The relationship between violence and alcohol abuse : self perception of addicted adults

102 Pages·2017·0.81 MB·English

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Theses, Dissertations, and Projects
2013
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Andrea Bredfeldt Viens
Smith College
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Viens, Andrea Bredfeldt, "The relationship between violence and alcohol abuse : self perception of
addicted adults" (2013). Masters Thesis, Smith College, Northampton, MA.
https://scholarworks.smith.edu/theses/602
This Masters Thesis has been accepted for inclusion in Theses, Dissertations, and Projects by an authorized
administrator of Smith ScholarWorks. For more information, please contact [email protected].
Andrea B. Viens
The Relationship between Violence
and Alcohol Abuse: Self Perception of
Addicted Adults

ABSTRACT
While it is widely accepted that there is a positive correlation between alcohol
use/abuse and violence, there is little consensus in the literature about the strength and
nature of this association. Thus the need for more complex multivariate and qualitative
studies has been recognized. This qualitative study explored what could be learned from a
sample of men and women who are members of Alcoholic Anonymous (AA) and self-
identify as having engaged in violence while under the influence.
For the vast majority of participants in this study, their violence came first;
however, they first received treatment for their alcohol use/abuse. For these participants,
their story of how their violence began was inextricably linked with the violence they
experienced in childhood; and the only discernable demographic trend was a childhood
history of violence and/or alcohol use/abuse.
In contrast, a history of downward mobility as measured by the parents’ education
and occupation was the only discernable trend in participants where their alcohol
use/abuse came first. This group also received treatment first for their use/abuse of
alcohol and was only violent when abusing alcohol. Finally, the use of alcohol was
associated with intense affect regulation that could work two ways: i.e., release the
inhibition against violent behavior or suppress the urge to act violently. There is a need
for future research to see if these trends are sustained.
THE RELATIONSHIP BETWEEN VIOLENCE AND ALCOHOL ABUSE:

SELF PERCEPTION OF ADDICTED ADULTS

A project based upon an independent investigation,
submitted in partial fulfillment of the requirements
for the degree of Masters of Social Work

Andrea B. Viens

Smith College School for Social Work
Northampton, Massachusetts 01063

2011
ACKNOWLEDGMENTS

This thesis would never have been accomplished without the support and contributions of
many family members and friends, including my life-long editor, Bill. I am particularly
grateful to the participants in this study who shared their life experiences and stories with
me.
I also wish to express my gratitude and appreciation to Dr. Mary Hall for her guidance,
humor, and wealth of knowledge. I am deeply grateful to my children, Hannah and Eben,
who bring me life and teach me how to enjoy it and to my partner, David, for his
generosity of spirit and encouragement.
This thesis is lovingly dedicated in honor of my mother Heide Bredfeldt. Without her
stories, experiences, history, and survival this thesis would never have been conceived.
TABLE OF CONTENTS

ACKNOWLEDGMENTS……………………………………………… ii
TABLE OF CONTENTS…………………………………………….. iii
CHAPTER
I. INTRODUCTION…………………………………………………… 1
II. LITERATURE REVIEW…………………………………………… 6
III. METHODOLOGY………………………………………………… 31
IV. FINDINGS………………………………………………………… 36
V. DISCUSSIOIN AND CONCLUSIONS…………………………… 60
REFERENCES………………………………………………………… 69
APPENDICES
Appendix A: Human Subjects Review Approval……………………. 86
Appendix B: Informed Consent……………………………………… 87
Appendix C: Interview Guide………………………………………… 89
Appendix D: Recruitment Poster……………………………………… 91
Appendix E: Transcriber’s Assurance of Research Confidentiality…… 92
Appendix F: The 12 Steps of Alcoholics Anonymous (AA)…………… 94
Appendix G: Counseling and Support Resource List…………………… 95
CHAPTER I
INTRODUCTION
There has been a growing recognition in the literature on the relationship between
violence and alcohol use of the need for more complex multivariate and qualitative
studies to investigate the natural history, diverse causal pathways and possible points of
intersection between violence and alcohol use/abuse (Lang, 1992; Roizen, 1997; Room &
Rossow, 2001; Wells, et al., 2007). The answers to these questions have far reaching
implications for health/mental health service delivery and public policy planning. For
example, in recognition of the positive correlation between incidents of violence and
alcohol use/abuse it is now widely accepted that the best practice in terms of service
delivery is to establish co-occurring treatment services where both problems can be
treated simultaneously by the same staff as opposed to attempting to treat each problem
separately through either substance abuse or mental health services (Brown, et al., 1999;
Hilarski & Wodarski, 2001; Teesson & Proudfoot, 2003). However, answers to the
questions of how and in what order each problem should be addressed in a particular case
on a co-occurring unit (e.g., can we effectively treat other mental health issues before the
patient stops abusing alcohol completely?) remains more an art than a science and
requires a more nuanced understanding of the interface between violent incidents and
alcohol use/abuse (Chartas & Culbreth, 2001; National Institute on Drug Abuse [NIDA],
2007; Room & Rossow, 2001; Thomas & Bennett, 2009).
To date, a substantial number of studies have explored the relationship between
violent behavior and alcohol use/abuse (Brown, et al., 1999; Foran & Leary 2008;
Godlaski & Giancola, 2009; Mignone, et al, 2009; Pernanen, 1991; Roizen, 1993).
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Included in this body of work are studies that are quantitative (Barnwell, et al., 2006;
Lennings et al., 2003; McMurran & McCulloch,, 2009), qualitative (Graham & Wells,
2003; McMurran, et al., 2010; Spunt et al., 1994) and mixed mythologies (Leonard &
Quigley, 1999; Walsh, 1999; Wells, et al., 2007). Regardless of the methodology,
historically most studies have been done on males. Most frequently studied have been
male offenders incarcerated for violent crimes, e.g. homicide and inter-partner violence
(Mayfield, 1976; Spunt, et al., 1994; Voss & Hepburn, 1968; Wieczoerk, et al., 1990).
There are also a substantial number of studies that look at the co-occurrence of alcohol
and violence in a particular cultural context. In this latter case, most frequently studied
has been drinking and violence in bars and other drinking establishments (Benson &
Archer 2002; MacAndrew & Edgerton, 1969; Parker & Williams, 2003). While
collectively this body of work has corroborated the existence of a positive relationship
between violence and alcohol use/abuse, there has been little consensus about the
strength and nature of this association (Barnwell, et al., 2006; Jenkins, 1990; Miller, et al,
2009; Murdoch, et al, 1990; Room & Rossow, 2001; Scott, et al., 1997; Spunt, et al.,
1994).
It is widely accepted that the cost to society of problems associated with violent
behavior and alcohol use/abuse are enormous with estimates ranging in the billions
(National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2000; National Institute
on Drug Abuse [NIDA], 1992; Miller, et al., 2006; Russo, 2008). This is because the cost
to society is both direct and indirect; and largely affects those who do not have the
problem with violent behavior and/or alcohol use/abuse. For example, the cost of trauma
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related health/mental health issues and damages to person and property born by the
victims of drunk drivers or the perpetrators in cases of interpersonal violence, etc.
(National Institute on Alcohol Abuse and Alcoholism [NIAAA], 2005; Mignone et al.,
2009).
The estimates of violence associated with alcohol use/abuse can range anywhere
from 24% to 86% (Fagan, 1990; Jenkins, 1990; Kinney & Leaton, 1982; Pihl & Peterson,
1995; U.S. Department of Justice [USDJ], 2008). There are many reasons for this
extreme variability. First and foremost definitions of violence are so varied since the
study of violence has been of interest to multiple disciplines e.g. criminology, sociology,
epidemiology, psychology and other health/mental health researchers and practitioners
(Martin, 1993; Miczek, et al., 1997). Violence may be defined as behavior that
intentionally inflicts, or attempts to inflict, physical harm e.g. predatory violence
(NIAAA, 2000; Walsh, 1999). In the same vein, definitions of violence frequently
overlap with the broader category of aggression. The latter may include behaviors that
are threatening, hostile, or damaging in a nonphysical way (NIAAA, 2000). Similarly,
there are many types of physical violence, e.g., rape, sexual abuse, bullying, homicide
etc. Definitions of violence may also vary by context, social and environmental
conditions and individual characteristics (Anderson, 1998; Graham & Wells, 2003;
MacAndrew & Edgerton, 1969; Walsh, 1999). Finally, cultural beliefs and myths as well
as formal legislation and treatment related to those who commit acts of violence can all
be pivotal in how violence comes to be socially constructed in a particular situation (Van
Soest & Bryant, 1995; Winlow, 2001).
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A second important reason associated with the extreme variability in the estimates of
violence associated with alcohol use/abuse is that the association may be two-way. Two
large bodies of work best illustrate this, one that examines alcohol use before violence
and the second examines the reverse, violence preceding alcohol use. In the research
literature reviewed on alcohol use/abuse preceding violence, most frequently asserted is
the disinhibition hypothesis (Boyatzis, 1975; Gutsafson, 1994; Reiss & Roth, 1993).
According to the disinhibition hypothesis, alcohol weakens mechanisms in the brain that
normally restrain aggressive and/or impulsive behavior in individuals with aggressive
tendencies (Boyatzis, 1975; Gutsafson, 1994; Reiss & Roth, 1993). There is also a large
body of work in this area that studies alcohol consumption preceding violence in
interaction with other factors that can impact the expression of aggression or violence,
e.g. drug use, peer pressure, social and cultural expectations (“boys will be boys”), etc
(NIAAA, 2000). In terms of violence preceding alcohol use/abuse most frequently noted
are persons with exposure to extensive violence in their childhood. This includes the
experience of being a victim and/or an observer of interpersonal violence in their home or
community.
A third important reason that estimates of violence associated with alcohol use
vary widely is that the estimates are derived from multivariate studies in which an
association was found between alcohol use and violence that was secondary to the
study’s main question. Roizen (1997) noted that the search for multiple causes of
problem attitudes and behaviors in social research has become increasingly complex in
recent decades. Advances in multivariate methods have become part of the stock in trade
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of the social scientist and can frequently have capabilities beyond what the data will
usually support (Roizen, 1997). Nonetheless, it is widely accepted that there are multiple
ways that alcohol gives rise to violence and violence to alcohol use (Graham & Wells,
2001; Lennings, et al, 2003; Miller et al., 2009). This in turn makes clear that the
relationship between alcohol and violence is complex and there is no one explanatory
model that accounts for the correlation.
In summary, a substantial body of research has explored the relationship between
alcohol use/abuse and violent behavior. It is widely accepted that there is a positive
correlation between these two variables but little consensus about the strength and nature
of the association. There is growing consensus that this is because the association may be
two-way, i.e. violence can precede alcohol use/abuse and vice versa. This has led to the
demand for more complex multivariate and qualitative studies that examine the natural
history, diverse causal pathways and possible points of intersection between violence and
alcohol use/abuse. This study was designed to makes its contribution to filling this gap in
the literature by exploring what we can learn from a sample of men and women who are
members of Alcoholics Anonymous that have at a minimum completed the eighth step of
the twelve step program and also self identify as having engaged in incidence of violence
where alcohol/use abuse was present.
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