Violence, Substance Abuse and Mental Illness

Of the many unfortunate outcomes of substance abuse and addiction, violence is one that has significant ripple effects on families and communities. Whether it’s violence turned inward or channeled into interpersonal conflict and crime, the link is clear. Understanding the complicated relationship between alcohol and violence against oneself or others is crucial in creating effective interventions and treatment for addiction.

Substance Abuse and Violence Against Oneself

We often think of the violence brought about by substance abuse in terms of harm perpetrated upon others. However, the violence people with addiction and mental illness do against themselves is essential to acknowledge. An astonishing 90% of all individuals who complete suicide meet the criteria for one or more diagnosable psychiatric conditions, including substance abuse. The mental health conditions most commonly associated with both fatal and non-fatal suicide attempts include:

• Depression
• Bipolar disorder
• Post-traumatic stress disorder (PTSD)
• Drug and alcohol use disorders

It’s challenging to compare the exact relative impact between specific mental health issues on the risk of suicide, but alcohol and drug use disorders link closely to suicide risk. People with a substance use disorder (SUD) are nearly six times likelier to report a suicide attempt in their lifetime than those who don’t have an SUD. Additionally, research performed on veterans shows that men with an SUD are more than twice as likely to die by suicide than those who don’t abuse substances.

Identifying Substance Abusers at Greatest Risk for Suicide

Despite the close and consistent association between substance abuse and suicide, the majority of people with substance-related issues don’t die by suicide. That makes it critical to identify the people with substance use disorders who may be at exceptional risk for suicide.

People with an SUD share many of the same suicide risk factors as people in the general population. For instance, past suicide attempts are a significant risk factor shared among all populations.

Depression is a severe risk factor for everyone, but in those with a drug or alcohol use disorder, the risk may be higher. There is high comorbidity between mood and substance use disorders that makes it essential to catch any mood disorders and diagnose them so the person can receive proper treatment.

Self-Harming Activity

In addition to the risk of suicide, drug and alcohol addiction increases the chances that a person will turn violence inward in non-fatal ways. People who feel trapped and out of control may seek to gain control of their feelings by doing things like cutting themselves or engaging in reckless behavior with the full acknowledgment that it might seriously harm or even kill them. Many people do these things due to feelings that they deserve punishment, or a perception that actively feeling pain is better than dealing with their current emotions.

People who self-harm often deliberately hide the effects, especially when the behavior creates visible damage such as with cutting. Other habits may be harder to see, and the individual may not even realize some of what they are doing constitutes self-harm. The behavior may require the skills of a mental health professional to bring to light.

Substance Abuse and Violence Against Others

When many people envision a picture of substance abuse-related violence, they think of street criminal activity like you would see in a movie. In reality, the majority of violence inspired by drug or alcohol addiction takes place behind closed doors. Domestic violence is an unfortunately common and heartbreaking result of addiction.

The term “domestic violence” refers to patterns of behavior that are abusive in any relationship, used by an intimate partner to control or keep power over the other partner in the relationship. It is a rampant problem on its own, but the addition of substance abuse escalates the danger and can make it even harder to escape from. Domestic abuse isn’t just physical. It can come in these forms:

• Emotional abuse
• Psychological abuse
• Sexual abuse
• Financial abuse
• Spiritual abuse
• Verbal abuse
• Social abuse
• Elder abuse
• Image-based abuse

It’s not always easy to identify domestic abuse, especially when it’s one of the less-talked-about types. Here are some examples of domestic abuse:

• Telling someone they can’t do anything right
• Demanding that someone dresses a specific way or keeps a particular haircut
• Discouraging or stopping someone from seeing friends or family members
• Preventing someone from making their own decisions
• Intimidating or threatening someone
• Making someone do things against their will
• Controlling what someone does or where they go
• Purposely embarrassing or shaming someone with insults or put-downs

Any combination of these behaviors indicates that domestic violence is affecting one partner in a relationship.

Addiction and Causes of Domestic Violence

All forms of domestic violence originate from the same source: a person’s desire to control and wield power over another. The link between drugs, alcohol and violence stems, in part, on the behavioral changes produced by these substances. When someone is intoxicated, they lose much of their control over their inhibitions.

While that can seem fun in the beginning or in friendly social situations, it can become terrifying when it comes to anger. Someone who has never even been in a scuffle can suddenly leap into a fistfight with no concern for the safety of either party, and people with vindictive tendencies may show off the full force of their anger. Both addiction and domestic violence share some characteristics, including:

• Loss of control over one’s actions
• Continuation of the behavior despite adverse consequences
• Worsening of the condition over time
• The involvement of shame or denial

When both people are struggling with an SUD, the risk of domestic violence may increase. When under the influence, neither person is acting rationally, and the victim may not be able to gauge how much danger they’re in. There is an increased chance that the victim will end up escalating the conflict, or won’t be able to defend themselves. Intoxication also makes it more difficult to call for help.

When physical abuse and addiction collide, they often leave the victim stuck in a vicious cycle. They may not be able to report the abuse in fear that the partner will retaliate on a physical, emotional or financial level. This fear leaves the perpetrator free to continue using or drinking, while exerting their will through the abuse. Getting locked in this cycle can have severe and lasting consequences for the victim.

Violence as a Gateway to Addiction

The relationship between addiction and violence is a two-way street. Not only can substance abuse lead to and worsen domestic abuse, but the effects of domestic abuse can also drive a victim to abuse substances themselves. Intimate partner violence (IPV) occurs alongside substance abuse at astonishing rates. Multiple studies tell us that substance abuse plays a role in anywhere from 40% to 60 of IPV incidents.

Many of the studies suggest that substance use and abuse facilitate or precipitate domestic violence by making violent tendencies worse. Spousal abuse is a known predictor of the victim developing issues surrounding drugs and alcohol. One worrying factor is that many women in abusive relationships report that their partner coerced them into using drugs or alcohol. This coercion is a direct attempt on behalf of the abusive partner to exert a form of control on the victim, and it can lead to a challenging path of addiction after repeated instances.

The problem of abuse as a gateway to addiction is particularly dangerous for mothers. One unique study of more than 2,000 prenatal patients in North Carolina showed that victims of violence were far more likely to use more than one substance before and during their pregnancy compared to those with no IPV experiences.

How Substance Abuse-Fueled Violence Impacts Children

The most disturbing drug, alcohol and violence statistics surround children. Although estimates fluctuate significantly between studies, some recent research suggests that more than 8.3 million children in the United States live with a parent who abuses or is dependent on drugs or alcohol. That’s 11% of all individuals under 18 who may be subject to violence rooted in substance abuse.

IPV profoundly impacts kids of any age, even those many people would consider too young to remember. Children display a variety of symptoms after exposure to conflict between parents, and violence precipitated by substance abuse is no different.

Compared to children who get exposed to non-severe violence or who live in a home where they don’t see the violence that occurs, kids exposed to severe IPV have more significant symptoms. Mothers and fathers have reported that these kids display more internalizing, externalizing and PTSD symptoms. Children who live with parents who abuse drugs and alcohol, but don’t see violence, share many of the same symptoms as children who live with parents who don’t abuse drugs, but do experience domestic violence.

Short-Term Effects of Violence on Children

Kids who witness the abuse of one parent are generally fearful and anxious for their safety and the safety of the abused parent. Due to this, they react in different ways, largely depending on age.

Preschool

Young children who get exposed to intimate partner violence often display signs of regression. They retreat to the relative safety of things they used to do, such as:

• Bed-wetting
• Thumb-sucking
• Increased crying or whining

Problems sleeping are common, and bedtime can become a source of extreme stress. Preschool children may also show signs associated with terror, like stuttering when speaking or running away to hide. Symptoms of separation anxiety may appear or get worse.

School-Aged Children

Children in grade school typically experience feelings of guilt and shame in connection to a parent’s abuse and addiction. They often place the blame on themselves, leading to low self-esteem. They may fall behind in school, not participate in activities, fail to make or keep friends and get into trouble more frequently. Physical symptoms of persistent guilt include headaches and stomachaches.

Teens

Teens tend to move beyond feelings of guilt to feelings of anger, which can cause them to act out in a variety of ways. They may fight with family members or skip out on school. Risky behaviors like unprotected sex and experimentation with drugs or alcohol may increase in frequency and severity. Teens who witness IPV may go on to bully others or start fights, and may go so far as to get in trouble with law enforcement.

Long-Term Effects of Violence on Children

Substance abuse-fueled violence has a permanent effect on children, with the consequences following them throughout adulthood. For instance, if a boy witnesses his mother’s partner abusing her, he becomes 10 times more likely to abuse his female partner as an adult. Girls who grow up seeing their father abuse their mother are more than six times likelier to experience sexual abuse, compared to women who grew up in non-abusive homes.

Kids who get exposed to abuse of a physical, sexual or emotional variety are also at higher risk for developing a wide array of health problems once they are adults. The potential issues range from mental health conditions like depression and anxiety to physical conditions like heart disease and obesity.

The Role of Substances in Crime

It’s likely impossible to determine the exact extent of the role of drug and alcohol abuse in the commission of crimes. However, data from government sources like the Arrestee Drug Abuse Monitoring program (ADAM II) from the National Institute of Justice shed some light on the relationship. The most recent ADAM II report is from 2013, and it collected urine samples from male arrestees at these five areas:

• Atlanta, Ga.
• Chicago, Ill.
• Denver, Colo,
• New York, N.Y.
• Sacramento, Calif.

One of the critical facts ADAM II presents is that drug use is a factor in a significant percentage of crimes. Victims who report that they believe the offender was intoxicated at the time make up less than half the number of total violent crime, but in reality, the percentage of drug use observed is much higher.

ADAM II tested for 10 drugs:

• Marijuana
• Cocaine and metabolites
• Opioids
• Amphetamines
• Barbiturates
• Benzodiazepines
• Buprenorphine
• Methadone
• PCP
• Oxycodone

The study combined objective biological measures obtained through drug screens with self-reported use among the people arrested and charged. These are three of the most significant findings of ADAM II:

• The percentage of arrestees who tested positive for drugs was lowest in Atlanta at 63%, and highest at 83% in Chicago and Sacramento.
• The percentage of arrestees with multiple drugs found in their system was lowest at 12% in Atlanta and highest at 50% in Sacramento.
• The most commonly used drug among arrestees was marijuana, with 34% in Atlanta up to 59% in Sacramento.

Substance abuse is a significant factor in the commission of crimes, violent and otherwise. Given that the cost of addiction treatment is far less than the cost of incarcerating an individual, many states are expanding the availability of treatment in the justice system as a form of diversion or an option to help ensure those already incarcerated don’t re-offend due to addiction upon release.

DUIs: The Most Notorious Form of Substance-Fueled Violence

Driving under the influence of alcohol or drugs is the most common form of substance-fueled violence, affecting both the driver and potentially anyone around them. Each day, 29 people in the U.S. die in car crashes that involve a driver impaired by alcohol. That works out to one death every 50 minutes and an annual cost of more than $44 billion.

How Big Is the Problem?

The CDC’s most recent figures on DUIs are from 2016. These are some of the most shocking statistics:

• Alcohol-impaired driving crashes accounted for 28% of all traffic-related deaths, killing 10,497 people.
• A full 17% of the 1,233 traffic deaths of children ages 0 to 14 years old involved a driver under the influence of alcohol.
• More than a million drivers were arrested for driving under the influence of alcohol or narcotics, representing only 1% of the self-reported episodes of impaired driving among adults every year.
• Drugs other than alcohol are present in about 16% of car crashes.
• Marijuana use is becoming more common, with 13% of nighttime and weekend drivers involved in crashes having cannabis in their system.
• Marijuana users are around 25% likelier to be involved in a crash than drivers with no evidence of marijuana use. However, other factors like age and gender may play a role in the increased risk.

Effective Strategies Against Intoxicated Driving

DUI is such an immense problem that states have had to implement many measures against the practice. These are some of the strategies that are effective for reducing or preventing drunk driving.

1. Drunk Driving Laws

Drunk driving laws cut off the amount of alcohol someone can legally drink before going on to drive. Nationwide laws stipulate that a blood alcohol concentration (BAC) of 0.08% is too high to drive legally. For those under 21, “zero-tolerance” laws make any measurable BAC illegal. All 50 states and the District of Columbia have these laws in place.

2. Sobriety Checkpoints

At a sobriety checkpoint, police can briefly stop vehicles in specific high-visibility locations to check for impaired drivers. After asking a few questions, officers may administer breathalyzer tests if they suspect a driver is intoxicated. Police have the option to stop all drivers, or just a designated portion.

3. Ignition Interlocks

For those who have already been guilty of one DUI and are at high risk of re-offending, the police may install ignition interlocks in their cars. This device has the driver take a breathalyzer and will not allow the person to start the car if their BAC is above a specific threshold — usually 0.02%. This strategy has proven highly effective for first-time offenders.

4. Multi-Component Interventions

These interventions are a combination of multiple programs and policies that work together to stop intoxicated driving. Communities, coalitions and task forces design and implement the programs.

5. Mass Media Campaigns

Sometimes, the issue is that people aren’t aware of the danger and consequences of drunk or intoxicated driving. These campaigns are often video-based and designed to persuade people not to drink and drive, while encouraging them not to let other drivers do so either.

6. Administrative Revocation or Suspension Laws

These laws allow police to remove driver’s licenses from anyone who tests above the legal BAC limit, or who refuses to accept testing. Individual states decide how long to suspend the license, with many opting for at least 90 days.

7. Alcohol Screening and Brief Interventions

Enlisting the help of people in health care, university or other specific settings to perform screenings for alcohol or drug problems can help get people into treatment as needed. These teachable moments can turn lives around and reduce the risk of someone incurring a DUI.

Gateway Foundation: Committed to Stopping the Cycle of Substance Abuse and Violence

The disease of addiction can result in multiple cycles of violence for the person who is addicted and those who love them. Substance abuse can even harm total strangers in the case of DUI. Gateway Foundation understands the complexities of drug-induced violence and the strategies needed to combat it. If you or someone you care about is struggling with drugs or alcohol and violence, contact Gateway Foundation to learn more about our evidence-based treatment for addiction

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Gateway Foundation

Gateway Foundation is a recognized leader in evidence-based addiction treatment proven to get results. Our experts in Addiction Medicine—including highly educated clinical and medical professionals and expert psychiatrists and nurses—deliver care that never stops. For over 50 years, Gateway Foundation has been helping individuals and their families recover from addictions and behavioral health issues and is the only provider that covers the entire state of Illinois with 16 facilities from the Wisconsin Border to the Kentucky Border. Gateway has specific programs focusing on substance use disorders, trauma, depression, anxiety, and other co-occurring issues. We’re licensed by the state of Illinois and accredited by the Joint Commission. We are in-network with all the major commercial insurance plans. Gateway Foundation: Addiction medicine, saving lives.