J Fam Viol (2011) 26:465471 DOI 10.

1007/s10896-011-9381-5

ORIGINAL ARTICLE

Alcohol and Domestic Violence: A Cross-Over Study in Residences of Individuals in Brazil

Tas de Campos Moreira & Maristela Ferigolo & Simone Fernandes & Xnia Barros & Cludia G. Mazoni & Ana Regina Noto & Jos Carlos Fernandes Galdurz & Helena M. T. Barros

Published online: 4 June 2011 # Springer Science+Business Media, LLC 2011

Abstract The objective of this study was to investigate psychological or physical violence associated with the use of alcohol, in residences of individuals in Brazil and, also describe the social characteristics of aggressors and victims. Therefore, this study expects to contribute to studies in Brazil that seek to clarify the relations between alcohol and violence in residences. A total of 454 respondents, 12 65 years old, were assessed, they were sorted by the Kish method, and the residences randomly. The SAMHSA questionnaire was utilized after translated and adapted to Brazilian conditions. 26% of the individuals reported psychological violence, and 16% reported physical violence. The studys main results set the differences in the reports for physical violence (OR 7, 95% CI: 413) and
T. de Campos Moreira : M. Ferigolo : S. Fernandes : H. M. T. Barros Universidade Federal de Cincias da Sade de Porto Alegre, Porto Alegre, Brazil H. M. T. Barros e-mail: helenar@ufcspa.edu.br X. Barros : C. G. Mazoni Universidade Luterana do Brasil, Canoas, Brazil A. R. Noto : J. C. F. Galdurz Universidade Federal de So Paulo, So Paulo, Brazil T. de Campos Moreira (*) Federal University Health SciencesUFCSPA, 245 Sarmento Leite Street, 3rd floor, suite 316, Porto Alegre, RS, Brazil CEP 90050170 e-mail: taiscm@ufcspa.edu.br T. de Campos Moreira e-mail: tais.moreira@bol.com.br

psychological violence (OR 5, 95% CI: 38) in residences where someone arrived or became intoxicated with alcohol (P <0.05). 50% of the aggressors were under the effects of alcohol, and 77% of the victims were relatives of their aggressors. Acts of violence are not necessarily associated with alcohol consumption. Men and women reported acts of domestic violence; psychological violence was the most prevalent form. Men are currently the primary aggressors, while women are primarily the victims Keywords Domestic violence . Alcohol . Gender Violence is a well known issue worldwide; domestic violence, in particular, represents a serious public health problem for women and children (World Health Organization 2002). Domestic violence frequently involves family members or relatives, and includes mistreatment of children and/or the elderly, as well as violence against spouses (WHO 2002). It is especially worrisome, due the fact that the family is the fundamental structural unit of society and should assure the physiological and psychological needs of its members. However, in some cases, this structure may support domestic violence, a behavior which progressively deteriorates the family (Palermo 2007). Domestic violence can be linked to several factors (Krug et al. 2002), including mental illness, acceptance of violent acts by the community, lack of communication, sex, a vulnerable self-image, frustration, and drugs or alcohol abuse (Leonard and Eiden 2007). Data on domestic violence indicate a high prevalence of sexual violence, physical violence, and psychological violence has been associated with alcohol and other drug use by a family member (Alvarado-Zaldivar et al. 1998). High rates of alcoholism are assumed to be present in most violent individuals due to alcohols glibness effect on

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behavior and cognition ( Boyle and Todd 2003; Field and Caetano 2004; Zilberman and Blume 2005). Therefore, there seems to be a snowball effect between domestic violence and alcohol abuse which leads to increasing problems in family relationships (WHO 2005). A national population-based survey in the United States indicated that physical availability of alcohol increases interpersonal and family violence (Mckinney et al. 2009). Other authors, however, have pointed out that only 50% or less of acts on domestic violence are associated with alcohol use (Fals-Stewart et al. 2003; Simo et al. 1997). The relationship between acute alcohol consumption and aggressive behavior is a complex phenomenon. Although studies have often pointed to statistical relationships between the acute effects of alcohol and violence, the debate continues regarding whether these relationships are causal or correlational (Chermack and Giancola 1997; Macdonald et al. 2005, 2008;). Fals-Stewart et al. (2003) reported that the relationship between alcohol and violence is spurious, since there are other variables involved. The presence of an antisocial personality, or even a connection between violence and a bad relationship with many difficulties that favors the development of aggression between partners, can contribute to this association (WHO 2002; Mota et al. 2007). Perpetrators of domestic violence are violent regardless of the consumption of alcohol (Galvani 2006). Patterns of alcohol consumption and the prevalence of alcohol-related problems may be linked to social and cultural factors, such as customs and attitudes of certain groups regarding alcohol use (Galvan and Caetano 2003). Variation in alcohol-related problems has also been found to exist within specific ethnic groups. For example, Hispanics, in popular Mexican America, seem to have more alcohol-related problems those of Cuban and Puerto Rican origins (Galvan and Caetano 2003). Acculturation to drinking patterns is not the same across different ethnic groups; for example, Hispanics from different Latin American countries bring a variety of drinking patterns when they migrate to the United States (Galvan and Caetano 2003; Zemore 2007). There are no studies separating Brazilians from other Latin American individuals. Thus, this study will be useful in examining on alcohol and violence among individuals of Portuguese background. Therefore, this study expects to contribute to studies in Brazil that seek to clarify the relationship between alcohol and violence in residences. This investigation evaluates the association between alcohol use and domestic violence by exploring household data in a specific Latin-American region. This descriptive article aims to: a) investigate the extent to psychological or physical domestic violence is associated with the use of alcoholic beverages at residences of

individuals in Brazil, and b) describe the social characteristics of aggressors and victims.

Method Participants From August, 2005 to November, 2005, data were collected from individuals between the ages of 12 and 65 years, according to the census sectors in a stratified sampling design, through field-research in cities with more than 200,000 inhabitants in the state of Rio Grande do Sul, which is the southernmost state in Brazil (Galdurz et al. 2007). A threestage conglomerate sample design was adopted. First, in each sampling city, the census sectors were selected at random. The second stage consisted of a systematic randomized sampling, using a sample interval to obtain 24 households. In the third stage, a respondent was drafted in each household to provide information concerning himself. The selection of the individual to be interviewed in each residence was determined by random criteria, according to age and gender, as proposed by Kish. After three failed attempts to locate the target interviewee, the household was disregarded (Galdurz et al. 2003; 2007). Data Collection The questionnaire, from the Substance Abuse and Mental Health Services Administration (SAMHSA) by the U.S. Department of Health and Human Services Public Health Service (SAMHSA 2001), was translated and adapted to Brazilian conditions, and used as a research instrument (Galdurz et al. 2007). Besides the typical drug use questions, social-demographic data, and opinions on the risks of frequent use, criteria of the syndrome of dependence on drugs were evaluated by the Diagnostic and Statistic Manual of Mental Disorders, Revised Third (DSM III-R) and developed by the National Household Surveys on Drug Abuse (NHSDA). History of treatment for and/or complications resulting from drug use, as well as acts of violence perpetrated and complications of the violence, were collected (Galdurz et al. 2007). The interviewers were trained to standardize the procedures used to approach both the household issue and individuals, and they were also specifically trained in the interview execution (Galdurz et al. 2007). All participants were informed about the study and invited to take part. This study was approved by the Ethics Committee at the Federal University of So Paulo/SP Paulista School of Medicine (UNIFESP-0066/05), and the Ethics Committee at the Federal Medical Sciences University Foundation of Porto Alegre (UFCSPA-192/06).

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Data Analysis To facilitate data analysis, answers were combined to form variables according to the violence categorization of the World Health Organization (WHO 2002): psychological violence (In your household, has there ever been exaggerated scolding, any type of scandal, the threat to break objects, or the breaking of objects?) and physical violence (threaten to punch, punch, threaten to hit, hit someone, threaten with a gun, harm with a gun, steal money or an object from the household, tried to have sexual relations against your will, perpetrated sexual relations against your will). Data collected regarding alcohol use included lifetime experience (whether the substance was used at least once in life), last months use (whether the substance was used at least once, during the 30 days that the survey preceded) and dependence, which was assumed when the individual gave affirmative response to two or more criteria from the NHSDA. The signs/symptoms according to the NHSDA are as follows: it took a great deal of time to obtain the drugs, to use them or recover from the effects; used a greater amount, or at a frequency greater than intended; tolerance greater amount to produce the same effects; physical risk under the effect of drugs or soon after the effect of the drugs; personal problems; the desire to reduce or stop the use of a specific drug (Galdurz et al. 2007). Then, the households were classified as household with intoxication (HWI; households where someone arrived or became intoxicated by alcohol) and households without reported intoxication (WRI; where no one arrived or became intoxicated by alcohol). The classification of the respondents ages was based on household surveys in Brazil (Galdurz et al. 2007). The analysis was performed using the Statistical Package for the Social Sciences (SPSS 12.0). Data were described by absolute frequency and percentage. The categorical variables were compared through the Chisquared test, and odds ratios (OR) were calculated with the respective 95% confidence intervals (CI). To identify associations between a given factor and domestic violence a p < 0.05 was assumed to be statistically significant. Logistic regression analysis was applied to explore the association between alcohol and domestic violence. Psychological violence and physical violence was the dependent variable, and factors such, as gender, age, education, dependence on alcohol, and home situation, were the independent variables. Variables with p < 0.20 in bivariate analysis were selected to be included in multivariate analysis. These variables were then introduced into the regression model using a stepwise forward procedure.

Results Out of a total of 456 households, respondents from two households (0.4%) decided not to participate for personal reasons after being informed about the nature of the study. Data from 454 individuals, 256 (56%) women and 198 (44%) men, were analyzed. Table 1 summarizes the samples characteristics. Of the interviewees, 402 (89%) reported having used alcohol in their lifetime, 204 (45%) had used alcohol in the past month, and 49 (11%) were classified as alcohol dependent. There were statistically significant differences between men and women regarding lifetime alcohol use (men 93% and women 84%) and monthly use (men 61% and women 42%) (p <0.05). Acts of violence and complications while under
Table 1 Social-demographic characteristics of interviewees in a household survey on the use of psychotropic drugs in 2005 (n =454) Characteristics
a

Total n (%)

Gender Female Male Ethnic group Caucasian Black or biracial Asian or other Education Elementary incomplete or illiterate Elementary complete High school incomplete High school complete Higher education incomplete Higher education complete or in graduate studies Age 1217 / 1825 2634 / 35 Marital status Single/divorced/separated Married Current activity Employed Unemployed Student Social-economic classes Class A and B Class C, D and E Psychological violence Physical/sexual violence
a

198 (44% ) 256 (56% ) 361 (79%) 83 (19%) 10 (2%) 154 (34%) 55 (12%) 44 (10%) 117 (26%) 34 (7%) 50 (11%)

36 (8%) / 64 (14%) 81(18%) / 273 (60%) 236 (52%) 218 (48%) 264 (58%) 142 (31%) 48 (11%) 196 258 116 73 (43%) (57%) (26%) (16%)

The sample characteristics are described as per household surveys in Brazil regarding drug use (GALDURZ et al. 2007).

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the influence of alcohol were reported: five individuals (1%) reported traffic accidents or problems at work due to the use of alcohol, 7 (2%) injured themselves in falls, and 20 (4%) had been personally involved in aggression episodes. Those households where someone arrived or became intoxicated due to alcohol use involves 39% of the sample (HWI; n =175). In 61% of the households, no one arrived or became intoxicated by alcohol (WRI; n =279). There were reports of aggression when an individual arrived at the household in a drunken state or intoxicated by drugs. In these cases, there were 32 (7%) cases of verbal aggression, 1 (0.2%) case of threatening to hit someone or throwing objects, and 4 (1%) cases of physical aggression (punches, slaps, pushes) upon the arrival of someone who was intoxicated at home. There were significant differences between the HWI households and the WRI households in acts of psychological violence (OR 5, 95% CI: 38) and physical violence (OR 7, 95% CI: 413). In relation to the profiles of perpetrators of domestic violence (aggressors) ( n = 156) and victims ( n = 119) reported by the respondents, it was ascertained that most aggressors were male (72%; n =112), and that most victims were female (57%; n =68). According to the perceptions of the interviewees, aggressors, and victims were young with a median age of 30 and 27 years old, respectively. At the time of the violent behavior, 45% (n =71) of the aggressors were under the influence of alcohol and/or others drugs. A total of 92 aggressors (77%) were reported to be related as family of their victims, and 94 of perpetrators (60%) were household residents. The search for clinical treatment or justice help by aggressors (27%) or victims (6%) was very rare. In the logistic regression analysis for the outcomes of psychological abuse and physical and sexual violence, it was observed that variables, such as age below 35 years, dependence on alcohol, and someone becoming intoxicated at home, were associated with a greater likelihood of psychological violence and physical violence (Tables 2 and 3).

Discussion Results of the study show that acts of psychological and physical violence that occur in households in cities in southern Brazil may be associated with the use of alcoholic beverages, although violence may also occur without any substance use. In other words, the problems related to violence do not exclusively involve the use of alcohol, and most episodes of drinking do not result in violence (Chermack and Giancola 1997; Edin et al. 2008). Alcohol is neither a necessary nor sufficient cause of violence. Instead, it is clear that alcohol contributes to

violence in some under some circumstances (Leonard 2005). In households were someone arrived or became intoxicated (HWI), an association could be observed between domestic violence (in its different forms) and alcohol. In this study, it was possible to identify situations of violence similar to those already reported in the national (Silva and Ferriani 2007) and international literature (Andersson et al. 2007; Foran and OLearry 2008). Domestic violence is facilitated by the fact that aggression takes place within the privacy of the home, without interference by other people (Deslandes et al. 2000). Alcohol-related problems among men and women appear to be important correlates of violence. One or both partners loss of control or lack of restraint around drinking may similarly manifest in interpersonal exchanges, resulting in aggression or violence (Curandi et al. 2002). Female victims of domestic violence do not tend to attribute alcohol use by the aggressor as the primary factor that led to the violent act. Indeed, the literature demonstrates that alcohol use is not the only or the main factor causing the violent behavior (Galvani 2006). Violence between two individuals in a relationship is a complicated and multifaceted problem, and many variables including family environment, dissatisfaction in the relationship, self-reported emotional problems, pre-existence of aggression, scenarios of violent families and stress contribute to abusive relationships (Parrot and Zeichner 2002; Ramisetty-Mikler et al. 2006). Studies provide only suggestive evidence that intoxication and excessive drinking may be linked to domestic violence (Leonard 2005). The present studys findings indicate that dependence on alcohol was associated with a two times higher chance of psychological and physical violence is this Brazilian group of individuals. Another study has also determined that there is an association between alcohol and violence when the presence of alcohol-related problems, and/or alcohol dependence is detected at the time of the event (Curandi et al. 2002). Also, excessive alcohol consumption may directly and indirectly influence physical aggression or other forms of violence (Stuart et al. 2008). Additionally, other studies reveal that subjects who complete alcoholism treatment and relapse are also likely to revert to violence (Mignone et al. 2009; OFarrell et al. 2003). Logistic regression analysis indicates that younger age (lessthen 35 years) is associated with psychological and physical violence. This result is consistent with findings from other authors, which have also demonstrated a positive relationship between age and violence (Flood and Pease 2009; Ramisetty-Mikler et al. 2006; Zaleski et al. 2009). Age and the developmental processes and relationships associated with age, appear to be factors that figure individuals attitudes toward violence against women, younger individuals have worse attitudes

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Table 2 The relationship between the studied factors (alcohol and socio-demographic factors) and the informants perception of psychological violence in the household a Characteristics of the informant Raw n (%) Without violence Gender Female Male Dependence on alcohol Yes No Age Below 35 years 35 years or more Education Studied 8 years or less Studied more than 8 years Home situation Someone has become intoxicated Nobody has become intoxicated
a

Adjusted P With violence OR (95% CI) OR (95% CI) P

146 (33%) 192 (42%) 23 (5%) 312 (69%) 125 (28%) 213 (47%) 275 (60%) 63 (14%) 97 (21%) 241 (52%)

51 (11%) 65 (14%) 26 (6%) 93 (20%) 67 (15%) 49 (10%) 95 (21%) 21 (5%) 83 (18%) 33 (8%)

0.5 <0.001 <0.001 0,4 <0.001

1.0 (0.661.55) 2.9 (1.605.39) 2.2 (1.493.53) 1.0 (0.601.80) 5.0 (3.448.62) 6.2 (3.3711.41) <0.001 2.2 (1.074.81) 2.4 (1.394.38) <0.05 <0.05

The variable of alcohol use, dependency, age and situation at home are included in the logistic regression.

The percentage was calculated on the total sample.

Table 3 The relationship between the factors under investigation (alcohol and socio-demographic factors) and the informants perceptions of physical violence in the household a Characteristics of the informant Raw n (%) Without violence Gender Female Male Dependence on alcohol Yes No Age Below 35 years 35 years or more Education Studied 8 years or less Studied more than 8 years Home situation Someone has become intoxicated Nobody has become intoxicated
a

Adjusted P With violence OR (95% CI) OR (95% CI) P

165 (36%) 216 (47%) 31 (7%) 350 (77%) 148 (33%) 233 (51%) 310(68%) 70(15%) 122(27%) 259(57%)

33 (7%) 40 (9%) 18 (4%) 55 (12%) 46 (10%) 27(6%) 60(13%) 13(3%) 55(12%) 18(4%)

0,4 <0,001 <0,001 0,3 <0,001

1 (0,61,8) 3,2(1,656,25) 3,0 (1,65,0) 1,2 (12,4) 7,0( 413) 6,2(3,3811,46) <0,001 2,1(1,364,22) 2,4(1,364,22) <0,05 <0,001

The variables of alcohol use, dependency, age and situation at home are included in the logistic regression.

The percentage was calculated on the total sample.

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than their older counterparts males in particular (Flood and Pease 2009). Men were identified the main perpetrators of domestic violence, and women as the main victims, a finding which is different from a recent publication included in the Brazilian National Alcohol Survey (Zaleski et al. 2009). Not all men who committed acts of violence were perceived by the interviewees to be under the influence of alcohol and/or other drugs when violent. Previous research shows that there are gender differences regarding drinking during events of intimate partner violence. For example, the likelihood of men drinking during such an event is nearly four times that of a woman drinking during the event (Field and Caetano 2004; Ramisetty-Mikler et al. 2006; Thompson and Kingree 2006). The gender difference in drinking during the events perhaps reflects general drinking rates, which tend to be higher for men than for women (Zaleski et al. 2009). Men who are heavy drinkers, tend to cause more severe harm to their victims than sober perpetrators, although domestic violence occurs in both situations (Galvani 2006). Husbands require 1314 doses of alcohol before committing physical violence; however their verbal aggression can begin earlier after 810 doses (Murphy et al. 2005). Living with an alcohol abuser increases family dysfunction and violence (Patel 2007), which was also found in our study, as more violence was reported in households with problems resulting from alcohol use. Psychological violence, the most reported form of violence, occurred in one fourth of the households, regardless of the presence of alcohol, similar to the findings by Schraiber et al. (2007). The prevalence of physical domestic violence is within the range of 1070% in many parts of the world and is generally perpetrated by the partner or spouse (Garcia-Moreno et al. 2006; Mota et al. 2007), a finding similar to the present results in which spouses were the main aggressors. In Brazil, the prevalence of male-female and female-male violence is quite similar (Zaleski et al. 2009), which is different from other Latin societies where violent acts are considered acceptable ways for husbands to control or punish their wives (Garcia-Moreno et al. 2006). Alcohol increasing likelihood for engaging in aggressive behavior for men more so than for women (Zaleski et al. 2009) was also detected in this study. Women whose partners had been drinking were significantly more likely to be injured than were women whose partners had not been drinking (Thompson and Kingree 2006). However, it should not be forgotten that, in cases of physical violence in the household, alcohol use cannot be considered to be the only contributor, because violence often begins before drinking and escalates to aggression with alcohol use (Galvani 2006). The interviews were carried out in the households; therefore, some data on violence may have been omitted

or lied about, as domestic violence is always a reason for prejudice, fear, shame, and blame (Ellsberg et al. 2001), and mens violence against women is generally condemned (Galvani 2006; Zaleski et al. 2009). Another limitation may be that all acts of domestic violence identified were reported by only one person residing in the household. In other words, the study only considered the subjective perception of the interviewee, and it did not identify whether the interviewee was the perpetrator or the victim, as that was not the surveys focus. To better identify perpetrators and victims, more specific questionnaires on violence must be used (Clark and Foy 2000; Schraiber et al. 2007; Sohal et al. 2007). Further, the cross-sectional study design made not impossible to determine whether or not alcohol use preceded domestic violence. Nevertheless, this study provides a supplementary contribution to research on domestic violence and alcohol use. Men and women reported similar amounts of psychological violence within a private location, such as the household. Men tended to be the main aggressors, and women the primary victims of physical domestic violence. There was an increased risk for domestic violence in homes where someone arrived at home intoxicated or became intoxicated with alcohol once at home. However, not all acts of violence are associated with alcohol consumption.
Acknowledgements The authors are grateful for the financial support of the Secretaria Nacional de Polticas sobre Drogas, SENAD, CAPES and CNPQ, which provided a Researcher Productivity Grant 1C to H.M.T. Barros.

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