This study examined the prevalence of perpetration of intimate partner violence among 356 men recruited from methadone maintenance treatment programs. We used logistic regression with covariance adjustment to examine the associations between intimate partner violence and illicit drug use by the participants, their female partners, or both. We found a high prevalence of intimate partner violence among the men in our sample. Significant associations between intimate partner violence and illicit drug use varied by types of drugs and whether the female partner or both partners were using drugs

Chang, Mingway P.

El-Bassel, Nabila

Fontdevila, Jorge

Gilbert, Louisa

Wu, Elwin

Columbia University Academic Commons

American Journal of Public Health | July 2007, Vol 97, No. 71230 | Research and Practice | Peer Reviewed | El-Bassel et al.⏐ RESEARCH AND PRACTICE ⏐Perpetration of IntimatePartner Violence AmongMen in MethadoneTreatment Programs inNew York City| Nabila El-Bassel, DSW, Louisa Gilbert, MS,Elwin Wu, PhD, Mingway Chang, MA, andJorge Fontdevila, PhDThis study examined the prevalenceof perpetration of intimate partner vi-olence among 356 men recruited frommethadone maintenance treatmentprograms. We used logistic regressionwith covariance adjustment to exam-ine the associations between intimatepartner violence and illicit drug use bythe participants, their female partners,or both. We found a high prevalenceof intimate partner violence amongthe men in our sample. Significant as-sociations between intimate partnerviolence and illicit drug use varied bytypes of drugs and whether the femalepartner or both partners were usingdrugs. (Am J Public Health. 2007;97:1230–1232. doi:10.2105/AJPH.2006.090712)Over the past 2 decades, accumulating re-search has found illicit drug use to be a keyrisk factor for men perpetrating intimate part-ner violence against women.1–7 Research alsohas found strong associations betweenwomen’s use of different illicit substances andexperiencing intimate partner violence.8–10Knowledge remains limited on how the rela-tion between drug use and intimate partnerviolence varies according to whether the per-petrator, the victim, or both use illicit drugs.We addressed gaps in the knowledge base onthe relation between illicit drug use by bothpartners in an intimate relationship and theperpetration of intimate partner violence.METHODSA random sample of 356 eligible men wasrecruited from methadone maintenance treat-ment programs in New York City. Eligible maleparticipants had to meet the following require-ments: be aged 18 years or older; have beenenrolled in a methadone maintenance treat-ment program for at least 3 months; and dur-ing the past year, had a sexual relationshipwith a woman whom he described as his girl-friend, spouse, regular sexual partner, ormother of his children.11Physical, sexual, and injurious intimate part-ner violence during the past 6 months andlifetime were assessed with the Revised Con-flict Tactics Scale.12 Sexual intimate partner vio-lence pertains to coercive acts intended to en-gage a partner in unwanted sexual activity,that range from verbal insistence (e.g., “In-sisted on having sex when my partner did notwant to but did not use physical force”) tophysical force (e.g., used force [like hitting,holding down, or using a weapon] to make mypartner have oral or anal sexual intercourse”).Injurious intimate partner violence refers topartner-inflicted violence that has causedphysical injury. (An example question forminor injurious intimate partner violence is“My partner had a sprain, bruise, or small cutbecause of a fight with me,” and an examplefor severe injurious intimate partner violenceis “My partner passed out from being hit onthe head in a fight with me.”) Whereas injuri-ous intimate violence refers to the conse-quences of partner-inflicted physical injury,physical intimate partner violence refers to thetype of violent assault (e.g., slapping, pushing,kicking) perpetrated against the partner. NotJuly 2007, Vol 97, No. 7 | American Journal of Public Health El-Bassel et al. | Peer Reviewed | Research and Practice | 1231⏐ RESEARCH AND PRACTICE ⏐TABLE 1—Logistic Regression of Perpetrating Intimate Partner Violence in the Past 6 Monthson Couples’ Illicit Drug Use in the Past 6 Months From Sample of Men (N=356) FromMethadone Maintenance Treatment Programs: New York City, 2000–2001Any Form of Intimate Partner  Any Form of Severe Intimate Partner Couples’ Illicit Drug Use No. Violence,a Adjusted ORb (95% CIs) Violence,c Adjusted ORb (95% CI)Crack or cocaineNeither partner used 201 NA NAOnly male participant used 77 1.2 (0.7, 2.2) 0.4 (0.1, 2.0)Only female partner used 25 3.3 (1.2, 8.7)** 5.8 (1.4, 24.0)**Both used 53 1.9 (0.9, 4.0)* 2.5 (0.7, 8.4)HeroinNeither partner used 165 NA NAOnly male participant used 129 1.4 (0.8, 2.4) 1.7 (0.5, 5.4)Only female partner used 9 1.1 (0.2, 5.1) 6.7 (0.8, 56.3)*Both used 53 1.4 (0.7, 3.1) 6.8 (1.9, 24.6)***MarijuanaNeither partner used 193 NA NAOnly male participant used 85 0.8 (0.5, 1.5) 0.8 (0.3, 2.4)Only female partner used 29 1.2 (0.5, 2.9) 0.8 (0.1, 5.0)Both used 49 1.4 (0.7, 2.8) 0.8 (0.2, 3.2)Polydrug usedNeither partner used 199 NA NAOnly male participant used 97 1.3 (0.8, 2.3) 1.0 (0.3, 3.1)Only female partner used 18 2.4 (0.8, 7.0) 5.2 (1.0, 26.9)**Both used 42 1.9 (0.9, 4.3) 10.0 (2.6, 39.1)***Any illicit drugeNeither partner used 70 NA NAOnly male participant used 141 1.2 (0.6, 2.3) 1.0 (0.2, 4.8)Only female partner used 26 1.3 (0.5, 3.5) 0.9 (0.1, 11.3)Both used 119 2.1 (1.0, 4.3)** 3.7 (0.8, 16.6)*Note. OR = odds ratio; CI = confidence interval; NA = not applicable.aAny form of intimate partner violence encompasses both minor and severe incidents of any type of intimate partnerviolence (physical, sexual, or injurious). Physical intimate partner violence refers to the type of violent assault (e.g.,slapping, pushing, kicking) perpetrated against the partner, whereas injurious intimate violence refers to the consequencesof partner-inflicted physical injury (e.g., need for medical attention, bone or tissue damage, felt pain).b The adjusted covariates were participant’s age, years of schooling, income, ethnicity, unemployment status, incarcerationstatus, duration on methadone, and methadone dose; female partner’s age, years of schooling, ethnicity, unemploymentstatus, and incarceration status; type of relationship, whether living together, length of relationship, participant’scontribution to household income; and participant’s other drug use, partner’s other drug use, participant’s heavy episodicdrinking, and partner’s heavy episodic drinking.cDefined as any incident of any type of intimate partner violence (sexual, physical, or injurious) that was rated severe. CTS2 items foreach subscale (injurious, physical or sexual IPV) fall into minor and severe categories.Acts of violence (regardless of type—injurious,physical or sexual) are classified as minor or severe acts of violence.Table 2 contains examples of minor and severe levels of violence.dPolydrug use was defined as use of at least 2 of the 3 illicit drugs asked about (i.e., crack or cocaine, heroin, and marijuana).eAny illicit drug use was defined as use of any of the 3 drugs asked about (i.e., crack or cocaine, heroin, and marijuana).*P < .10; **P < .05; ***P < .01.all physical IPV necessarily results in injuries.We defined any form of intimate partner vio-lence (combining minor and severe subscales)and any form of severe intimate partner violenceas at least 1 incidence of sexual, physical, orinjurious intimate partner violence.We used the Drug Use and Risk BehaviorQuestionnaire to measure participants’ use ofcrack or cocaine, heroin, and marijuana in thepast 6 months.13 We focused on these 3 illicitdrugs because they were found to be associ-ated with intimate partner violence in the liter-ature.4,10 Participants also reported whethertheir female partners used these drugs over thepast 6 months. Polydrug use was defined as useof at least 2 of the 3 illicit drugs. Any illicit druguse was defined as use of any of the 3 drugs.For each type of illicit drug use, we constructeda “couples’ illicit drug use” variable with 4 at-tributes: (1) neither the participant nor his fe-male partner used the drug, (2) only the maleparticipant used the drug, (3) only the femalepartner used the drug, or (4) both the partici-pant and his female partner used the drug.We collected data on sociodemographiccharacteristics (age, years of schooling, income,ethnicity, unemployment status, and incarcera-tion status for participants and their femalepartners), relationship characteristics (type ofrelationship, length of relationship, participants’contribution to household expenses), and self-reports of heavy episodic drinking, defined formen as consuming 5 or more alcoholic drinks2and for women as consuming 4 or more alco-holic drinks14 within a 6-hour period.To estimate the associations between the in-dependent variables of couples’ illicit drug useand the dependent variables of any form ofintimate partner violence, we used logistic re-gression with the covariance adjustment(Table 1); covariance adjustment also includedmeasures of heavy episodic drinking, becauseof the association between heavy episodicdrinking and intimate partner violence.15–17Separate models were constructed for use ofeach drug by the female partner only, by themale partner only, and by both partners. Thereference group for each of these models wasno use of the drug by the participant and hispartner. For a drug of interest, we included co-variance adjustment for use of the other illicitdrugs (e.g., heroin and marijuana when crackor cocaine was the drug of interest).RESULTSOf the 356 participants, 45% were Latino,38% were African American, 11% were Cau-casian, 2% were Native American, and 4%were mixed race. Their mean age was 43.6years (SD=8.5). The percentages of male par-ticipants who used illicit drugs in the past 6months were as follows: crack or cocaine,37%; heroin, 51%; marijuana, 38%; and anyillicit drug, 73%. For the female partner, thepercentages were as follows: crack or cocaine,22%; heroin, 17%; marijuana, 22%; and anyillicit drug, 41%.Table 2 shows the prevalence of men whoperpetrated intimate partner violence by typeand severity. Results indicated that 58% ofthe sample reported perpetrating any form ofAmerican Journal of Public Health | July 2007, Vol 97, No. 71232 | Research and Practice | Peer Reviewed | El-Bassel et al.⏐ RESEARCH AND PRACTICE ⏐TABLE 2—Prevalence Among Sample ofMen (N=356) From MethadoneMaintenance Treatment Programs WhoHave Perpetrated Intimate PartnerViolence in Their Lifetime and in thePast 6 Months, by Type and Severity:New York City, 2000–2001Type of Intimate Lifetime Past 6 MonthsPartner Violence No. % No. %Any forma 208 58 137 38Any form, severeb 62 17 28 8Physicalc 173 49 95 27Physical, severe 57 16 25 7Sexuald 113 32 74 21Sexual, severe 15 4 7 2Injuriouse 68 19 36 10Injurious, severe 17 5 11 3aIntimate partner violence was defined as anyincident of minor or severe type of intimate partnerviolence (physical, sexual, or injurious).bSevere intimate partner violence was defined asany incident of severe type of intimate partnerviolence (physical, sexual, or injurious).cAn example question for minor physical intimatepartner violence was “I threw something at my partnerthat could hurt”; for severe physical intimate partnerviolence, “I used a knife or gun on my partner.”dAn example question for minor sexual intimatepartner violence was “I made my partner have sexualintercourse without a condom”; for severe sexualintimate partner violence, “I used force (such ashitting, holding down, or using a weapon) to make mypartner have oral or anal sexual intercourse.”eAn example question for minor injurious intimatepartner violence was “My partner had a sprain, bruise,or small cut because of a fight with me”; for severeinjurious intimate partner violence, “My partner passedout from being hit on the head in a fight with me.”intimate partner violence against their currentpartner in their lifetime and 38% in the past6 months.Table 1 presents the association between il-licit drug use by participants and their femalepartners and perpetration of intimate partnerviolence. Crack or cocaine use by the femalepartner was significantly associated with perpe-tration of any intimate partner violence and anysevere intimate partner violence. Heroin use byboth partners was significantly associated withperpetration of any severe intimate partner vio-lence. Polydrug use by the female partner andby both partners was significantly associatedwith perpetration of any severe intimate partnerviolence. Any illicit drug use by both partnersalso was significantly associated with perpetra-tion of any intimate partner violence.DISCUSSIONThe high rates of perpetrating different typesof recent intimate partner violence reported inthis random sample of men attending metha-done maintenance treatment programs under-score the need to address the co-occurring pub-lic health threat of intimate partner violenceand drug abuse. Multiple associations werefound between the use of different drugs bythe female intimate partner or both partnersand perpetration of intimate partner violence.Although the data on female partners’ illicitdrug use were collected from the male partici-pants, findings suggested that drug treatmentprograms should assess how patterns of cou-ples’ drug use and female intimate partner druguse may be creating relationship problems thatlead to intimate partner violence. By identifyingand addressing the service needs of drug-usingfemale partners and couples at risk for intimatepartner violence, drug treatment programs mayreduce couples’ drug use and help stem the epi-demic of intimate partner violence and its dele-terious effects on this population.About the AuthorsNabila El-Bassel, Louisa Gilbert, Elwin Wu, and MingwayChang are with the Social Intervention Group, ColumbiaUniversity School of Social Work, New York, NY. JorgeFontdevila is with the Center for AIDS Prevention Studies,University of California, San Francisco.Requests for reprints should be sent to Nabila El-Bassel,DSW, Social Intervention Group, Columbia UniversitySchool of Social Work, 1255 Amsterdam Ave, New York,NY 10027 (e-mail: ne5@columbia.edu).This brief was accepted August 21, 2006.ContributorsN. El-Bassel and L. Gilbert conceptualized and imple-mented the study. N. El-Bassel conceptualized the dataanalysis plan, wrote the brief, and supervised the pro-cess of data analysis. L. Gilbert participated in the con-ceptualization of the data analysis and revision of thebrief. E. Wu participated in the data analysis and revi-sion of the brief. M. Chang conducted the data analysis.J. Fontdevila participated in the conceptualization of thestudy and reviewed the brief.AcknowledgmentsThis study was supported by the National Institute onDrug Abuse (grant DA012335).We acknowledge the contributions of the staff of theMethadone Maintenance Treatment Program at theBeth Israel Medical Center, New York, for their help inconducting this study.Human Participant ProtectionThe protocol was reviewed and approved by the institu-tional review boards of Columbia University and theMethadone Maintenance Treatment Program at theBeth Israel Medical Center, New York.References1. Abbott J, Johnson R, Koziol-McLain J, Lowenstein SR.Domestic violence against women: incidence and prev-alence in an emergency department population. JAMA.1995;273:1763–1767.2. Miller BA, Downs WR. The impact of family vio-lence on the use of alcohol by women. Alcohol HealthRes World. 1993;17:137–143.3. Chermack S, Fuller B, Blow F. Predictors of ex-pressed partner and non-partner violence among pa-tients in substance abuse treatment. Drug Alcohol De-pend. 2000;58:43–54.4. Chermack ST, Walton MA, Fuller BE, Blow FC.Correlates of expressed and received violence acrossrelationship types among men and women substanceabusers. Psychol Addict Behav. 2001;15:140–151.5. Hotaling GT, Sugarman DB. An analysis of riskmarkers in husband to wife violence: the current stateof knowledge. Violence Vict. 1986;1:101–124.6. Leonard KE, Bromet EJ, Parkinson DK, Day NL,Ryan CM. Patterns of alcohol use and physically aggres-sive behavior in men. J Stud Alcohol. 1985;46:279–282.7. El-Bassel N, Fontdevila J, Gilbert L, Voisin D,Richman BL, Pitchell P. HIV risks of men in metha-done maintenance treatment programs who abuse theirintimate partners: a forgotten issue. J Subst Abuse.2001;13:29–43.8. Brewer DD, Fleming CB, Haggerty KP, Catalano RF.Drug use predictors of partner violence in opiate-dependent women. Violence Vict. 1998;13:107–115.9. Kilpatrick DG, Acierno R, Resnick HS, SaundersBE, Best CL. A 2-year longitudinal analysis of the rela-tionships between violent assault and substance use inwomen. J Consult Clin Psychol. 1997;65:834–847.10. El-Bassel N, Gilbert L, Wu E, Go H, Hill J. Rela-tionship between drug abuse and intimate partner vio-lence: a longitudinal study among women receivingmethadone. Am J Public Health. 2005;95:465–470.11. El-Bassel N, Gilbert L, Golder S, et al. Deconstruct-ing the relationship between intimate partner violenceand sexual HIV risk among drug-involved men andtheir female partners. AIDS Behav. 2004;8:429–439.12. Straus M, Hamby S, Boney-McCoy S, et al. TheRevised Conflict Tactics Scales (CTS2): developmentand preliminary psychometric data. J Fam Issues. 1996;17:283–316.13. El-Bassel N, Gilbert L, Schilling RF, et al. Drugabuse and partner violence among women in metha-done treatment. J Fam Violence. 2000;15:209–225.14. 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Perpetration of intimate partner violence among men in methadone treatment programs

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Perpetration of intimate partner violence among men in methadone treatment programs

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