences subsequent alcohol use is provided by a longitudinal study by Testa and Leonard (2001) showing that women’s experiences of IPV in the first year of marriage were positively associated with greater stress, lower marital satisfaction, and increased occasions of heavy episodic drinking at the first wedding anniversary. Although effects of IPV on subsequent drinking were modest, the study provides some support for the notion that the association between women’s alcohol problems and victimization found in crosssectional studies may reflect the use of alcohol as a reaction to victimization. In another longitudinal study, Salomon, Bassuk, and Huntington (2002) found that experiences of partner violence predicted subsequent onset of drug use among a sample of low-income mothers, although violence was not associated with subsequent problem alcohol use. The goal of the current study was to examine evidence for effects of women’s substance use on their subsequent experiences of IPV as well as for effects of IPV on women’s subsequent substance use. Evidence for these bidirectional effects was examined in a longitudinal study involving a community sample of young women. We considered women’s illicit drug use as well as alcohol use. It is possible that because of its illicit nature and association with deviance and criminal activity, women’s drug use is more strongly associated with violent victimization than is alcohol use (Kilpatrick et al., 1997). The sample was diverse in terms of women’s relationship status and included single, cohabitating, and married women. While many intimate relationships were maintained over the course of the study, a significant number ended, allowing us to examine the role of women’s substance use on subsequent partner violence both within enduring relationships as well as across relationships.
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2. Method 2.1. Participants Participants consisted of a subsample of the 1014 women, ages 18–30, who participated in the ‘‘Women 2000’’ study, a three-wave longitudinal study of substance use and victimization experiences. Women 18–30 years of age living in Buffalo, NY, and its immediate suburbs were identified using random digit dialing between May 2000 and April 2002. In-person interviews were completed with 61% of eligible women identified, a rate that is comparable or superior to completion rates for surveys that were conducted solely by telephone (Greenfield, Graves, & Kaskutas, 1999; Welte, Barnes, Wieczorek, Tidwell, & Parker, 2001). The sample matched closely the characteristics of the local population. For example, 75% of the sample were White and 17% were African American, compared to 72% and 21%, respectively, for the geographic area from which the sample was drawn. Median household income for the sample was between US$30,000 and 40,000, which also matches the median household income for metropolitan area. Of the 964 women who had completed the first two waves of data collection as of May 2003, 724 reported a current heterosexual relationship at Wave 1 and were included in the analyses. Women who were not in a relationship (n = 229) or who were in a lesbian relationship (n = 11) at Wave 1 were not included in analyses. Average age was 24.06 years (S.D. = 3.70) and average relationship length at Wave 1 was 3.96 years (S.D. = 3.96). 2.2. Procedure Eligible women were recruited to participate in an initial interview, to take place at the Research Institute on Addictions, University at Buffalo, State University of New York (RIA) and to complete follow-up mail questionnaires at 12 months (Wave 2) and 24 months (Wave 3) postbaseline. They were told that the initial session would include computer-administered questionnaires and a face-to-face confidential interview involving personality, alcohol and drug use, and sexual experiences. Upon arrival at RIA, study procedures were explained and informed consent was obtained. The majority of questionnaire data were collected using a computer-assisted format (CASI) because studies suggest that participants are more willing to report on sensitive behaviors using this mode of administration (Gribble, Miller, Rogers, & Turner, 1999). However, other information, including alcohol consumption, was collected via personal interview. Women were paid US$50 for participation. Wave 2 data were collected using paper-and-pencil questionnaires that were similar to measures used in the Wave 1 CASI interview but focused on the past 12 months. After confirming addresses by telephone, these questionnaires were sent 2 weeks before the 1-year anniversary date of the Wave 1 interview and returned by postage-paid envelope. Women were sent a US$50 check upon receipt of the questionnaire booklets. Most booklets (94%) were returned within 1 month of the anniversary date.
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2.3. Measures 2.3.1. Partner violence Women’s experiences of IPV were assessed using the minor violence (five items), severe violence (seven items), and severe psychological aggression (four items) subscales from the CTS-2 (Straus, Hamby, Boney-McCoy, & Sugarman, 1996). We assessed whether or not each item had occurred, rather than the frequency of occurrence. Instructions preceding the items were as follows: ‘‘Following is a list of behaviors that sometime happen in relationships. Please indicate whether or not a boyfriend or dating partner ever did any of these things to you in your lifetime. Consider experiences you may have had with any sexual or romantic partner, not just your current partner.’’ If a woman responded positively to at least one item on a subscale, she was subsequently asked, via computer, how old she was the first time any of these experiences had occurred, whether these experiences had occurred in the past 12 months, and whether her current partner had done any of these things to her. Thus, we were able to determine whether a woman had experienced minor violence, severe violence, or psychological aggression in her lifetime, in the past 12 months, or from her current partner. At Wave 2, the same CTS subscales were included in the questionnaire booklets immediately following the section on intimate partner relationships and were assessed specific to each heterosexual partner identified. Women who had reported a current partner at Wave 1 were first asked to report whether or not they had experienced any violent acts from this partner in the past 12 months. All women provided this information, regardless of whether they still considered this man to be their current partner. For women who reported a new partner(s) at Wave 2 or at some point in the past year, they were also asked about the occurrence of any violent acts from these partners in the past 12 months. 2.3.2. Relationship satisfaction For each identified heterosexual relationship women were asked ‘‘How emotionally satisfying do you find your relationship?’’ and ‘‘Overall, how satisfied are you with your relationship?’’ Items were rated on five-point scales, ranging from 1 (not at all satisfied) to 5 (extremely satisfied). Because these items were highly correlated (r=.86), they were combined into a single mean satisfaction score (M = 4.03, S.D.=.96). 2.3.3. Substance use Women completed a battery of questions regarding their alcohol consumption, including current quantity and frequency of consumption. For purposes of this study, we created a variable to indicate the frequency of heavy episodic drinking. This variable consisted of the mean response to two questions, the first assessing the frequency of consuming five or more drinks in a single day in the past 12 months, the second assessing the frequency of drinking until drunk or intoxicated in the past 12 months. Both items were assessed on a six-point scale ranging from 0 (never) to 5 (5 or more days per week) and were highly correlated at Wave 1 (r=.67) and at Wave 2 (r=.71). The majority reported at least one occasion of heavy episodic
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drinking in the past year (75.5% at Wave 1, 60.7% at Wave 2). At Wave 1, the mean response was 0.91 (S.D. = 0.79) and the median was 1, roughly corresponding to a frequency of less than once a month. Mean at Wave 2 was 0.82 (S.D. = 0.88). The correlation between Wave 1 and Wave 2 was .65. Use of drugs other than alcohol was assessed using a series of separate questions regarding frequency of use of marijuana, cocaine, opiates, psychedelics, club drugs, barbiturates, amphetamines, inhalants, and nonprescribed prescription drugs. Use of one or more drugs during the past year was reported by 33.7% at Wave 1 and 35.6% at Wave 2. The most commonly used drug was marijuana (30.1% at Wave 1, 29.0% at Wave 2), with cocaine a distant second (5.3% at Wave 1, 6.1% at Wave 2). Using Wave 1 drug use data, women were assigned a score from 0 to 2 corresponding to no drug use (n = 479), marijuana use only (n = 149), or hard drug use, with or without marijuana (n = 96). In addition, women were assigned a frequency of use score based upon the drug used most frequently in the past 12 months. Scores ranged from 0 (no use in the past 12 months) to 6 (used every day or nearly every day). Mean frequency of drug use was at 1.22 (S.D. = 1.96) at Wave 1 and 1.11 (S.D. = 1.86) at Wave 2, corresponding to about two or three times per year. Correlation between Wave 1 and Wave 2 drug use frequency was .69. 2.3.4. Demographics Age, ethnicity, marital status, and living arrangements were assessed. Although we included questions about education, employment, and income, we did not use these demographic variables. Given the young age of the sample, these did not appear to be reliable indicators of socioeconomic status.
3. Results 3.1. Prevalence of intimate partner violence Upon entry into the study, 56.1% reported experiencing minor violence and 30.8% reported experiencing severe violence from an intimate partner at some point in their lives. Average age at which violence first occurred was 19.11 (S.D. = 3.13). At Wave 1, 26.4% reported experiencing minor violence from their current partner and 11.7% reported experiencing severe violence. In addition, 20.6% reported experiencing minor violence and 9.1% reported experiencing severe violence in the past 12 months. At Wave 2, 26.9% reported minor violence and 12.2% reported severe violence in the past 12 months. The prevalence of current relationship violence is comparable to other studies of young adult samples (e.g., Capaldi & Crosby, 1997; Magdol et al., 1997; McLaughlin, Leonard, & Senchak, 1992). Of the 724 women who reported a current male partner at Wave 1, 196 were married, 163 were cohabitating, and 365 were single and not living with their partners. There were significant differences among these three groups on all variables depicted in Table 1. Consistent with previous research (Magdol, Moffitt, Caspi, & Silva, 1998b), cohabitating
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Table 1 Intimate partner violence prevalence and risk factors: married, cohabitating and single women Age Percent white Wave 1 heavy episodic drinking frequency Wave 1 drug use level (0 – 2) Lifetime minor violence Lifetime severe violence Wave 1 current relationship: minor violence Wave 1 current relationship: severe violence Wave 2 minor violence, same partner Wave 2 severe violence, same partner Wave 2 violence, new partnera
Married (n = 196)
Cohabitating (n = 163)
Single (n = 365)
27.09 (2.52) 85.6% .63 (.61) .18 (.50) 52.6% 29.6% 27.6% 11.2% 18.4% 4.6% 0%
23.74 (3.24) 70.6% .92 (.76) .60 (.76) 70.6% 42.3% 41.7% 20.3% 40.5% 17.1% 22.5%
22.57 (3.46) 73.9% 1.05 (.86) .57 (.75) 51.5% 26.3% 18.9% 8.2% 22.5% 11.2% 8.6%
a
Percentages based on 16 married women, 40 cohabitating women and 162 single women who reported a new partner at Wave 2.
women are more likely than married or single women to report experiencing lifetime and current relationship IPV. Married women were older, more likely to be White, and reported less substance use compared to cohabitating or single women. Because previous studies have shown IPV to occur more frequently among younger, minority and cohabitating couples (Heyman & Neidig, 1999; Magdol et al., 1998b), we controlled for age, race, and married and cohabitating status in all subsequent analyses. Table 2 presents the zero-order correlations among violence and substance use variables for the full sample. Wave 1 drug use level was positively and significantly correlated with most Wave 1 and Wave 2 IPV variables. Although Wave 1 heavy episodic drinking was positively correlated with drug use, it was generally not correlated with either Wave 1 or Wave 2 IPV. 3.2. Does women’s substance use predict intimate partner violence within ongoing relationships? We examined the impact of women’s Wave 1 substance use on their experiences of IPV within ongoing relationships, as reported at Wave 2. Two separate hierarchical logistic regressions were performed, the first predicting minor violence reported at Wave 2 and the second predicting severe violence at Wave 2. These analyses considered experiences of Wave 2 violence that were perpetrated by the man identified as the current partner at Wave 1, that is, within ongoing relationships. On the first step, race, age, married (yes/no), and cohabitating (yes/no) status at Wave 1 were entered. On the second step, we entered Wave 1 severe psychological aggression, as well as Wave 1 minor violence (in the equation predicting minor violence) or severe violence (in the equation predicting severe violence). Psychological aggression has been identified as a predictor of subsequent IPV within existing relationships (Quigley & Leonard, 2000). On the last step we entered Wave 1 substance use variables: frequency of heavy episodic drinking in the past 12 months and
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Table 2 Intercorrelations among Wave 1 and Wave 2 violence and substance use variables 1 1. W1 psychological aggression 2. W1 minor physical violence 3. W1 severe physical violence 4. W1 heavy episodic drinking frequency 5. W1 drug use (0 = none, 1 = marijuana, 2 = hard drugs) 6. W2 minor physical violence 7. W2 severe physical violence 8. W2 violence—new partnera 9. W2 heavy episodic drinking frequency 10. W2 drug use frequency
2
3
4
5
6
7
8
9
.55*** .52***
.56***
.01
.02
.01
.07
.15***
.11**
.39***
.39***
.37***
.32***
.08*
.19***
.30***
.27***
.33***
.05
.18*** .57***
.02
.16
.17*
.03
.20**
.01
.01
.02
.65*** .32*** .11**
.10**
.09*
.13**
.30*** .57*** .17*** .21***
.12
.05 .08*
.08 .05 .27***
a
Correlations involving Wave 2 violence based on n = 218. All other correlations based on n = 724. * P < .05. ** P < .01. *** P < .001.
level of illicit drug use in the past 12 months. So that we could distinguish between the effects of marijuana use and hard drug use relative to no drug use, we performed an indicator contrast for this categorical variable, using no drug use as the reference category. As shown in Table 3, the addition of the substance use variables substantially improved prediction of Wave 2 minor violence beyond the contribution of Wave 1 violence. This increase in predictive power was due to significantly increased odds of experiencing Wave 2 violence associated with hard drug use; neither heavy episodic drinking nor marijuana use alone were significant independent predictors of Wave 2 minor violence. The pattern of results was identical for prediction of severe violence. In sum, increased odds of experiencing Wave 2 violence within ongoing relationships were associated with being younger, cohabitating, experiencing Wave 1 psychological aggression and violence, and Wave 1 hard drug use. 3.3. Does women’s substance use predict intimate partner violence in new relationships? Although most Wave 1 partners were still classified by the women as current partners at Wave 2, 193 (26.7%) reported that these relationships had ended by Wave 2 and 218 women (30.1%) reported a new heterosexual partner at some point in the preceding 12
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Table 3 Hierarchical logistic regression predicting Wave 2 minor and severe violence from same partner v2 Minor violence Step 1 Racea Age Cohabitating Married Step 2 W1 psychological aggression W1 minor violence Step 3 Heavy episodic drinking Marijuana use only Hard drug use Severe violence Step 1 Race1 Age Cohabitating Married Step 2 W1 psychological aggression W1 severe violence Step 3 Heavy episodic drinking Marijuana use only Hard drug use
Step OR
Step 95% CI
Final OR
Final 95% CI
0.66* 0.93 2.57*** 1.13
0.45 – 0.98 0.88 – 0.98 1.69 – 3.88 0.67 – 1.89
0.68 0.91** 2.04** 1.12
0.44 – 1.07 0.86 – 0.97 1.27 – 3.29 0.62 – 2.02
3.83*** 3.22***
2.39 – 6.13 2.05 – 5.06
3.94*** 3.05***
2.44 – 6.36 1.91 – 4.85
1.20 0.98 2.41**
0.93 – 1.56 0.59 – 1.64 1.36 – 4.26
1.20 0.98 2.41**
0.93 – 1.56 0.59 – 1.64 1.36 – 4.26
0.58* 0.96 1.71* 0.50
0.35 – 0.97 0.89 – 1.03 1.00 – 2.92 0.22 – 1.13
0.68 0.91** 2.04** 1.12
0.44 – 1.07 0.86 – 0.97 1.27 – 3.29 0.62 – 2.02
3.63*** 3.92***
1.98 – 6.67 2.01 – 7.64
3.94*** 3.05***
2.44 – 6.36 1.91 – 4.85
1.00 1.78 2.87**
0.71 – 1.40 0.92 – 3.44 1.39 – 5.92
1.00 1.78 2.87**
0.71 – 1.40 0.92 – 3.44 1.39 – 5.92
36.29***
115.49***
16.71**
21.42***
67.80***
9.69*
a Odds ratio less than 1 indicates that White women are at decreased risk. * P < .05. ** P < .01. *** P < .001.
months. To examine whether Wave 1 substance use was associated with the likelihood of having a new partner by Wave 2, hierarchical logistic regression was performed. Demographic variables were entered on the first step, followed by Wave 1 psychological aggression, minor violence, and severe violence on the second step, and substance use variables on the third step. Women were less likely to enter a new relationship if they were White, older, married, and cohabitating, and more likely if they experienced minor violence. After controlling for these variables, substance use improved prediction of entering a new relationship (v2 = 48.27, P < .001). Heavy episodic drinking (OR = 1.76, CI 1.38–2.26), use of marijuana (OR = 2.03, 95% CI = 1.30–3.15), and use of hard drugs (OR = 1.79, 95% CI = 1.04 –3.07) all increased the odds of entering a new relationship.
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Table 4 Hierarchical logistic regression predicting Wave 2 violence from a new partner v2 Step 1 Racea Age Cohabitating Step 2 W1 minor violence Step 3 Heavy episodic drinking Marijuana use only Hard drug use
Initial OR
CI
Final OR
Final CI
16.26** 0.34* 0.83* 3.48*
0.14 – 0.86 0.70 – 0.98 1.27 – 9.55
0.25* 0.77** 3.59*
0.09 – 0.73 0.64 – 0.93 1.17 – 10.97
3.64*
1.11 – 11.87
4.11*
1.14 – 14.86
0.69 5.90* 15.57**
0.36 – 1.31 1.50 – 23.84 3.03 – 80.08
0.69 5.90* 15.57**
0.36 – 1.31 1.50 – 23.84 3.03 – 80.08
5.43* 14.74**
a
Odds ratio less than 1 indicates that White women are at decreased risk. *P < .05. **P < .01.
Hierarchical logistic regression was used to examine whether Wave 1 substance use was associated with increased odds of experiencing any Wave 2 violence from a new partner.1 Because only 16 married women reported a new partner at Wave 2, they were omitted from this analysis, resulting in n = 202. Demographic variables were entered on the first step, followed by lifetime history of minor IPV on the second step, and Wave 1 substance use variables on the third step. As shown in Table 4, after controlling for demographics and history of minor violence, the addition of Wave 1 substance use substantially improved prediction of violence from a new partner. The indicator contrast, comparing marijuana use only to no drug use and hard drug use to no drug use, revealed that both types of drug use resulted in increased odds of experiencing Wave 2 violence from a new partner relative to women who did not use drugs. Heavy episodic drinking did not predict violence from a new partner. 3.4. Do women’s experiences of intimate partner violence predict subsequent substance use? The relationship between women’s substance use and experiences of IPV may be bidirectional. That is, women may increase their frequency of substance use in response to experiencing partner violence. To determine whether experiencing IPV contributes to subsequent substance use, we conducted two separate hierarchical multiple regressions, the first predicting frequency of Wave 2 heavy episodic drinking, the second predicting frequency of Wave 2 drug use. We used frequency of drug use, rather than drug use level as the
1
Few women reported experiencing severe violence from a new partner (n = 15) and all of these also reported experiencing minor violence from a new partner. Given the modest sample size and exploratory nature of the analyses, we restricted the equation to prediction of any Wave 2 violence from a new partner, which is equivalent to prediction of minor violence from a new partner.
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dependent variable because we believed that frequency of drug use would be more sensitive to change as a result of experiencing violence. In each of these equations, we entered demographic variables and Wave 1 substance use on the first step. On the second step, Wave 1 psychological aggression, minor violence, and severe violence were included. Wave 1 IPV did not improve prediction of Wave 2 heavy episodic drinking, DR2=.000, P=.93, which was predicted by being White and by Wave 1 drinking. Wave 1 drug use frequency was a significant and strong predictor of Wave 2 drug use frequency; however, Wave 1 violence variables contributed only marginally to prediction of Wave 2 drug use, DR2=.005, P=.07. We speculated that the relationship between experiences of IPV and subsequent substance use may not be direct but rather may be mediated by relationship satisfaction. Path analysis was used to test this notion. As shown in Fig. 1, Wave 1 psychological
Fig. 1. Path analysis: Indirect effects of partner violence on subsequent heavy episodic drinking. All paths shown are significant at P < .05 level or greater. The path coefficients are standardized betas from multiple regression analysis.
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aggression and minor violence (but not severe violence) from the current partner predicted Wave 1 relationship satisfaction, which was in turn negatively associated with Wave 2 heavy episodic drinking. A similar path analysis predicting Wave 2 drug use revealed a nonsignificant negative path from Wave 1 relationship satisfaction to subsequent frequency of drug use (r = .03). A recent study found that increased drug use following partner violence was observed primarily among women who did not initially use drugs at baseline (Salomon et al., 2002). To explore this possibility, we examined whether women who did not use drugs at Wave 1 were more likely to initiate drug use at Wave 2 if they experienced partner violence. We found no differential initiation of drug use at Wave 2 according to whether the woman had experienced Wave 1 minor violence [v2(1) < 1] or severe violence [v2(1) < 1].
4. Discussion The study provides evidence that women who use drugs are at increased risk of experiencing subsequent partner violence, even after controlling for previous IPV experiences and known risk factors such as young age, cohabitation, and previous IPV victimization. Within ongoing relationships, hard drug use, but not marijuana use alone, predicted subsequent minor and severe IPV. One possible explanation for this pattern of results is that drug use itself increases the likelihood that violence will occur in a relationships. Although we did not assess partner drug use, it is likely that drug using women were in partnerships with drug using men. Use of drugs by the woman or her partner may have increased irritability and volatility, impaired social interaction and ability to handle conflict, and thus increased the likelihood of violence. The fact that marijuana use alone was not associated with experiencing violence in ongoing relationships is consistent with research suggesting that marijuana may suppress aggressive responding (Myerscough & Taylor, 1985). Conflicts specifically related to drug use, such as disagreements over sharing available drugs and conflict over spending household resources on drugs may also have contributed to partner violence (Gilbert, El-Bassel, Rajah, Foleno, & Frye, 2001). These types of conflict illustrate both the systemic and economic compulsive violence associated with drug use as described in Goldstein’s (1985) tripartite model. Women in the study of Gilbert et al. (2001) also indicated that they were verbally abused by their partners as a result of their low status as drug-using women. Psychological abuse has been linked to subsequent violence (Quigley & Leonard, 2000). Although it is tempting to conclude that drug use itself led to violence, we have no event-level data linking use of drugs with violent episodes. Hence, an equally plausible explanation for our findings is that it is not women’s drug use per se that increases vulnerability to subsequent violence. Rather, because drug use is illegal and socially deviant, the association between drug use and IPV may reflect the influence of a third variable, such as antisocial behavior, difficulty managing stress or conflict, or risky lifestyle, that is common both to drug users and to women in violent relationships.
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Kilpatrick et al. (1997) also found a prospective relationship between women’s drug use, but not alcohol use, and subsequent experiences of physical and sexual violence from all sources, not limited to intimate partners. These authors explained their results as reflecting the influence of the risky lifestyle associated with drug use on exposure to violence. We believe that our findings regarding drug use and new relationships support this notion. First, drug users are more likely to enter new relationships, thereby increasing their potential exposure to partner violence over time. Further, women who use drugs are more likely to experience violence in these new relationships. This finding is consistent with the suggestion of Kilpatrick et al. that drug users are involved in an illegal and socially deviant subculture that includes violent men. It is likely that drug using women choose their sexual partners from this riskier pool of men. It is noteworthy that women’s heavy episodic drinking did not emerge as a predictor of violent victimization either within ongoing or new relationships. The failure to observe an effect of women’s drinking on subsequent violence within ongoing relationships is consistent with recent evidence suggesting that mutual drinking within couples is associated with higher perceived marital quality (Roberts & Leonard, 1998) and less violence (Quigley & Leonard, 2000) than marriages in which the husband drinks but the wife does not. However, among this sample, heavy episodic drinking was not completely benign but rather was associated with relationship instability. The failure to observe an association between heavy episodic drinking and violence in subsequent relationships may reflect the fact that unlike drug use, alcohol use, even heavy episodic use, is legal, normative, and socially sanctioned among young people. Hence, women who engage in heavy episodic drinking may not be restricted to socializing within deviant social groups or limited to these groups when choosing partners. Although we did not observe a direct effect of violence on subsequent substance use, consistent with Testa and Leonard (2001), experiences of psychological aggression and minor violence were negatively associated with relationship satisfaction. In turn, satisfaction had a modest negative effect on subsequent heavy episodic drinking. We did not find evidence for either a direct or indirect effect of violence on frequency of drug usage or that violence increased the likelihood of initiating drug use. The modest effects of violence on subsequent drinking and the nonsignificant effects on drug use likely reflect the fact that not all women turn to substance use as a way of coping with unhappy relationships. Changes in drug use are likely to be very difficult to detect due to the fact that only about half as many women used drugs as used alcohol. Although the effects of women’s drug use on subsequent experiences of IPV were relatively strong, the interpretation of these effects is not unambiguous. Because the larger study focused on women’s substance use and experiences of victimization, we examined experiences of partner violence solely from the woman’s perspective and did not obtain information the woman’s own perpetration of violence or on the partner’s substance use. Because we did not assess women’s perpetration of IPV, it is plausible that the effect of women’s drug use on her subsequent experiences of partner violence actually reflects the impact of her drug use on her own perpetration of violence toward her partner, and the subsequent impact of her perpetration on her partner’s perpetration toward her. A number
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of studies have demonstrated that women’s perpetration of violence is very highly correlated with men’s perpetration of violence, however, we are not aware of any published studies suggesting that women’s violent behavior is causally linked to male partner’s violent behavior. In the context of longitudinal survey data, it is often impossible to delineate the temporal relationship between these two types of violence. It is also possible that the apparent effects of women’s drug use on subsequent IPV actually reflect effects of male partner’s drug use on his perpetration of violence. As with IPV, women’s drug use is often highly correlated with her partner’s drug use, and distinguishing the independent and interactive effects is often difficult because of the relatively fewer couples in which wives have used drugs but their partners have not (Mudar, Leonard, & Soltysinki, 2001). The use of a large community sample of young women who are involved in various types of relationships of varying length is a strength of the study. Results may not generalize to older women or to high-risk samples, however. Moreover, we caution that our findings regarding the impact of women’s drug use on violence in new relationships, while intriguing, should be considered exploratory given the relatively low number of new relationships and their short duration, resulting in low levels of violence. The availability of Wave 3 data will better enable us to explore the role of women’s substance use on violence as new relationships develop, an area which has received very little research attention. Despite these limitations, this study appears to be the first to establish a temporal relationship between women’s drug use and subsequent experiences of violence. As such, it is an important first step in understanding the role of women’s substance use in their experiences of IPV.
Acknowledgements This research was supported by Grants R01 AA12013 from the National Institute on Alcohol Abuse and Alcoholism and NIH Director’s Office of Research on Women’s Health and K02 AA00284 from the National Institute on Alcohol Abuse and Alcoholism (MT).
References Anderson, K. L. (2002). Perpetrator or victim? Relationships between intimate partner violence and well-being. Journal of Marriage and the Family, 64, 851 – 863. Capaldi, D. M., & Crosby, L. (1997). Observed and reported psychological and physical aggression in young, atrisk couples. Social Development, 6, 184 – 206. Gilbert, L., El-Bassel, N., Rajah, V., Foleno, A., & Frye, V. (2001). Linking drug-related activities with experiences of partner violence: A focus group study of women in methadone treatment. Violence and Victims, 16, 517 – 536. Goldstein, P. J. (1985). The drug/violence nexus: A tripartite conceptual framework. Journal of Drug Issues, 15, 493 – 506. Greenfield, T. K., Graves, K. L., & Kaskutas, L. A. (1999). Long-term effects of alcohol warning labels: Findings from a comparison of the United States and Ontario, Canada. Psychology & Marketing, 16, 261 – 282.
M. Testa et al. / Addictive Behaviors 28 (2003) 1649–1664
1663
Gribble, J. N., Miller, H. G., Rogers, S. M., & Turner, C. F. (1999). Interview mode and measurement of sexual behaviors: Methodological issues. Journal of Sex Research, 36, 16 – 24. Heyman, R. E., & Neidig, P. H. (1999). A comparison of spousal aggression prevalence rates in the U.S. army and civilian representative samples. Journal of Consulting and Clinical Psychology, 67, 239 – 242. Heyman, R. E., O’Leary, K. D., & Jouriles, E. N. (1995). Alcohol and aggressive personality styles: Potentiators of serious physical aggression against wives? Journal of Family Psychology, 9, 44 – 57. Kantor, G. K., & Asdigian, N. (1997). When women are under the influence. Does drinking or drug use by women provoke beatings by men. Recent Developments in Alcoholism, 13, 315 – 336. Kantor, G. K., & Jasinski, J. (1995). Prevention of teen violence: Evaluation of a multidimensional model. Paper Presented at the 4th International Family Violence Conference, Durham, NH. Kantor, G. K., & Straus, M. A. (1989). Substance abuse as a precipitant of wife abuse victimizations. American Journal of Drug and Alcohol Abuse, 15, 173 – 189. Kilpatrick, D. G., Acierno, R., Resnick, H. S., Saunders, B. E., & Best, C. L. (1997). A two-year longitudinal analysis of the relationships between violent assault and alcohol and drug use in women. Journal of Consulting and Clinical Psychology, 65, 834 – 847. Lipsey, M. W., Wilson, D. B., Cohen, M. A., & Derzon, J. H. (1997). Is there a causal relationship between alcohol use and violence? A synthesis of evidence. In M. Galanter (Ed.), Recent developments in alcoholism ( pp. 245 – 282). New York: Plenum. Magdol, L., Moffitt, T. E., Caspi, A., Newman, D. L., Fagan, J., & Silva, P. A. (1997). Gender differences in partner violence in a birth cohort of 21-year-olds: Bridging the gap between clinical and epidemiological approaches. Journal of Consulting and Clinical Psychology, 65, 68 – 78. Magdol, L., Moffitt, T. E., Caspi, A., & Silva, P. A. (1998a). Developmental antecedents of partner abuse: A prospective-longitudinal study. Journal of Abnormal Psychology, 107, 375 – 389. Magdol, L., Moffitt, T., Caspi, A., & Silva, P. A. (1998b). Hitting without a license: Testing explanations for differences in partner abuse between young adult daters and cohabitors. Journal of Marriage and the Family, 60, 41 – 55. Malik, S., Sorenson, S. B., & Aneshensel, C. S. (1997). Community and dating violence among adolescents: Perpetration and victimization. Journal of Adolescent Health, 21, 291 – 302. McLaughlin, I. G., Leonard, K. E., & Senchak, M. (1992). Prevalence and distribution of premarital aggression among couple applying for a marriage license. Journal of Family Violence, 7, 309 – 319. Mudar, P., Leonard, K. E., & Soltysinki, K. (2001). Discrepant substance use and marital functioning in newlywed couples. Journal of Consulting and Clinical Psychology, 69, 130 – 134. Myerscough, R., & Taylor, S. P. (1985). The effects of marijuana on human physical aggression. Journal of Personality and Social Psychology, 49, 1541 – 1546. Quigley, B. M., & Leonard, K. E. (2000). Alcohol and the continuation of early marital aggression. Alcoholism, Clinical and Experimental Research, 24, 1003 – 1010. Roberts, L. J., & Leonard, K. E. (1998). An empirical typology of drinking partnerships and their relationship to marital functioning and drinking consequences. Journal of Marriage and the Family, 60, 515 – 526. Salomon, A., Bassuk, S. S., & Huntington, N. (2002). The relationship between intimate partner violence and the use of addictive substances in poor and homeless single mothers. Violence Against Women, 8, 785 – 815. Schumacher, J. A., Feldbau-Kohn, S., Slep, A. M. S., & Heyman, R. E. (2001). Risk factors for male-to-female partner physical abuse. Aggression and Violent Behavior, 6, 281 – 352. Silverman, J. G., Raj, A., Mucci, L. A., & Hathaway, J. E. (2001). Dating violence against adolescent girls and associated substance use, unhealthy weight control, sexual risk behavior, pregnancy, and suicidality. JAMA: Journal of the American Medical Association, 286, 572 – 579. Stets, J. E., & Straus, M. A. (1990). Gender differences in reporting marital violence and its medical and psychological consequences. In M. A. Straus, & R. J. Gelles (Eds.), Physical violence in American families ( pp. 151 – 165). New Brunswick, NJ: Transaction. Straus, M. A., Hamby, S. L., Boney-McCoy, S., & Sugarman, D. B. (1996). The Revised Conflict Tactics Scales (CTS2): Development and preliminary psychometric data. Journal of Family Issues, 17, 283 – 316.
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Testa, M., & Leonard, K. E. (2001). The impact of marital aggression on women’s psychological and marital functioning in a newlywed sample. Journal of Family Violence, 16, 115 – 130. Welte, J., Barnes, G., Wieczorek, W., Tidwell, M. -C. O., & Parker, J. (2001). Alcohol and gambling pathology among U. S. adults: Prevalence, demographic patterns and comorbidity. Journal of Studies on Alcohol, 62, 706 – 712. White, H. R., & Chen, P. -H. (2002). Problem drinking and intimate partner violence. Journal of Studies on Alcohol, 63, 205 – 214.