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Partner Violence Experiences

and Women’s Drug Use:

Exploring the Connections

Brenda A. Miller, Ph.D.

INTRODUCTION

This chapter focuses on women’s drug use and their experiences

with partner violence. First, the chapter presents rates of partner

violence in the United States and evidence from previous research

connecting partner violence and women’s substance abuse. Second,

data from an ongoing study in western New York demonstrate evidence

for the connection between women’s drug use and their experiences of

partner violence. Finally, the chapter discusses possible explanations

for these connections and the implications for policy and practice.

RATES OF PARTNER VIOLENCE

AND PRIOR RESEARCH

Partner violence can be identified by specific acts and behaviors that

are directed from one partner to another. One of the more commonly

used instruments to assess partner violence is the Conflict Tactics Scale

(CTS) developed by Straus and colleagues (Straus and Gelles 1990,

pp. 113-132). Specific acts are used to define minor and severe violence

and can be measured for the past year or other specified time periods.

Severe violence is indexed by the following behaviors: kicked, bit, or

hit with a fist; hit or tried to hit with something; beat up; choked;

threatened with a knife or gun; or used a knife or fired a gun.

Based on a random national survey conducted in 1985 in which

the CTS was used, baseline rates of husband-to-wife violence were

estimated at 11 percent for overall violence and 3 percent for severe

violence (Straus and Gelles 1990, p. 118). These rates were for the

12 months preceding the survey and represent a yearly estimate of

violence. When compared with a similar national survey conducted in

1975 (Straus and Gelles 1990, p. 118), these rates of husband-to-wife

violence did not show a statistically significant difference. Applying
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this rate of husband-to-wife violence to the general population, Straus

and Gelles estimated that more than 2 million wives are severely assaulted each year by their husbands.

From these same nationwide data, Kantor and Straus (1990,

pp. 203-224) report finding a connection between spousal violence

and women’s and men’s drinking. They report one in four incidents

of wife abuse involved drinking by either the husband alone or the

husband and wife immediately preceding the event. However, because

three-fourths of all incidents involved violent situations in which

neither the husband nor the wife was drinking, alcohol or other drug

(AOD) use can best be described as connected to partner violence only

for some events and/or some people.

In addition to studies by Eberle (1982) and Gorney (1989) that

identified relationships between women’s AOD use and their experiences of partner violence, work by the author and colleagues has demonstrated evidence for these connections. Based on interview data from

472 women drawn from 5 sources (outpatient alcoholism clinics, drinking/driving classes, shelters for partner violence, outpatient mental

health clinics, and a general population sample), significantly higher

levels of severe partner-to-woman violence were reported by women in

alcoholism treatment relative to the general population (Downs et al.

1993; Miller et al. 1993). Another study also showed higher rates of

partner violence for a sample of women in alcoholism treatment than

for women in the community (Miller et al. 1989).

RECENT EVIDENCE FOR CONNECTIONS

In a study funded by NIDA, the author and coworkers have continued to investigate the relationships between women’s AOD use and

their experiences of violent victimization, focusing specifically on

samples of women identified because of their involvement with illicit

drugs. Two directions for these relationships were investigated: Does

drug use increase the risk of partner violence? Does partner violence

increase the risk of drug use?

This NIDA study includes 609 women drawn from three different

sources: outpatient drug treatment (n=157), shelters for partner violence (n=144), and the community (n=308). Two different samples

were drawn from the community to match the drug treatment and
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shelter samples on age and on geographic proximity of residence.

This geographic match is important when focusing on violent victimization to control for the context and social settings in which people live.

Figure 1 shows the distribution of the sample across the shelter, drug

treatment, and two matched community sources.

Data for this study were obtained from indepth interviews. Four

waves of data were collected at 6-month intervals. Results presented

here are limited to the data collected in the first wave.

Women’s drug use focused on illegally obtained drugs or prescription

drugs used intentionally in a nonprescribed manner. Women were asked

whether they had ever used, used regularly (defined as at least once a

week for at least a month), or used daily (defined as daily use for 2 weeks

or more) any of the following substances: sedatives or tranquilizers,

stimulants (e.g., methamphetamine), analgesics (e.g., Dilaudid), inhalants, marijuana, hallucinogens, cocaine in any form, and heroin and

methadone. Specifically, lifetime drug use and drug use in the 6 months

preceding the first interview were used in these analyses. Drug-related

problems also were assessed, as well as measures of tolerance and withdrawal. Although the primary focus was on women’s use of drugs other

than alcohol, measures of women’s alcohol use and alcohol problems

also were obtained. Quantity and frequency measures of alcohol use

allowed for assessment of heavy drinking periods across the lifespan and

within the past 6 months. Alcohol-related problems were assessed

according to the criteria for alcohol abuse and alcohol dependence of

the Diagnostic and Statistical Manual of Mental Disorders, Third Edition,

FIGURE 1. Distribution of the sample across the shelter, drug

treatment, and two matched community sources (n=609)
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Revised (American Psychiatric Association 1987). Women were defined

as having an AOD problem if they met one of the following three

criteria: any daily drug use, any regular drug use and symptoms of

tolerance or withdrawal, or a diagnosis of alcohol dependence. For

these comparisons, the community and shelter groups were divided

into women with AOD problems and those without.

Violence from intimate partners was assessed by the CTS (Straus

1979; Straus et al. 1980; Straus and Gelles 1990, pp. 113-132) supplemented by additional items (Miller et al. 1989). In the first interview

in wave one, women were asked about violence occurring in their

lifetime and in the past 6 months.

Figure 2 compares the rates of severe partner violence for women

in the drug treatment group with that of their matched sample from

the community. The community sample is separated into two groups

according the presence or absence of lifetime AOD problems. Rates

FIGURE 2. Rates of severe partner violence: Comparisons of women

in drug treatment and women in the community with and

without lifetime AOD problems

*Significant posthoc tests (1 v. 2; 1 v. 3)

†Significant posthoc tests (1 v. 2; 1 v. 3; 2 v. 3)

KEY: AOD=alcohol or other drug
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of partner violence are presented for the past 6 months and lifetime.

Significantly more women in the drug treatment group (26 percent)

experienced severe partner violence during the 6 months prior to the

first interview than did women in the two community comparison

groups (9 percent each). The second comparison in this figure presents

the percentage of women who had experienced any severe violence from

a partner during their lifetimes. A significantly higher percentage of

women in the drug treatment group experienced severe partner violence

than did women from either community group (88 percent, 70 percent,

and 40 percent, respectively). Furthermore, women in the community

who had AOD problems reported significantly higher rates of lifetime

severe partner violence than did community women without AOD

problems.

Figure 3 compares the rates of partner violence for women in the

shelter with and without AOD problems with rates in the matched

FIGURE 3. Rates of severe partner violence: Comparisons of women

in shelters with and without AOD problems and women in

the community with and without AOD problems

*Significant posthoc tests (1 v. 3; 1 v. 4; 2 v. 3; 2 v. 4)

†Significant posthoc tests (1 v. 3; 1 v. 4; 2 v. 3; 2 v. 4; 3 v. 4)

KEY: AOD=alcohol or other drug
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(to shelter) community sample with and without AOD problems. As

expected, women in the shelter, regardless of whether or not they had

AOD problems, had extremely high rates of severe partner violence

during the past 6 months (with AOD problems, 80 percent; without

AOD problems, 75 percent). These rates were significantly higher than

the rates for women in both community samples (with AOD problems,

16 percent; without AOD problems, 3 percent). Figure 3 also presents

the prevalence of severe partner violence across the lifetime for women

in the shelter and community samples. There were no significant

differences in rates of severe partner violence among women in the

shelter, with and without AOD problems (100 percent and 88 percent,

respectively). In contrast, within the community, women with AOD

problems had rates of partner violence almost twofold higher than the

rates of women without AOD problems, and these differences were

significant.

The measure of severe violence is based on specific violent behaviors

women have experienced from their partners. Table 1 presents these

behaviors for four groups of women: women from drug treatment,

women from shelters, women from the community with AOD problems,

and women from the community without AOD problems. For these

analyses, women from both community samples (community matched to

the drug treatment and community matched to the shelter samples) are

TABLE 1. Prevalence of different types of severe partner violence:

Comparisons for drug treatment, shelter, and community

samples (percent)

Drug Community Community Significant

Type of Severe Treatment Shelter With AOD Without AOD Posthoc

Violence (1) (2) (3) (4) Comparisons

Hit with fist 80 86 54 22 1,4; 2,4; 3,4; 1,3; 2,3

Hit with object 69 67 40 13 1,4; 2,4; 3,4; 1,3; 2,3

Beat up 79 82 50 21 1,4; 2,4; 3,4; 1,3; 2,3

Burned or scalded 10 6 5 2 1,4

Choked 66 64 38 18 1,4; 2,4; 3,4; 1,3; 2,3

Threatened with

 gun or knife 45 47 23 11 1,4; 2,4; 1,3; 2,3

Other threat 58 68 38 11 1,4; 2,4; 3,4; 1,3; 2,3

Used gun or knife 23 20 13 5 1,4; 2,4

Forced sex 44 51 37 12 1,4; 2,4; 3,4

KEY: AOD=alcohol or other drug
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combined. Women in the drug treatment group and women from the

shelters show similar rates of each specific form of violence; there were

no statistically significant differences. Although high rates of severe

violence were expected among women from the shelter sample, the

similarity in rates for women in drug treatment was surprising. For

example, 80 percent of the women in drug treatment had been hit with

a fist, 66 percent had been choked, and 45 percent had been threatened

with a knife or gun, whereas the corresponding figures for the shelter

sample were 86 percent, 64 percent, and 47 percent.

Comparisons of women in the community with and without AOD

problems reveal that for virtually all types of severe violence, women

with AOD problems have much higher levels of violence—often two,

three, or almost four times higher. For example, 54 percent of the

women in the community with AOD problems have been hit with a

fist compared with 22 percent of the women in the community without

AOD problems. Also, 38 percent of the women with AOD problems

and 11 percent of the women without AOD problems report other

threats against their lives.

IMPLICATIONS FOR POLICY AND PRACTICE

Do victimization experiences, such as partner violence, make

women more vulnerable to AOD problems? The author and associates’

work on childhood victimization suggests that they do (Miller et al.

1993). One mechanism that may link victimization experiences to

AOD problems is posttraumatic stress disorder (Miller et al. 1997,

pp. 357-385). AOD use may also be a more general coping mechanism

for victimization experiences (Miller et al. 1997, pp. 357-385).

Do AOD problems make women more vulnerable to victimization,

such as partner violence? There is some indication that a relationship

exists in this direction as well (Miller 1996, pp. 239-260). Both the

acute condition of being intoxicated or high and the chronic condition

of being addicted to alcohol or other drugs may make women more

vulnerable to victimization. This view is not a case of blaming women

for their victimization but rather one of understanding vulnerabilities

and empowering women to make changes in their lives.

These data and other studies suggest that drug problems and partner violence co-occur for women. Although the data are insufficient
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to determine the causal pathways, the relationships discussed here

provide important information for policy and practice. For treatment

providers, it is critical to understand the importance of victimization

and victimization histories to the experiences of women and their

willingness and ability to respond to specific treatment protocols. Not

only are experiences of partner violence common in the lives of most

women who are in drug treatment, but also the experiences of severe

partner violence are recent. Many women were in treatment during the

6 months prior to the interviews. Thus, experiences of violent victimization are occurring while women are in treatment for their addictive

disorders. This should be expected to affect their treatment experience

and their vulnerabilities to relapse.

From a policy standpoint, designing systems that are responsive to

women’s needs and to their experiences is important. For women drug

users, consolidated support services for both addiction and victimization

issues are needed. Many AOD treatment facilities fail to screen for

family violence or to provide services for identified problems (e.g.,

Bennett and Lawson 1994). Likewise, AOD problems are not addressed

in shelters, and in some cases women are removed from shelters if they

have an AOD problem.

Addressing partner violence through the criminal justice system

is often insufficient for solving the problems of today’s families (Fagan

1996). Identifying someone to blame does not constitute a solution

to the problem. Of particular concern is that focusing resources on the

offender fails to address the intergenerational issues of AOD problems

and family violence. More recent work by the author and colleagues

has begun to examine the impact of mothers’ AOD problems on their

children (Smyth and Miller 1997; Miller et al. 1995), specifically,

children’s vulnerability to violent victimization by their mothers or by

other adults that surround the families. Understanding how the experiences in childhood set the stage for adult experiences and actions can

promote more effective intervention efforts and specifically promote

prevention strategies that can address problems early in the process.

Much of the research to date has focused on the individual and dyad

level of analyses. Yet, families are affected by their communities also.

Restructuring norms and values in communities to reduce the acceptance of violence is needed. Recognition that individuals who try to

change must face environments and social settings that promote drug
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use and violence is important. We need to consider contextual and

structural changes that can be promoted to support individuals in

looking for a way out of cycles of violence and substance abuse.

REFERENCES

American Psychiatric Association. Diagnostic and Statistical Manual of Mental

Disorders, Third Edition, Revised. Washington, DC: American Psychiatric

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Bennett, L., and Lawson, M. Barriers to cooperation between domestic-violence

and substance-abuse programs. Fam Soc 75(5):277-286, 1994.

Downs, W.R.; Miller, B.A.; and Panek, D.D. Differential patterns of partner-towoman violence: A comparison of samples of community, alcohol-abusing,

and battered women. J Fam Violence 8:113-135, 1993.

Eberle, P.A. Alcohol abusers and non-users: A discriminant analysis of differences between two subgroups of batterers. J Health Soc Behav 23:260-271,

1982.

Fagan, J. The Criminalization of Domestic Violence: Promises and Limits. Washington, DC: U.S. Department of Justice. (No. NCJ157641), 1996.

Gorney, B. Domestic violence and chemical dependency: Dual problems, dual

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Kantor, G.K., and Straus, M.A. The “Drunken Bum” Theory of Wife Beating.

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Brunswick, NJ: Transaction Publishers, 1990.

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Miller, B.A.; Downs, W.R.; and Gondoli, D.M. Spousal violence among

alcoholic women as compared to a random household sample of women.

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Smyth, N.J., and Miller, B.A. Parenting Issues for Substance-Abusing Women.

In: Straussner, S.L.A., and Zelvin, E., eds. Gender Issues in Addiction: Men

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Straus, M.A. Measuring intrafamily conflict and violence: The Conflict Tactics

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Straus, M.A., and Gelles, R.J. Societal change and change in family violence

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AUTHOR

Brenda A. Miller, Ph.D.

Acting Director

Research Institute on Addictions

1021 Main Street

Buffalo, NY 14203-1016

(716) 887-2557 (Tel)

(716) 887-2252 (Fax)

miller@ria.org (E-mail)