Rapid evidence review: The role of alcohol in contributing to violence in intimate partner relationships

Research has evidenced the contribution of heavy alcohol use to a range of significant harms to people other than the drinker. Importantly, recent research highlights that alcohol-related harms to women from others largely stem from the behaviour of intimate male partners. Harms in relationships linked to alcohol use may extend from fairly minor grievances to more severe impacts, including intimate partner violence (IPV). The public health burden of IPV is considerable and alcohol use has been consistently identified as a risk factor for IPV perpetration.

This rapid review of alcohol’s contribution to violence in intimate relationships was based on a review of:

• Articles that explicitly mentioned conceptual models or theories in the context of the relationship between IPV and alcohol use; and
• Meta-analyses that have examined problem alcohol use as the exposure and IPV perpetration or victimisation as the outcome of interest, and vice versa. Qualitative evidence from a recent meta-ethnography was used to provide further context to quantitative findings.
• Evidence for the effectiveness (and cost-effectiveness) of approaches that might impact on the relationship between alcohol and IPV perpetration and victimisation. This was achieved through a rapid review of systematic reviews.

Key findings from the review of the evidence on the relationship between alcohol use and IPV

• Different ideas and explanations link alcohol use and IPV. Whether alcohol use plays a causal, contributory or other role in IPV remains an area of debate.
• Meta-analyses show a robust association between alcohol use and IPV perpetration and victimisation in heterosexual relationships. Women appear to be at a higher risk of having physical IPV perpetrated against them by a male partner who has been drinking than vice versa.
• Alcohol-related IPV occurring in the context of lesbian, gay, bisexual and/or transgender relationships is understudied.
• Explanations for why some people who drink alcohol perpetrate IPV are complex. Considering the interplay between broader contextual and environmental influences, and relationship and individual characteristics is likely to be useful in linking models of alcohol use and IPV.

Key finding from the review of evidence for the effectiveness of approaches to tackle alcohol-related IPV

• Systematic reviews have identified a lack of robust evidence to determine whether population-level approaches to alcohol pricing and taxation, community-level policies and interventions to reduce alcohol availability, couples-based and individual-level alcohol treatment, and integrated alcohol and IPV perpetrator interventions effectively reduce or eliminate IPV-related outcomes.

Implications for research

• Overall, further research is required to better understand the contextual and environmental factors that link alcohol use and IPV perpetration and victimisation. Additional qualitative research is needed to provide a richer understanding of the relationship, and to better understand the impact of alcohol-related IPV across different drinking behaviours and forms of IPV.
• Although some assessments have been undertaken, the impact of whole population approaches on alcohol-related IPV requires further investigation. More specifically, we lack a clear understanding of the effects of pricing policy measures on alcohol-related IPV.
• Few interventions exist to address IPV perpetration among men accessing treatment for their alcohol use. Further evidence-based integrated interventions need to be developed and evaluated.

Implications for policy

• It is clear that there is a complex relationship between alcohol use and IPV. Theoretical frameworks underpinning policy actions need to incorporate a model of alcohol-related IPV that acknowledges the contextual and environmental factors that link alcohol use and IPV perpetration.
• Although few interventions exist to reduce alcohol-related IPV perpetration, evidence about the nature and relationship of alcohol-related IPV points to a need for guidance on addressing IPV among men accessing treatment for their alcohol use.

Bringing together the findings from across the different review elements, we have identified that different ideas and explanations have been provided about the relationship between alcohol use and IPV. Theoretical explanations for why some people who drink alcohol perpetrate IPV are complex and whether alcohol use plays a causal, contributory or other role in IPV remains an area of debate. Considering the interplay between broader contextual and environmental influences, and relationship and individual characteristics may be useful in linking theoretical explanations and models of the relationship between alcohol use and IPV.

Alongside these theoretical and conceptual developments and debates, meta-analyses have provided evidence of a consistent and robust association between alcohol use and IPV perpetration and victimisation. Women appear to be at a higher risk of having IPV perpetrated against them by a male partner who has been drinking than vice versa. A synthesis of qualitative studies (meta-ethnography) found that substance use (including alcohol use) plays a complex role in IPV perpetration. Being under the influence of alcohol or other substances (intoxication) is interwoven with a range of other contributing contextual factors in influencing IPV perpetration.

Systematic reviews have identified a lack of robust evidence to determine which intervention approaches most effectively reduce or eliminate IPV-related outcomes. Further research is urgently needed to address the gaps in the evidence base.