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- The relationship between alcohol and violence is complex and mediated by personality, expectancies, situational factors, and social norms.
- The vast majority of drinking episodes does not lead to violence, and most violence does not involve drinking.
- Genetic difference, general health status, mental health, age, and gender may all contribute to heightened risk.
- Certain drinking patterns and violent behaviors may share common risk factors.
- In general, violence is likely to be associated with heavy drinking and alcohol abuse.
- The relationship between heavy drinking patterns and violence offers an opportunity for targeted harm reduction measures.
- Addressing individual, environmental, social, and cultural factors may help reduce both alcohol abuse and the incidence of alcohol-related violence.
- For examples of interventions, see the online database Initiatives Reporting: Industry Actions to Reduce Harmful Drinking.
Violence has many complex causes. Individual, community, cultural, biological, and psychosocial factors all play significant and interactive roles (e.g., Collins & Messerschmidt, 1993; White & Gorman, 2000). Research evidence supports an association between certain drinking patterns and some forms of violence, although there is no evidence that alcohol consumption causes violence.
The vast majority of drinking episodes does not lead to violence, and most violence does not involve drinking. At the same time, in the case of some individuals and groups, behavioral patterns may include both abusive alcohol consumption and violent tendencies. Currently, there is no simple theoretical model that adequately explains the relationship between alcohol and violence (Bushman, 1997; Lipsey, Wilson, Cohen, & Derzon, 1997; Pernanen, 1991).
While there is evidence that alcohol may be involved when offenses are committed, there is no evidence that it is the cause of violence. Where alcohol consumption is reported at the time an offense is committed, this may reflect only that offenders or victims consume alcohol often, not that its consumption caused the perpetrator to commit the violent act (Pernanen, 1991).
Another aspect that needs to be considered is that a large number of violent acts are committed in areas where it is more likely that individuals will have consumed alcohol—for example, around bars and nightclubs.
In general, higher rates of drinking, heavy drinking, and alcohol abuse are reported for violent offenders than for the general population (Martin, 1993). Alcohol abuse is also associated with intimate partner violence (IPV), sexual assaults, and suicide (Home Office, 2004a). Further, IPV is perpetrated more often by excessive drinkers and alcoholics compared to light drinkers. In addition, alcohol use by the offender, victim, or both has been reported in about one third to one half of all incidents of sexual assault (Home Office, 2004b).
The relationship between heavy drinking patterns and violence offers an opportunity to address those individuals most at risk for being victims and/or perpetrators of violent acts. This approach seeks to reduce the potential for harm and targets patterns of drinking and other behaviors that may increase the chance of a violent act being committed.
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Several models have been offered to help explain the relationship between alcohol and violence at the individual level. One model suggests that alcohol causes violent behavior through its psychopharmacological effects, such as impairment of cognitive processes that affect perceptions of and attention to cues, interpersonal communication, awareness of consequences, behavioral inhibition, and judgment (Badawy, 1986; Boles & Miotto, 2003). According to this line of argumentation, such impairment increases the risks for violence. In addition, chronic intoxication may contribute to subsequent aggression due to factors such as withdrawal, sleep deprivation, nutritional deficits, impairment of neuropsychological functioning, or enhancement of psychopathologic personality disorders (see ANNEX 1: The Basics About Alcohol; Badawy, 1986).
A second model suggests that violent behavior leads to heavy alcohol use. This model is based on the assumption that violent individuals often choose peer groups and lifestyles that promote heavy drinking. In addition, violent individuals may use alcohol as an excuse to commit a violent act (Collins, 1993; Moncrieff & Farmer, 1998).
A third possible model is the common cause model, which suggests that heavy drinking patterns and violence are related because they share common risk factors rather than a direct causal link (Fergusson, Lynskey, & Horwood, 1996; White & Gorman, 2000). These risk factors include genetic or temperamental traits, antisocial personality disorder, parental modeling of heavy drinking and aggression, and poor relations with parents. Although there is strong support for this model, there are also unique factors that determine whether an individual will become a heavy drinker, a violent offender, or both.
In addition to individual factors, it has been argued that the drinking context plays a strong role in the association between alcohol and violence. In other words, there are certain settings or situations in which alcohol-related violence is more likely to occur than in others. These settings include bars and sporting events, where fighting or other kinds of violence may take place.
It has been argued that bars and other drinking establishments are crime “hot spots” since they bring together motivated offenders and suitable targets in the absence of effective social control (Roncek & Maier, 1991). For example, in the United Kingdom, violence around pubs and nightclubs occurs most often on weekend nights (Home Office, 2004c). Rates of violence have been found to be highest around pub closing times, as crowds of intoxicated strangers converge on the street at the same time. In addition, certain characteristics of licensed establishments—for example, noise, inconvenient access routes, poor ventilation, overcrowding, permissive social environments, and aggressive staff—may make them more conducive to fighting and violence (MODULE 4: Responsible Hospitality; Arnold & Laidler, 1994).
Internationally, violence is among the leading causes of injury and death for people aged 15 to 44. The rates of alcohol use by both offenders and victims of violent acts vary across studies and across countries. While cross-national comparisons suggest that violence associated with alcohol consumption may be similar in some countries, in others, there is a significant difference. For example, rates are higher in northern and eastern Europe than in southern European countries. This difference has been attributed to views on both alcohol and violence in these countries and to the norms and patterns of drinking within different communities (Room & Rossow, 2001).
As a general rule, cultures in which alcohol use is well-integrated into everyday functions—as in Mediterranean countries—have much lower rates of alcohol-related violence than cultures where alcohol is not well integrated—as in Nordic countries—or cultures that are ambivalent about the role of alcohol in society, as the United States (Room, 1976). This difference is likely attributable in part to variations in drinking patterns. Violence appears to be related to high-quantity consumption. Where excessive drinking or acute intoxication are more common, there is a greater likelihood that it may be associated with violence than in cultures where drinking may be frequent but the quantities are lower (Grant & Litvak, 1998). In addition, and equally as important, the relationship of alcohol to violence is strongest in societies that condone violent behavior (Coid, 1986).
However, it must be noted that alcohol may be involved in violence only among certain individuals and only under some conditions and situations. A model that takes this into account, incorporating elements of the individual and contextual models and cultural variables offered above, is likely to offer a more accurate reflection of the nature of this complex relationship.
Implications for policy and prevention
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The existing research on the role of alcohol in violence makes it clear that one singular model cannot account for the alcohol-violence relationship in all incidents and for all individuals. Similarly, not all strategies are equally effective in curbing the occurrence of violence involving heavy drinking. Initiatives that attempt to reduce incidents of excessive consumption and targeted interventions that deal with drinking environments may help reduce violence where alcohol is involved.
Intervention strategies that reduce aggressive behavior in general are also needed, particularly within certain populations. Thus, special measures may be developed to target individuals who are at high risk or are already exhibiting aggressive tendencies. While targeted approaches are needed to address the association between certain drinking patterns and violence, policy and prevention initiatives need to integrate a range of factors in order to be effective.
Since alcohol-related violence is most likely to be associated with heavy and problematic drinking patterns, measures that attempt to modify such behaviors may be a useful tool (see MODULE 5: Drunkenness and MODULE 6: Binge Drinking). Increasing awareness among individuals of positive and negative drinking patterns and their possible outcomes is an important first step. Screening for problem drinkers may be appropriate in many instances, followed by counseling for individuals found to be at risk (see MODULE 18: Screening and Brief Intervention).
Other broader approaches include changing environmental conditions in order to decrease the likelihood of violent incidents in general (e.g., The Portman Group, 2000). Strategies include measures around the management and design of drinking establishments and other venues to reduce factors that may contribute to aggressive behavior and violent outbreaks (MODULE 4: Responsible Hospitality). Increasing social control through better enforcement and cooperative measures that involve the community as a whole are also helpful (MODULE 14: Public Order and Drinking Environments). It is important to realize that the reduction of violence, including violence associated with some drinking patterns, requires collective involvement of any community and needs to rely on partnerships. Only a concerted effort and a responsibility shared by government, law enforcement, business, educators, parents, clergy, and many others can hope to effect the culture change ultimately required to change violent behavior.
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In addressing the issue of drinking and violence, it is important to acknowledge that most drinking does not lead to violence and that violent behavior is associated with a number of other aspects. Those violent incidents that involve alcohol generally also involve harmful or abusive drinking patterns.
As a result, targeted interventions around violence and alcohol would benefit from a focus on those drinking patterns that are associated with harm. Developing approaches to modify these patterns helps minimize risks. However, effective interventions are also predicated upon the inclusion of other approaches that target not only the drinking pattern, context, and environment, but also address the root of the problem through education, coping skills, and changing of expectancies and views on inter-gender and interpersonal relationships.
Given the complexity of the issue, it is therefore important to adopt a multifaceted approach to reducing violence associated with drinking, focusing primarily on the violence and on removing the drinking component as a contributing factor. Such approaches can only be successful if they have broad participation and include various segments in society that play a role in shaping perceptions and culture and that ensure the maintenance of social controls.
POLICY OPTIONS: Drinking and Violence
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In developing policies and approaches, consideration of a number of key elements is required. While some elements may be necessary at a minimum and under most conditions, others may not be appropriate in all cases, or may be difficult to implement. The list below offers a menu of areas that need to be addressed, based on effective approaches that have been implemented elsewhere. Specific examples are provided in the online database Initiatives Reporting: Industry Actions to Reduce Harmful Drinking.
Reducing heavy and problem drinking
Focus on positive drinking patterns and discourage harmful patterns through:
- Alcohol education strategies for young people, teachers, and parents.
- Public awareness campaigns around drinking patterns and outcomes, especially around heavy and problem drinking.
- Early screening and identification of high-risk drinkers, especially among violent offenders; referral to treatment services, if needed.
Modifying the drinking environment
Implement responsible hospitality strategies and measures, including:
- Training of staff in serving and conflict resolution.
- Ensuring the availability of adequate transportation.
- Ensuring the availability of food and nonalcoholic beverages.
- Encouraging diversity of patrons.
- Limiting the sale and consumption of alcohol at sporting events and other public gatherings.
- Using durable safety glass or plastic containers.
Improving social control
Implement approaches and collective strategies in partnership with diverse groups, including law
enforcement, women’s groups, communities, serving establishments, and others.
- Improving law enforcement, especially around licensed premises, as well as sporting and other events.
- Enforcing underage drinking laws.
- Providing incentives and enforcement to ensure responsible serving practices in establishments.
Reducing violent behavior generally
Identifying at-risk groups through targeted interventions, such as:
- Improving pre-school enrichment programs, life skills, and coping programs.
- Offering and encouraging activities and community involvement.
- Training in anger management and communication skills, especially among offenders.
- Increasing education and awareness about violent behavior in schools, the community, and among the population at large.
- Addressing social problems that contribute to the causes of violence.
- Changing male attitudes and acceptance of gender roles.
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