The issues of substance abuse and family violence are, of course, of interest independently. However, there is the growing recognition that many social and human problems such as these, do not occur independently, but actually interweave, interact and impact each other. Such is the case with substance abuse and family violence. The two are closely related, therefore it is important that we take the time to examine the relationship between them. Navigating the complexities of this relationship is no easy task for clinicians, as there are many contributing factors involved in the incidence of both.

Risk Factors

There are shared risk factors in both violence and substance abuse, these risks can come from individual, familial, and environmental factors. While there are not many studies that make use of the appropriate statistical techniques needed to differentiate between causation and coincidence[1], it seems that some of the causes, and certainly the correlates, of family violence and substance abuse intersect. Research in these fields has shown that there is a relationship between the risk factors of both violence and substance abuse.

Individual Factors:

Personality and behavioral correlates of substance abuse and family violence that intersect include hyperactivity[2,3], ’difficult’ temperament[4], impaired attachment to mother[5], early sexual activity[6], antisocial and/or runaway behavior[7], lack of social confidence, difficulty with peer relationships, as well as social isolation and social deprivation [8,9,10,11,12,13,14]. In addition, children who move homes frequently during childhood are at a higher risk for family violence, substance abuse, and parental addiction [15,16,17,18].

Familial Factors:

Researchers have been able to demonstrate that the risk factors that show the strongest connection to family violence and substance abuse are those that relate to parents and family [19,20,21]. Parental/familial factors that contribute to these two issues are parental behaviors and family structuring. These include parental inconsistency, poor limit setting, severe disciplinary tactics [22,23,24,25,26,27,28], poor communication [29,30], parental absence and unavailability [31,32,33,34], and familial social isolation [35,36,37].

In addition, the presence of a stepfather has been shown to dramatically increase the risk of sexual abuse for female children[38]. One could speculate that the high rate of marital discord and conflict in substance abusing families may contribute to divorce, which in turn may lead to the introduction of a stepfather, an outsider, into the addicted family system.

Environmental Factors:

Much of the attention in the areas of substance and family violence has been focused on individual and micro-environmental (family) risk factors. However, macro-level variables clearly play an important role in both [39,40,41,42]. These include community norms [43,44], neighborhood disorganization[45], cultural disenfranchisement[46], and the availability, or lack of availability, of community education on both substance abuse and family violence.

Poor school performance, absence, and early dropping out are known to be factors that increase the risk of alcohol and drug misuse in adolescence. These factors also correlate with children who have been abused and who come from addicted families [47,48,49,50,51,52,53].

Alcohol and Other Drugs as Disinhibitors:

There is agreement among researchers that chemical dependence does not entirely explain sexual abuse or other forms of violence. It can, however, be a contributing factor. Alcohol and drugs have the potential to provoke and amplify any psychiatric disorder or emotional instability that lies within the chemical user, including poor impulse control, bipolar disorder, characterological disorders, low frustration tolerance, and violent behaviors [54,55]. Alcohol and drugs lower the inhibitions that keep people from acting upon violent or sexually aggressive impulses[56]. It appears that if a person has the tendency to behave in a pedophilic, violent, or unacceptable manner, alcohol and/or drugs may act as a psychological disinhibitor, thus enabling the person to engage in these behaviors.

Alcohol and/or drug use may act to enable the offender to disregard the societal taboos around incest and child abuse. Tolerance and patience are also diminished by alcohol and drugs, leaving a parent much more likely to physically harm a child when intoxicated than when sober. Finally, alcohol and/or drug consumption can act to lessen any shame or guilt the abuser may experience after the offense. This numbing of negative emotions or internal inhibition may further perpetuate destructive or aggressive behavior by defending the abuser from his or her own internal process.

Family Communication Problems:

Communication within the addicted family system becomes distorted and dysfunctional. Often the spouse will try to control the alcoholic’s or addict’s behavior by nagging, pleading, or expressing disappointment[57]. As the addict’s disease progresses, communication may become inconsistent, unrealistic, paranoid, or even unintelligible (i.e slurred speech). When intoxicated or hung over, the addict may make some damaging judgmental comments or become verbally abusive to others. If the addict is experiencing drug induced amnesia (a blackout), verbal abuse or promises that are made may be completely forgotten. Dysfunctional communication adds extra tension to the couple and family system, feeding a climate in which family violence may occur. The parents’ frustrations may be misdirected at the children or lead to violent interactions between the couple.

Inconsistent communication may also leave children confused about family rules and disappointed about parental broken promises[58]. Couples may blame each other for their problems. They project onto each other, which keeps either partner from seeing his or her own contribution to the problems, thus eliminating the possibility of change. Patterns of avoidance and withdrawal are often used as a defense against confronting the partner[59]. Avoidance may involve long periods of tense silence that further amplify negative feelings and distrust. The tension of avoidance and withdrawal has the potential for eventual eruption, with the explosive expression of pent-up anger being either physical or verbal.

Similarly to problems in communication, the addicts relationship is hardly ever free of sexual problems[60,61,62]. Excessive use of alcohol or prolonged alcohol use is a common factor in the onset of secondary impotence in men[63], and in infrequent orgasm in women[64]. The spouse of the addict may struggle to respond to the addicts sexual advances while the addict is intoxicated or even sober. The addict may then experience this as rejection and could interpret it as a reflection of his or her inadequacies. Poor sexual relations lead to further stress and frustration for the couple. This frustration and stress may manifest itself as violence toward the children or the spouse, and/or exploitation of children to fulfill sexual needs.

Aggressive Behavior in Children of Substance Abusers:

Another dynamic that links violence and substance abuse concerns the behavior of children of substance abusers (COSAs). It is suggested that COSAs have a specific temperamental vulnerability[65]. These children, as a group, have less ability to recover from emotional distress and increased emotional lability. As such they are more likely to express aggression and tend toward violence.

Treatment

The combination of substance abuse and family violence can be devastating. It can leave children and spouses traumatized, potentially feeding the cycle of abuse. In order to help those who are afflicted by substance abuse and family violence, the substance addiction must be treated alongside the tendency for violence, so that one does not feed the other. Individuals must be equipped with non chemical coping skills to help them process negative emotions and prevent those emotions from transforming into outbursts of violence and abuse.

Substance abuse and family violence is a challenging issue for both researchers and clinicians, as the links between the two can be complex and tightly interwoven. Does substance abuse lead to violence? Or is it violence that leads to substance abuse? Are they caused by other factors common to both? The answers to all these questions may be yes, but it is important to understand the specific circumstances under which each is true. Every day there are more and more victims of substance abuse and family violence. Intervention, prevention, and compassionate awareness are key in tackling these issues.

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