Interventions to reduce intimate partner violence perpetration among people with substance use disorders

The Effectiveness of Intervention Programs for Perpetrators of Intimate Partner Violence with Substance Abuse and/or Mental Disorders: A Systematic Review

Despite the high prevalence and severity of intimate partner violence (IPV) perpetration among men with mental health (MH) problems and substance use (SU), there is limited evidence on the most effective ways to reduce IPV within these groups. Hence, the present systematic review aims to evaluate the effectiveness of psychological interventions for male IPV perpetrators with MH issues and SU problems. Five databases (B-On, Pubmed PsycInfo, Science Direct, and Scopus) were searched for studies examining the effectiveness of IPV interventions. Twenty-three studies met the inclusion criteria, with 13 interventions described. Interventions were grouped into (1) specific interventions for SU among IPV perpetrators (k = 8), (2) nonspecific interventions for SU among IPV perpetrators (K = 3), and (3) specific interventions targeting MH among IPV perpetrators (k = 2). Cognitive behavioral therapy and motivational interviewing techniques were the most common approaches. Both specific and nonspecific programs addressing SU problems showed some positive effects on perpetrators' behavior and attitudes. However, data from the two intervention programs focusing on MH showed reduced symptoms and re-assaults but without significant differences between the conditions. Despite methodological shortcomings in the studies, the specific and nonspecific interventions targeting SU and IPV show promise, which hinders drawing firmer conclusions. Nonetheless, further research is necessary to deepen our understanding of the MH impact interventions on IPV perpetrators.

Integrated Motivational Strategies for Intimate Partner Violence Perpetrators with Substance Use: A Randomized Controlled Trial

Objective: Intimate partner violence (IPV) perpetrators with alcohol and/or other drug use problems (ADUPs) have been identified as one of the main high-risk and highly resistant groups of perpetrators requiring special attention in intervention programs for IPV perpetrators. This randomized controlled trial (RCT) aimed to evaluate whether an individualized motivational plan adjusted to ADUPs (IMP-ADUPs) was superior to standard motivational strategies (IMP) in reducing ADUPs, and IPV and increasing treatment adherence in IPV perpetrators. Method: Data from a full sample of IPV perpetrators (n = 140) and a subsample of participants with ADUPs (n = 55) were collected at pre- and post-intervention and 12-month follow-up. Final outcomes included alcohol, cocaine, and cannabis use, self-reported IPV, risk of recidivism assessed by facilitators, and official IPV recidivism. Proximal outcomes included treatment adherence (stage of change, intervention dose, active participation, and dropout). Results: Both intent-to-treat (ITT) and per-protocol (PP) analyses were conducted. The IMP-ADUPs condition was superior to the IMP in reducing alcohol use at post-intervention in both the full sample and ADUPs subsample. The full sample of participants in the IMP-ADUPs condition were in a more advanced stage of change post-intervention and showed increased active participation during the intervention process than IMP participants. All participants were in a more advanced stage of change at post-intervention and reduced their alcohol use and their risk of recidivism at post-intervention and 12-month follow-up. Conclusions: These results underscore the need to develop individualized treatment approaches to address participants' risks and needs and promote their motivation to change.

Treatment effectiveness for male intimate partner violence perpetrators depending on problematic alcohol use

BACKGROUND

Problematic alcohol use (PAU) is highly correlated with intimate partner violence perpetration (IPV). However, when treatments for male IPV perpetrators that address alcohol consumption are evaluated, the results are varied. Therefore, the main goal of this study was to assess the differential long-term effectiveness of a standard individual treatment programme for male IPV perpetrators depending on the presence of PAU.

METHODS

The sample was composed of 641 male IPV perpetrators who completed a specialized individual treatment programme for gender violence perpetrators. All of the participants were followed for one year after treatment completion.

RESULTS

The effects of PAU on treatment success were evaluated by means of multiple logistic regression analyses. The full model was reliable (χ² = 10.243; df = 3; p = .016), and overall, 88.8% of the predictions were accurate. The findings indicated that the probability of successful treatment does not depend on the presence of PAU.

CONCLUSIONS

The relationship between IPV perpetration and PAU is highly complex, and several underlying mechanisms should be further evaluated. Accordingly, interventions should not only screen for alcohol consumption but also for all individual characteristics that might necessitate tailored treatment.

Intimate Partner Aggression During the COVID-19 Pandemic: Associations With Stress and Heavy Drinking

Objective

This study aimed to test empirically whether (1) the local impact of the COVID-19 pandemic was associated with increases in intimate partner aggression (IPA) and heavy drinking, and (2) heavy drinking moderated the association between COVID-19 stress and IPA perpetration.

Method

Participants were 510 individuals (approximately 50% who endorsed a sexual or gender minority identity) recruited via Qualtrics Research Services in April 2020, during the height of shelter-in-place (SiP) restrictions across the United States. They completed a questionnaire battery that included measures of COVID-19 stressors, physical and psychological IPA perpetration, and heavy drinking.

Results

Rates of physical and psychological IPA perpetration significantly increased after implementation of SiP restrictions which aimed to mitigate the transmission of COVID-19. COVID-19 stress was significantly and positively associated with physical and psychological IPA perpetration; however, COVID-19 stress was positively associated with physical IPA perpetration among non-heavy drinking, but not heavy drinking, participants.

Conclusions

Drawn from a large sample of participants of diverse sexual identities, findings tentatively implicate COVID-19 stress as a critical correlate of IPA perpetration and suggest that "low risk" individuals (i.e., non-heavy drinkers) should not be overlooked. These data provide preliminary support for the usefulness of public health polices and individual-level interventions that target stress, heavy drinking, and their antecedents.

Risk factors for elevations in substance use and consequences during the COVID-19 pandemic among sexual and gender minorities assigned female at birth

BACKGROUND

Problematic substance use (SU) has increased substantially during the COVID-19 pandemic. While studies have identified risk factors for problematic SU during the pandemic (e.g., anxiety, depression, using substances to cope), these studies have been predominately cross-sectional, rarely examined changes in SU contexts during the pandemic as potential risk factors, and neglected sexual and gender minorities (SGM) - a health disparity population disproportionately impacted by substance use disorders and the pandemic.

METHOD

We utilized two waves of data collected one month apart from a sample of 212 SGM assigned female at birth who used alcohol and/or cannabis (18-25 years old) collected between August 2020-February 2021. We examined associations between potential risk factors (i.e., retrospectively reported changes in anxiety/depression and in using substances in different contexts since before the pandemic): and 1) retrospectively reported changes in alcohol and cannabis consumption; 2) coping motives for use and SU consequences; and 3) subsequent changes in coping motives and consequences.

RESULTS

An increase in solitary SU was a robust risk factor for concurrent and prospective increases in SU, coping motives, and consequences. Increases in SU with romantic partners were associated with concurrent increases in alcohol/cannabis consumption and consequences. Increases in anxiety and depression were associated with concurrent increases in SU and higher coping motives and consequences.

CONCLUSIONS

Results indicate that solitary SU and increases in SU with romantic partners are robust risk factors for increases in SU and consequences in the context of the pandemic. Further, findings provide support for the self-medication theory of substance use.

Cognitive and Affective Mediators of Alcohol-Facilitated Intimate Partner Aggression

This multisite study examined whether aggressive cognitions and facial displays of negative affect and anger experienced during provocation mediated the association between alcohol intoxication and intimate partner aggression (IPA). Participants were 249 heavy drinkers (148 men, 101 women) with a recent history of IPA perpetration. Participants were randomly assigned to an Alcohol or No-Alcohol Control beverage condition and completed a shock-based aggression task involving apparent provocation by their intimate partner. During provocation, a hidden camera recorded participants' facial expressions and verbal articulations, which were later coded using the Facial Action Coding System and the Articulated Thoughts in Simulated Situations paradigm. Results indicated that the positive association between alcohol intoxication and partner-directed physical aggression was mediated by participants' aggressive cognitions, but not by negative affect or anger facial expressions. These findings implicate aggressogenic cognitions as a mediating mechanism underlying the association between the acute effects of alcohol and IPA perpetration.

Spirituality and Parenting among Women Experiencing Intimate Partner Violence

PURPOSE

While spirituality and parenting have been examined among caregivers experiencing adversity, less research has explored these factors among mother survivors of intimate partner violence (IPV). Given the potentially protective role of spirituality, understanding how parenting is associated with spirituality is important.

METHOD

The current study explored parenting practices, parent-child communication, and spirituality among 175 women caregivers who had experienced recent IPV. Hierarchical linear regression was used to examine associations between maternal age, education, HIV status, and illicit substance use (model 1); child age and gender (model 2); parent-child comfort communicating about sexual practices, IPV, HIV/AIDS, and substance use (model 3); and positive and negative parenting practices (model 4) with spirituality.

RESULTS

Findings suggested positive parenting practices, greater comfort talking about IPV, and greater discomfort talking about substance use were associated with higher spirituality.

CONCLUSIONS

Results highlight the value of parenting and communication strategies among women caregivers experiencing recent adversity.

Differential cognitive profiles of intimate partner violence perpetrators based on alcohol consumption

Despite extensive evidence of heterogeneity in intimate partner violence (IPV) perpetrator profiles, there has been little research into neuropsychological deficits that might help us understand differences within this violent population. Moreover, studies on this topic have not paid much attention to the role of alcohol abuse in neuropsychological domains of IPV perpetrators. Hence, the current study was designed to examine neuropsychological differences among individuals who have committed domestic violence with high (n = 28, HA) and low (n = 35, LA) levels of alcohol consumption, and non-violent individuals (n = 37) to establish differential neuropsychological profiles. An exhaustive neuropsychological assessment battery was employed which combined the computer-based Cambridge Neuropsychological Test Automated Battery with pencil-and-paper measures. Compared to controls, HA IPV perpetrators had slower processing speed and significantly more impairments in attentional set-shifting or switch attention, working and long-term memory, cognitive flexibility, planning, decision-making, emotion decoding skills, and perspective taking. Furthermore, there were differences between IPV perpetrator subgroups in attentional set-shifting or switch attention and cognitive empathy, with HA IPV perpetrators displaying more severe impairments in both cognitive domains than LA IPV perpetrators. Finally, the LA IPV perpetrators had significantly more impairments in working and long-term memory, executive functioning, and emotion decoding skills than controls, but they did not differ in processing speed, attentional set-shifting or switch attention, decision making, or perspective taking. Thus, the current findings suggest that IPV perpetrators with neuropsychological difficulties, especially those who are heavy drinkers, may have the greatest need for cognitive interventions. These cognitive deficits could be employed as targets for developing specific cognitive rehabilitation programs adjuvant to psychotherapeutic intervention for IPV perpetrators.

Understanding Men's Elevated Alcohol Use, Gender Equity Ideologies, and Intimate Partner Violence Among Married Couples in Rural India

Qualitative evidence suggests that husbands' inequitable gender equity (GE) ideologies may influence associations between husbands' alcohol use and intimate partner violence (IPV) against wives. However, little quantitative research exists on the subject. To address this gap in the literature, associations of husbands' elevated alcohol use and GE ideologies with wives' reports of IPV victimization among a sample of married couples in Maharashtra, India, were examined. Cross-sectional analyses were conducted using data from the baseline sample of the Counseling Husbands to Achieve Reproductive Health and Marital Equity (CHARM) study. Participants included couples aged 18 to 30 years ( N = 1081). Regression models assessed the relationship between husbands' elevated alcohol use and GE ideologies (using the Gender-Equitable Men [GEM] Scale) and wives' history of physical and/or sexual IPV victimization ever in marriage. Husbands and wives were 18 to 30 years of age, and married on average of 3.9 years ( SD ± 2.7). Few husbands (4.6%) reported elevated alcohol use. Husbands had mean GEM scores of 47.3 ( SD ± 5.4, range: 35-67 out of possible range of 24-72; least equitable to most equitable). Approximately one fifth (22.3%) of wives reported a history of physical and/or sexual IPV. Wives were less likely to report IPV if husbands reported greater GE ideologies (adjusted odds ratio [AOR]: 0.97, 95% CI [0.95, 0.99]), and husband's elevated alcohol use was associated with increased risk of IPV in the final adjusted model (AOR: 1.89, 95% CI [1.01, 3.40]). Findings from this study indicate the need for male participation in violence intervention and prevention services and, specifically, the need to integrate counseling on alcohol use and GE into such programming.

Effectiveness of secondary and tertiary prevention for violence against women in low and low-middle income countries: a systematic review

BACKGROUND

Violence against women (VAW) is a major problem worldwide, with one in three women experiencing violence in their lifetime. While interventions to prevent violence (primary prevention) are extremely important, they can take many years. This review focuses on secondary and tertiary prevention interventions that address the needs of survivors of violence and aim to prevent recurrence. This review also focuses on studies taking place in low and low-middle income countries, where rates of VAW are highest.

METHODS

Searches of peer-reviewed and grey literature took place from March-June 2016 through databases (Embase, CINAHL, WHO Global Index Medicus, Medline, PsychINFO, Web of Science, Cochrane Library, Applied Social Sciences Index and Abstracts and Sociological Abstracts) and by consulting experts in the field. Only primary research was eligible for inclusion and studies had to focus on secondary or tertiary prevention for survivors of VAW in low or low-middle income countries. All study designs were eligible, as long as the study examined client-related outcome measures (e.g., incidence of violence, health outcomes or client satisfaction). Data were extracted and quality of the studies was assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies and a qualitative quality assessment tool developed by Mays and Pope. Due to the low number of results and heterogeneity of the study populations and outcomes, a narrative synthesis was conducted and evidence was summarized.

RESULTS

One thousand two hundred fifteen studies were identified through the search strategy and 22 of these met the eligibility criteria. Overall, the evidence for interventions is weak and study limitations prevent definitive conclusions on what works. There is some evidence that interventions targeting alcohol use, both among perpetrators and survivors, may be effective at reducing VAW through secondary prevention, and that psychotherapy might be effective for survivors of non-partner sexual violence through tertiary prevention. Finally, some evidence exists for crisis centres increasing survivors' access to services (through both secondary and tertiary prevention), however, assessment of their impact on future VAW are needed.

CONCLUSIONS

Though some interventions for survivors of VAW have shown evidence of effectiveness, further research is needed, especially high-quality studies with quantitative outcome data.