Intimate Partner Violence: How Alcohol Misuse Affects It

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A relationship with a spouse or partner affects both mental and physical health. Both persons are entrusted with intimacy, trust, and feelings of safety. However, when one person in the relationship is verbally or physically aggressive toward their partner, the partner becomes a victim of intimate partner violence (IPV). Persons with alcohol use disorder (AUD) also exhibit several patterns of aggression that can amplify the harmful effects of IPV, so understanding and treating both is crucial.

In this article:

What is Intimate Partner Violence?
Types of Abuse and Abusive Relationship
How Alcohol Affects Intimate Partner Violence
Alcohol and Intimate Partner Violence Risk Factors
Integrated Treatment for AUD and Intimate Partner Violence
Why Treat AUD and IPV Simultaneously?

What is Intimate Partner Violence?

An intimate partner can be someone from a current or previous romantic relationship. The relationship may be same-sex, heterosexual, or nonsexual.¹ What makes it intimate are the romantic feelings for the other person.

Intimate partner violence occurs when someone is physically, psychologically, financially, or sexually aggressive or violent towards the other. It can even include harassment, stalking, and cyberstalking behaviors. The goal is to overpower and control the other person in the abusive relationship.¹

According to research from the American Psychiatric Association (APA), one in four women and one in nine men in the United States have experienced intimate partner violence in their lifetimes. Among the survivors of intimate partner violence, 20% report developing new psychiatric symptoms, such as anxiety, depression, and post-traumatic stress disorder (PTSD). They also note an increase in their alcohol and drug misuse.²

Alcohol Use Disorder Criteria Linked to IPV

AUD and IPV can co-occur within a relationship. The American Psychological Association created the Diagnostic and Statistical Manual for Mental Disorders; its fifth edition lists criteria used to diagnose someone with alcohol use disorder. Some of these criteria contribute to the onset of aggression or the escalation of aggression into violence often associated with IPV, including:^3,4,5

Drinking more or for longer than intended: Research shows that the more alcohol consumption, the likelier someone will engage in interpersonal violence. Out of the participants in one study on the relation of alcohol to IPV, 30% to 40% reported that the influence of alcohol increased their potential for more severe acts of aggression or violence against their partner.
Continued drinking despite it causing problems with friends or family: Studies show heavy drinking can lead to a dependence on alcohol, making it too difficult to quit. When trying to stop, severe withdrawal symptoms can appear. These can be so severe that the only way to alleviate them is to continue drinking, despite it causing abusive relationship problems.
Taking risks that could lead to dangerous outcomes: Those who engage in heavy drinking are unable to make good decisions. They can experience blackouts or memory loss. During these blackout periods, they may become aggressive or engage in intimate partner violence. One study found a link between alcohol-related blackouts and the onset of psychiatric symptoms that lead to harmful behaviors.

Types of Abuse and Abusive Relationship

In an abusive relationship, maltreatment of a spouse or partner can take many forms. One or more types of abuse can exist simultaneously. These types of abuse can manifest physically, or they can be observed as verbal and emotional manipulations.⁶

Physical Mistreatment

Physical mistreatment means intentional bodily harm, such as restraining, pinching, hitting, slapping, pushing, or choking. Physical violence may differ among couples. However, some characteristic examples of physical mistreatment include:⁶

Hiding bruises or injuries with clothing, such as wearing long sleeves in the summer
Marks of violence such as cuts, welts, rope marks, or broken items in the home
Visitors not allowed to see the vulnerable person alone
Drug or medication misuse

Psychological Distress

Psychological distress occurs when someone intentionally causes emotional or mental pain. This is achieved through teasing, bullying, yelling, name-calling, infantilizing treatment, or prolonged intentional silence to achieve a goal or coerce behaviors from others. Signs and symptoms of someone under psychological distress include:⁶

Increasing levels of anxiety, especially while around specific people
Behaviors attributed to dementia (rocking, biting, or sucking)
Non-responsiveness or withdrawn silence
Withdrawing or being isolated from friends and family

Sexual Mistreatment

Sexual mistreatment means someone forces unwanted sexual activity. Forced activity can include taking nude photos, touching, watching adult movies, or completing sexual acts. Symptoms of sexual maltreatment include:⁶

Bleeding in underwear or on personal body parts
Reporting about their mistreatment experiences
Bruises on or near genitalia or breasts
Receiving unexpected infections or sexual diseases

Financial Mistreatment

Financial and resource mistreatment occurs when someone takes and misuses money without permission. Examples include using debit cards to clean out the account of a partner or pawning items they stole from the home of their partner. Signs of someone being exploited may consist of:⁶

Finding that money is missing from a bank account
Adding someone unusual to their bank account
Missing home items with no explanation of where they went or why they are missing

Neglect or Abandonment

Neglect and abandonment are cruel acts that can leave someone physically and psychologically troubled. Neglect is when someone does not give their spouse the care they need to stay healthy. Abandonment is when they leave their partner alone in a situation in which they cannot get what they need to stay healthy.

Examples of neglect include not allowing someone to eat or making them sleep in an unsafe location. Examples of abandonment involve dropping them off in the middle of nowhere without transportation, food, water, or other survival tools. Someone who experiences neglect or abandonment may be:

Living in unsanitary conditions
Living alone but unable to take care of themselves
Lacking good personal hygiene

How Alcohol Affects Intimate Partner Violence

Research shows that while men get aggressive and violent more often when drinking alcohol, women are considered the primary aggressor in many intimate partner relationships.⁷

Because alcohol impairs thinking, judgment, and decision-making skills, it enables a person with aggressive tendencies to react violently. This is especially true if someone instigates or provokes an adverse reaction.⁷ Drinking alcohol adds fuel to the fire. The fire, in this scenario, is negative emotions that lead to harmful behaviors.

There is not enough evidence proving alcohol is a causal factor of interpersonal violence, but research shows a direct link between the two. When compared, those with alcohol use disorder (AUD) have different characteristics than those without AUD, including:⁸

Higher levels of impulsive behavior
Increased need to take risks
Lower serotonin levels
Lower dopamine levels
Less activation of the thalamus and hippocampus
Higher activation of the amygdala

Alcohol and Intimate Partner Violence Risk Factors

Biological, environmental, psychological, social, and physiological risk factors may contribute to the development of alcohol use disorder and intimate partner violence. The risk factors listed below are the ones that overlap between developing AUD and engaging in IPV.

Individual Risk Factors

Individual factors can arise from events outside the control of any one person. They can also be due to things they are born with and their own choices. Individual factors include:⁹

Delinquent behavior as a child or teen
One or more mental health disorders
Insufficient non-violent coping skills
Poor control over impulses
Low self-esteem and insecurity
History of physical or psychological types of abuse
Strong desire for power and control
Lack of positive friendships and relationships
High emotional dependency on others

Community Factors

Community factors are the elements of the area in which someone lives that influence thoughts, feelings, and actions. For example, someone living in a neighborhood with easy access to affordable higher education is more likely to obtain a college degree. There may also be neighborhood elements that negatively impact a life. Community factors that may lead to AUD and IPV include:⁹

Lack of job opportunities
Lack of educational opportunities
High rates of drug and alcohol misuse
High crime incidences, including IPV
Lack of feeling safe or protected
Little community intervention or efforts to make things better

Unstable and unsafe home conditions may amplify the distress caused by chaotic interpersonal relationships. Living in a solid structure that allows someone to sleep well, utilize heating and cooling systems, and perform basic hygiene routines leads to less psychological distress. However, living in a space where constant fighting, yelling, bullying, victimization, and exposure to IPV are unavoidable also can lead to psychological distress.

This trauma can also come from less obvious sources. For example, time spent in active-duty combat is linked to higher rates of both AUD and IPV among veterans. Stress leads to increased inflammation, leading to an increase in mental health disorders, including alcohol misuse.^{10, 11}

Abusive Relationship Factors

Abusive relationship factors come from the interactions between people who see one another frequently, such as friends, family, peers, coworkers, partners, and spouses. Examples of abusive relationship factors include:⁹

Growing up observing intimate partner violence or alcohol misuse
Being inappropriately physically disciplined
Hanging out with peers who misuse alcohol or are aggressive or violent
Being in an abusive relationship with people who are controlling or jealous
Experiencing divorce or separations
Being raised by parents who encourage AUD or IPV

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Integrated Treatment for AUD and Intimate Partner Violence

Alcohol use disorder and intimate partner violence are two separate mental health issues. However, both can develop within the same individual—the person initiating violence against their partner may misuse alcohol as well. Thus, treating both simultaneously is the best way to overcome them effectively without a relapse. When AUD amplifies the violent tendencies of a person engaging in IPV, treatment must occur with licensed clinicians to treat mental health and substance use disorders.

Integrated treatment includes a variety of interventions that are proven to work for both alcohol use disorder and IPV. Behavioral therapies are a crucial component of integrated treatment. Behavioral therapies work by changing harmful thought processes to improve behaviors. Examples of behavioral therapies include:¹²

Cognitive-behavioral therapy (CBT)
Motivational enhancement therapy
Trauma-focused cognitive-behavioral therapy
Contingency management

Integrated treatment involves 12-step facilitation and relapse prevention groups that offer guidelines and teach new skills to prevent relapse and a return to intimate partner violence.¹²

Family or couples counseling is beneficial in recovery because both AUD and IPV affect the loved ones of someone dealing with multiple issues. Each can learn boundaries, coping skills, anger management, conflict resolution, and more.¹²

Why Treat AUD and IPV Simultaneously?

Integrated treatment can occur on an inpatient, outpatient, or combination basis. The key is completing them together.¹² If one person recovers from alcohol use disorder but does not learn how to manage emotions, an argument or physical altercation could trigger a relapse on alcohol.

Knowing how to cope with anger and other negative emotions associated with IPV is imperative for the sake of future relationships. To date, coping skills consist of misusing alcohol and lashing out, neither of which leads to happy endings.

Furthermore, if someone recovers from engaging in intimate partner violence but not alcohol misuse, continued drinking could lead them back into abusing their partner.¹² To avoid this, seek therapies such as cognitive-behavioral therapy through the following:

Individual therapy
Family therapy
Couples therapy

If someone you know has alcohol use disorder, experiences or engages in intimate partner violence, or both, they can still live a happy, healthy life without either. Call 800-948-8417 Who Answers? to speak to a specialist concerning alcohol use recovery.

Resources

Anxiety & Depression Association of America. (2018). Intimate Partner Violence: What Is It and What Does It Look Like?
The American Psychiatric Association. (2019). Intimate Partner Violence: A Guide for Psychiatrists Treating IPV Survivors.
Øverup, C. S., DiBello, A. M., Brunson, J. A., Acitelli, L. K., & Neighbors, C. (2015). Drowning the Pain: Intimate Partner Violence and Drinking to Cope Prospectively Predict Problem Drinking. Addictive Behaviors, 41, 152-161.
National Institute of Alcohol Abuse and Alcoholism. Alcohol and the Brain: An Overview.
Wetherill, R. R., & Fromme, K. (2016). Alcohol-Induced Blackouts: A Review of Recent Clinical Research with Practical Implications and Recommendations for Future Studies. Alcoholism, Clinical and Experimental Research, 40(5), 922-935.
Department of Social and Health Services. Types and Signs of Abuse.
Eckhardt, C. I., Parrott, D. J., & Sprunger, J. G. (2015). Mechanisms of Alcohol-Facilitated Intimate Partner Violence. Violence Against Women, 21(8), 939-957.
Sontate KV, Rahim Kamaluddin M, Naina Mohamed I, Mohamed RMP, Shaikh MF, Kamal H, and Kumar J (2021) Alcohol, Aggression, and Violence: From Public Health to Neuroscience. Frontiers in Psychology. 12:699726.
Center for Disease Control and Prevention. (2021). Risk and Protective Factors for Perpetration.
Schmeer, K. K., & Yoon, A. J. (2016). Home Sweet Home? Home Physical Environment and Inflammation in Children. Social Science Research, 60, 236-248.
Moffitt, T. E., & Klaus-Grawe 2012 Think Tank (2013). Childhood Exposure to Violence and Lifelong Health: Clinical Intervention Science and Stress-Biology Research Join Forces. Development and Psychopathology, 25(4 Pt 2), 1619-1634.
Yule, A. M., & Kelly, J. F. (2019). Integrating Treatment for Co-Occurring Mental Health Conditions. Alcohol Research: Current Reviews, 40(1), arcr.v40.1.07.