Domestic violence and alcohol use: Trauma-related symptoms and motives for drinking☆
Introduction
Compared with men, women are disproportionately exposed to chronic types of interpersonal violence (IPV), such as domestic violence (Kessler et al., 2001, Jones et al., 2001). Chronic traumatic events have been implicated in more severe post-trauma symptomatology, such as depression, PTSD, and complex PTSD (CPTSD), a proposed diagnosis intended to address trauma-related psychopathology (Herman, 1992, Roth et al., 1997). Chronic traumatic events have also been associated with increased problems with alcohol use (Clark and Foy, 2000, Simpson, 2003, Stewart, 1996). However, the relationships among IPV, alcohol use, trauma symptoms, and motives for drinking have been relatively unaddressed in the literature. This study examines alcohol use among battered women from a community sample. Particular attention is paid to the predictive value of trauma symptoms and motives for heavy episodic drinking.
As noted above, chronic traumatic events have been associated with multiple negative sequelae. The term “complex PTSD” has been proposed to capture a broad range of affective, behavioral, and interpersonal symptoms (Herman, 1992) thought to be associated features of PTSD (Roth et al., 1997), including changes in affect regulation, difficulties with impulsivity, alterations in consciousness or attention, disruptions in sense of self, disruptions in interpersonal relationships, somatization, and changes in beliefs (Allen et al., 1998, Ford and Kidd, 1998, Roth et al., 1997). Follow-up studies examining CPTSD across various types of chronic traumatic IPV found support for the clinical usefulness of the symptom constellation (e.g., Ford and Kidd, 1998, Roth et al., 1997).
Exposure to repeated interpersonal traumatic events also has been associated with alcohol use and alcohol use disorders (Nelson et al., 2002, Volpicelli et al., 1999). Specifically, IPV is associated with greater likelihood of alcohol-related consequences in women (Rice et al., 2001). In a large prospective study, IPV during the first year of marriage was predictive of heavy episodic drinking one year later (Testa, Livingston, & Leonard, 2003).
The relationship between chronic traumatic events and both alcohol-related consequences and heavy episodic drinking appears to be explained by PTSD symptoms (for reviews, see Jacobsen et al., 2001, Stewart, 1996), such that those meeting criteria for PTSD are also more likely to experience negative consequences related to drinking and to engage in heavy episodic drinking. Further, research examining the functional relationships among trauma, PTSD, and alcohol use has consistently found that drinking is motivated by various coping-oriented reasons. These include using alcohol to medicate sleep difficulties (Nishith, Resick, & Mueser, 2001) and to reduce negative affect (Cannon et al., 1992), tension (Simpson, 2003), and PTSD hyperarousal symptoms (Stewart, Conrod, Samoluk, Pihl, & Dongier, 2000). In addition, associations have been found between alcohol consumption and higher levels of intrusive symptoms of PTSD (Read, Brown, & Kahler, 2004).
The self-medication hypothesis has been proposed as an explanation for the relationship between PTSD symptoms and alcohol use (McFarlane, 1998, Stewart, 1996). The self-medication hypothesis states that alcohol is used to reduce or manage symptoms of PTSD, and negative reinforcement maintains the alcohol use. In support of this theory, negative reinforcement has been found to mediate the relationship between psychological distress and alcohol use in sexual assault victims (Miranda, Meyerson, Long, Marx, & Simpson, 2002).
Coping motives are beliefs regarding the use of alcohol as a means to cope with negative affect and psychological distress (Cooper, Frone, Russell, & Mudar, 1995). Studies examining coping motive models of post-trauma alcohol use in women have found significant relationships between coping motives and alcohol consumption and between coping motives and PTSD, depression, and anxiety symptoms (Grayson and Nolen-Hoeksema, 2005, Schuck and Widom, 2001, Ullman et al., 2005). In these studies, coping motives were found to act as a mediator between psychological distress and alcohol use (Grayson & Nolen-Hoeksema, 2005) and as a mediator between PTSD and alcohol problems (Ullman et al., 2005). Consistent with the self-medication model, these findings suggest coping motives are a critical component in explaining trauma-related alcohol use. However, these relationships have been demonstrated only in victims of sexual victimization. Thus, it is unknown whether coping mediates the relationship between trauma symptoms and alcohol use in other trauma-exposed populations.
Section snippets
Rationale of the present study
As noted, previous research has addressed the relationship between exposure to chronic traumatic events and alcohol use; however, the potential contributing role of trauma symptoms, including symptoms of both PTSD and CPTSD, to problematic alcohol use has not been examined. In addition, relatively little of the research conducted has focused on potential explanatory mechanisms of the relationships between trauma symptoms and heavy episodic drinking (Grayson and Nolen-Hoeksema, 2005, Ullman et
Participants
This sample consisted of 369 participants recruited from local domestic violence shelters (49%) and other victim-assistance agencies (51%) through flyers. Sixty-seven women did not meet inclusion criteria during the telephone screenings. Twelve additional women were excluded due to apparent psychosis, illiteracy, intoxication at the time of the assessment, or potential danger to the participant. During telephone screenings, relationship duration and abuse severity were assessed. Participants
Recent alcohol consumption
Of the women who reported using alcohol, the average drinking days in a month was nearly seven (M = 6.7, SD = 7.4). The average number of standard drinks consumed during one day was 4.2 (range: .25–25; SD = 5.3).
Peak drinking and trauma-related symptoms
With the use of Wilks' criterion, the combined DVs were significant, F(6, 638) = 2.14, p < .05. The univariate tests were statistically significant for dysphoria, F(2, 323) = 5.21, p < .01, and trauma factors, F(2, 323) = 5.69, p < .01. Based on a Tukey HSD posthoc comparison between the three groups,
Overview
This study examined relationships between trauma symptoms and heavy episodic drinking in recent domestic violence victims. Although the relationship between exposure to chronic traumatic events, PTSD symptomatology, and increased alcohol problems has been described in previous studies (Schuck and Widom, 2001, Testa et al., 2003), this is the first study to examine whether trauma symptoms, more broadly, are also associated with alcohol use. This study is also the first to provide support for the
References (40)
- et al.
Affective correlates of alcohol and cocaine use
Addictive Behaviors
(1992) - et al.
Patterns and mental health predictors of domestic violence in the United States: Results from the National Comorbidity Survey
International Journal of Law and Psychiatry
(2001) - et al.
Substance use and posttraumatic stress disorders: Symptom interplay and effects on outcome
Addictive Behaviors
(2004) - et al.
Childhood victimization and alcohol symptoms in females: Causal inferences and hypothesized mediators
Child Abuse and Neglect
(2001) - et al.
The reliability of the Alcohol Timeline Followback when administered by telephone and by computer
Drug and Alcohol Dependence
(1996) - et al.
Functional associations among trauma, PTSD and substance-related disorders
Addictive Behaviors
(1998) - et al.
Women's substance use and experiences of intimate partner violence: A longitudinal investigation among a community sample
Addictive Behaviors
(2003) - et al.
Complex posttraumatic stress disorder in women from a psychometric perspective
Journal of Personality Assessment
(1998) - et al.
The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations
Journal of Personality and Social Psychology
(1986) Trauma symptom inventory: Professional manual
(1995)
Methodological issues in the study of sexual abuse effects
Journal of Consulting and Clinical Psychology
Trauma Symptom Inventory: Psychometrics and association with childhood and adult victimization in clinical-samples
Journal of Interpersonal Violence
Trauma exposure and alcohol use in battered women
Violence Against Women
Drinking to regulate positive and negative emotions: A motivational model of alcohol use
Journal of Personality and Social Psychology
Development and validation of a three-dimensional measure of drinking motives
Psychological Assessment
Early childhood trauma and disorders of extreme stress as predictors of treatment outcome with chronic posttraumatic stress disorder
Journal of Traumatic Stress
Motives to drink as mediators between childhood sexual assault and alcohol problems in adult women
Journal of Traumatic Stress
Complex PTSD: A syndrome in survivors of prolonged and repeated trauma
Journal of Traumatic Stress
Toward terminological, conceptual, and statistical clarify in the study of mediators and moderators: Examples from the child-clinical and pediatric psychology literatures
Journal of Consulting and Clinical Psychologyv
Substance use disorders in patients with posttraumatic stress disorder: A review of the literature
American Journal of Psychiatry
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This research was supported in part by NIMH Grant R01MH55542 (P.I., Patricia A. Resick, Ph.D.) by NIAAA Grant F32AA014728-01 (P.I., Debra Kaysen, Ph.D.) and by a grant from the Alcohol Beverage Medical Research Foundation. Portions of this manuscript were presented as a poster at the 27th Annual Meeting of the Research Society on Alcoholism. Vancouver, B.C. (June, 2004).