Alcohol and intimate partner violence
Download
1 / 34

Alcohol and Intimate Partner Violence - PowerPoint PPT Presentation


  • 378 Views
  • Updated On :

Alcohol and Intimate Partner Violence Anika A. H. Alvanzo, MD, MS Virginia Commonwealth University Medical Center Introduction Alcohol Misuse/Alcohol Use Disorders (AUD) ~16% at risk drinkers; ~ 9% AUD Cost ~ $185 billion 3rd leading cause of death Intimate Partner Violence (IPV)

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Alcohol and Intimate Partner Violence' - benjamin


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Alcohol and intimate partner violence l.jpg

Alcohol and Intimate Partner Violence

Anika A. H. Alvanzo, MD, MS

Virginia Commonwealth University Medical Center


Introduction l.jpg
Introduction

  • Alcohol Misuse/Alcohol Use Disorders (AUD)

    • ~16% at risk drinkers; ~ 9% AUD

    • Cost ~ $185 billion

    • 3rd leading cause of death

  • Intimate Partner Violence (IPV)

    • 1/4 women and 1/12 men

    • Cost ~ $6 billion/yr

    • ~ 1/3 of homicides of women


This lecture will cover l.jpg
This Lecture Will Cover:

  • Alcohol/IPV

    • Definition and Epidemiology

    • Health Consequences

    • Identification

    • Treatment

    • Association between alcohol and IPV

    • Treatment for co-occurrence



Alcohol use guidelines l.jpg
Alcohol Use Guidelines

  • Standard drink

    • 12 oz. beer

    • 5 oz. of wine

    • 1.5 oz. of spirits (hard liquor)

  • ≤ 2 drinks/day for men

  • ≤ 1 drink/day for women


Definitions of alcohol use l.jpg
Definitions of Alcohol Use

  • Heavy/“At-risk” drinking

    • Men: ≥ 5 drinks/day or ≥15 drinks/week

    • Women: ≥4 drinks/day or ≥8 drinks/week

  • Binge drinking

    • Historically: used for 2+ days drunk

    • More recently: pattern with BAC ≥ 0.08%


Definition of aud l.jpg

Alcohol dependence ≥ 3

Withdrawal

Tolerance

Exceed limits

Not able to stop/cut down

Much time drinking

Give up other activities

Use despite problems

Alcohol abuse ≥ 1

Role failure

Risk of bodily harm

Legal problems

Relationships

Definition of AUD


Epidemiology of use and aud l.jpg
Epidemiology of Use and AUD

Sex/Age differences:

Men Women

Heavy drinking: 17% 13%

Current abuse: 7% 3%

Current dependence: 5% 2%

18-24 yo

20%

9%

13%


Epidemiology l.jpg
Epidemiology

Racial/Ethnic Differences:

Native Am

Whites

Hispanics

Blacks

Asians

Current

Heavy

Abuse/ Dependence

58%

70%

60%

53%

48%

22%

16%

12%

16%

10%

12%

9%

8%

7%

4%


Health consequences of aud l.jpg
Health Consequences of AUD

  • GI

    • Pancreatitis- 10%

    • Liver diseases

      • 80% fatty liver

      • 35% hepatitis

  • Neuro

    • Neuropathy- 10%

    • CBL dysfx- <1%

  • CV- 20% ↑ mortality

  • Blood- toxic for blood

  • Mental Health

    • Depression

      • 40% co-occurrence


Identification of drinking l.jpg
Identification of Drinking

  • Clinical indicators for screening

    • New patient

    • Annual exam

    • ER visit

    • Pregnancy

    • Rx medicine that interacts with alcohol

    • Clinical suspicion

      • Alcohol on breath

      • Family member statements


Screening l.jpg
Screening

  • NIAAA Clinician’s Guide

    • # of heavy drinking days in past year

      • Men: ≥ 5 drinks; women: ≥ 4 drinks

    • Weekly drinking average

      • # of drinking days in average week

        X

      • # of drinks on average drinking day

5

4

20

Weekly average =


Screening13 l.jpg
Screening

  • Alcohol Use Disorders Identification Test (AUDIT)

    • 10 items

    • + if ≥ 8 for men and ≥ 4 for women

  • PRIME MD- Patient Health Questionnaire

    • 5 items

    • + if ≥ 1


Treatment for aud l.jpg
Treatment for AUD

  • Behavioral

    • Brief Interventions

    • Cognitive Behavioral Therapy

    • 12-step programs

  • Pharmacologic

    • Acamprosate (Campral)

      • Dose: 2g/day; 666mg tid

    • Disulfiram (Antabuse)

      • Dose: 250mg/day

    • Naltrexone (ReVia)

      • Dose: 50-100mg/day



Definition of ipv l.jpg
Definition of IPV

  • A pattern of intentionally coercive and assaultive behaviors

    • Perpetrator is/was/wishes to be an intimate partner

    • Goal of behavior is to exert control


Definition of ipv17 l.jpg
Definition of IPV

  • IPV includes many types of behavior

    • Physical

    • Sexual

    • Psychological/emotional

    • Stalking

    • Threats

    • Property destruction

    • Neglect


Epidemiology of ipv l.jpg
Epidemiology of IPV

  • Sex differences:

    • Women ↑ victims; men ↑perpetrators

      • Lifetime prevalence: men 8%, women 25%

      • Women comprised 85% of IPV victims in 1999

  • Age differences:

    • Victimizations: highest prevalence age 20-24

    • Homicides: highest prevalence age 35-49


Epidemiology of ipv19 l.jpg
Epidemiology of IPV

  • Racial and ethnic differences

    • African Americans ↑ IPV

    • Hispanics ↓ IPV non-Hispanics

    • White women smallest ↓ in IPV homicide


Ipv associated health effects l.jpg
IPV: Associated Health Effects

  • ↑ healthcare expenditures

  • GI

    • Chronic abdominal pain

    • Digestive problems

  • GU

    • Pelvic pain

    • Sexually transmitted infections (STI)

  • Mental Health

    • Substance misuse

    • Depression, anxiety, PTSD


Healthy people 2010 ipv l.jpg

Access to care

Environ quality

Immunizations

Injury and violence

Mental health

Overweight/Obesity

Physical activity

Sexual behavior

Substance abuse

Tobacco use

Healthy People 2010: IPV

Leading Health Indicators


Identification of ipv l.jpg
Identification of IPV

  • Clinical indicators for screening

    • New patient

    • Annual exam

    • Urgent/emergent visit

    • Pregnancy

    • Clinical suspicion


Red flags for ipv l.jpg

Historyclues

↑ somatic complaints

Injury ≠ exam

Mental illness

Recurrent STIs

Substance misuse

Physical exam clues

Central injuries

Defensive wounds

Multiple stages of healing

Injury in pregnancy

Red Flags for IPV


Identification l.jpg
Identification

  • Framing statements

    • “Because violence is so common in our society, I have begun asking all of my patients about it.”

  • Indirect questions

    • “How do you and your partner handle disagreements?”

  • Direct questions

    • “Are you in a relationship with someone who hurts or threatens you?”


Abuse assessment screen l.jpg
Abuse Assessment Screen

  • 5-item questionnaire

  • Asks about:

    • Lifetime physical abuse

    • Past year physical abuse

    • Sexual abuse

    • Abuse during pregnancy

  • Includes body map


Abuse assessment screen26 l.jpg

1 = Threats of abuse including use of a weapon

2 = Slapping, pushing; no injuries and/or continuing pain

3 = Punching, kicking, bruises, cuts and/ or continuing pain

4 = Beating up, severe contusions, burns, broken bones

5 = Head injury, internal injury, permanent injury

6 = Use of weapon; wound from weapon

Abuse Assessment Screen

Mark The Area Of Injury On The Body Map Using the Following Scale:


Danger assessment tool l.jpg
Danger Assessment Tool

  • 20-item questionnaire

  • Assesses risk for lethality

  • Factors linked to severe or lethal IPV

  • Calendar to document assaults


Interventions l.jpg
Interventions

  • Victims:

    • Validate disclosure (e.g. show empathy)

    • Respond to safety concerns

    • Provide resources

      • National Hotline 1-800-799-SAFE

  • Perpetrators:

    • Batterer intervention programs

    • Individual counseling


Alcohol and ipv victimization l.jpg
Alcohol and IPV Victimization

  • IPV victims ↑ problems with alcohol

    • 3x more heavy use

    • 5% → 16% → 24% with ↑ violence

  • Women in alcohol treatment ↑ IPV

    • 87% moderate IPV vs. 28% in community

    • 40% severe IPV vs. 8% in community

  • IPV problem drinking


Alcohol and ipv perpetration l.jpg
Alcohol and IPV Perpetration

  • Men in batterer intervention = ↑ alcohol

    • Up to 50% have alcohol problem

    • ↑ violence on heavy drinking days

  • Men in alcohol treatment = ↑ IPV

    • Prevalence ~ 50%


Trauma sud interventions l.jpg
Trauma/SUD Interventions

  • Seeking Safety

    • Group behavioral intervention

    • PTSD and SUD

    • ↓ PTSD symptoms and substance use

  • Trauma Recovery Empowerment Model

    • Group behavioral intervention

    • Hx trauma and mental illness

    • ↓ trauma symptoms and substance use


Treatment of aud and ipv l.jpg
Treatment of AUD and IPV

  • Perpetration

    • Few studies ↓ IPV after alcohol Rx

    • Only 1 study of integrated therapy

      • + effect on alcohol & IPV post-treatment

      • No difference at 6 month f/u


Summary l.jpg
Summary

  • Alcohol misuse + IPV = major public health problems

  • Alcohol misuse + IPV commonly co-occur

  • Should routinely ask about both

    • Ask about both in routine clinical encounter

    • Screen for IPV in addiction treatment settings

    • Screen for alcohol misuse in settings serving victims of IPV

  • More research is needed



ad