For more details, see Gadd et al.,2 Radcliffe et al.,5 Love et al.,8 Gilchrist et al.11
Aims
Interviews were conducted separately with male IPV perpetrators and their female (ex)-partners to:
- describe what contributes to IPV and ascertain their relationship/support needs
- explore the role of intoxication and substance use within violent acts
- test/revise the main IPV perpetrator typologies from meta-ethnography [WP1(i)]
- identify pathways into substance use and IPV.
Methodology
Participants’ stories about substance use, relationships and particular examples of abuse were elicited in interviews, using techniques adapted from the FANI method.83
Recruitment
Thirty-seven men were recruited from six community-based substance use treatment services in England. Keyworkers at these services identified men with a history of IPV perpetration from their caseloads and researchers also approached prospective male participants in waiting rooms. Men 18 years or older, receiving substance use treatment, able to be interviewed in English and answering positively to questions in the IPV screening questionnaire were eligible.
Men were asked to provide contact details for their (ex)-partner/s so that researchers could invite them for interview. Contact details were provided for 32 (ex)-partners, 14 of whom agreed to participate.
Procedure
Participants were advised of limits to confidentiality. Different researchers interviewed women and men in the same dyad to ensure no inadvertent information sharing and services’ safeguarding protocols were followed to ensure participant safety. Participants received £20 to compensate their time.
Data analysis
Timelines were created to track the sequence of events through each participant’s life. Case studies were then written up as ‘pen portraits’, capturing the complexity revealed in each interview. In 14 cases, where both partners were interviewed, men’s and women’s accounts were compared. The analysis integrated a theoretically driven thematic and narrative approach84 to identify key ways in which substance use featured in attributions and explanations for IPV.85 NVivo (QSR International, Warrington, UK) was used for managing qualitative data.
Results
Sample characteristics
Table 1 shows male and female dyad characteristics.
| Men | Women | |
|---|---|---|
| White | 13 | 12 |
| Ethnic minorities (excluding White minorities) | 1 | 2 |
| Mean age (years) | 41 (5.9) | 41 (9.7)a |
| Age range (years) | 33–50 | 28–56 |
| Relationship status | ||
| In a relationship currently | 7 | 7 |
| Separated | 7 | 7 |
| Treatment of heroin/crack | 12 | N/A |
| Treatment of cocaine/alcohol | 1 | N/A |
| Treatment of alcohol | 1 | N/A |
| Never used heroin/crack | 6 | |
| Formerly used heroin/crack | 4 | |
| Currently using heroin/crack | 4 | |
Themes and narratives
Codes included Intoxication, Withdrawal and Craving, and Financial Abuse linked to Substance Use. The overarching narratives, used by male and female participants, were: sexual betrayal/sexual jealousy, mutual combat/fighting back, protection/control and psychological vulnerabilities (Figure 3).
FIGURE 3 Themes and narrative descriptions. (Figure not reproduced here; see the original article.)
Intoxication provided explanations for IPV perpetration for both men and women. Sometimes violence associated with intoxication was an aberrant and/or one-off incident. Sometimes intoxication was entangled with enduring violence in perpetrators’ paranoid perceptions of sexual betrayal. Separating the effects of intoxication from controlling behaviour that justified physical violence was often difficult. Craving and withdrawal from heroin and crack also provided explanations for violence, where partners competed for drugs, and in disputes about how to raise funds to buy drugs. While male partners referred to the need to protect (ex)-partners from unscrupulous others, women often reported these behaviours as controlling. Women who did not use drugs often described substance-related financial abuse, where money was taken for drugs ‘he’s having money off me all the time again’ (Gemma, cannabis use, Geoff/Gemma dyad), and family members’ possessions stolen. Psychological vulnerabilities featured in participants’ rationalisation of IPV. Most male and female participants reported experiencing childhood and adult adversity and related mental health problems (Table 2). Substance use was described as suppressing disturbing thoughts that resulted in violence when they emerged.
| Explanation for IPV | Male perpetrator | Female survivor |
|---|---|---|
| Intoxication | I’d had a drink, not a lot but I’d had a drink, and I was laid on the settee. They came in and my eldest son says to me, ‘We've been to a pub …’ and I just (flipped) … We had an argument, I didn’t slap her slap her, I just went (actions brushing her away), ‘**** off’ (Lucas, treatment for alcohol, Lucas/Bianca dyad) | You could tell he was intoxicated. He went to bed, he came back down 10 minutes later, started shouting again, name calling, carrying on, and I stood up to him and said, ‘Please go to bed, leave it and we’ll talk about it tomorrow’. He headbutted me and slapped me across the face (Bianca, no drug use, Lucas/Bianca dyad) |
| Craving and withdrawal | When we was both using, we used to shoplift, yeah, and, what happened, she said something to me and I said, I threw her on the floor, yeah, I think I was out of it, or something, but there was big hole, yeah, and she fell into the hole and the Police came … and I went to prison for it … I was agitated … and like, the come down, I was coming down, so like I needed something … (Tim, treatment for heroin and crack, Tim/Karen dyad) | He’d beaten me up and pushed me down a manhole … and I was bleeding, my face was busted up … He had taken a big plank of, erm, rock … to chuck at me. I fell, he was fighting me, and I fell in the manhole and he was still hitting me with the stick (Karen, heroin and crack use, Tim/Karen dyad) |
| Financial abuse | That’s what caused most of the arguments ’cause I was always on drink, I was on drugs. Always spending a lot of money … You know, always out just doing my own thing … When I have had no drugs, I was always taking money off her and I’d feed habits (Mike, treatment for cocaine and alcohol, Mike/Jenny dyad) | I was in bed and it was payday that day … he woke me up asking for money. I was like, ‘No, I’m not getting money’ and he wasn’t even dressed at the time. So he said, ‘I’m coming bank. I’m going to take the money off you’ and I ran out and I turned round thinking that he can’t get me ‘cause he’s not dressed. By the time he get dressed, I’m gone and I turned round and he was actually coming down the road with no clothes on and he beat me up in the streets (Jenny, no drug use, Mike/Jenny dyad) |
| Psychological vulnerabilities | When I first went away to a children’s home when I was five, got abused off the bloke who ran it … when I got sent back into a children’s home when I was 13 it affected my mind so much that I just basically looked for things to stop thinking about stuff like that. You know, I was very violent, you know, growing up towards adult men. If they touched me, I just beat them up … it’s all to do with my own insecurities around men and a lack of trust. So … (Matt, treatment for heroin and crack, Matt/Mary dyad) | Yeah and that’s what makes me think that what he’s doing is quite psychotic because he’s acted out his drama, his insecurities, his anger and frustrations of not being in control inflicting it on someone else and unfortunately that happened to be me. (Mary, former stimulant user, Matt/Mary dyad) |
(Ex)-partners were distinguished according to whether they had (1) never used, (2) previously been dependent on or (3) continued to use illicit substances or alcohol. Analysis of these dyad accounts revealed the confusion and deception women felt as men projected their loss of control upon them. Men’s attempts to coercively control their (ex)-partners frequently became more dangerous and desperate when women questioned or challenged their substance use or the diversion of funds it entailed. Abusive men often sought to exonerate and excuse their violence. Survivors who used substances felt unable to be open and honest, reflecting stigma connected to their own substance use, fear of further IPV and removal of children.
Analysing data from 37 interviews with perpetrators to address the cognitive, behavioural, affective and contextual factors contributing to IPV, 3 overlapping pathways into substance-related IPV were distinguished (Figure 4):
FIGURE 4 Key steps in substance use-related IPV pathways. IPA, intimate partner abuse. (Figure not reproduced here; see the original article.)
- Men in the rule-breaking pathway (n = 11) reported childhood exposure to physical abuse and emotional abuse in male-dominated households, early rule-breaking behaviours and engagement in antisocial and offending behaviours.
- Men in the entrenched substance use pathway (n = 13) reported childhood exposure to high levels of trauma (particularly sexual and physical abuse), early substance use, addiction and an entrenched substance-using lifestyle.
- Men in the relationship insecurity pathway (n = 13) reported being in long-term relationships, lifestyles that included employment, housing and support networks. Substance-related IPV was often driven by alcohol intoxication and discussed alongside sexual jealousy and insecurities. Men reported low levels of childhood trauma and substance use onset during adolescence.
Perpetrator typologies
Various typologies have been proposed: perpetrators of severe and escalating forms of IPV, characterised by multiple forms of abuse, terrorisation, threats and possessive and controlling behaviour; and perpetrators of a more moderate form of relationship violence.39,78,86 In our study, 35 of the 37 men depicted their IPV as situational and/or a product of mutual combat, whereas all but one (ex)-partner depicted coercively controlling abuse, to which around half responded with some violent resistance. Distinguishing dyads based on whether survivors had ever used drugs and, if they had, whether they were desisting from or still using substances offer more meaningful distinctions. Across the three pathways, men’s childhood and early experiences led to different journeys into IPV associated with intoxication, withdrawal, acquisition and substance-using lifestyles. Each pathway presented differently with varying core features, for example, generalised violence, mental health or jealousy and different predisposing background factors, including types and timing of childhood abuse and trauma.
Implications for intervention development
Our findings improve our understanding of heterogeneity in men who perpetrate IPV and misuse substances and propose treatment/intervention targets,87 further supporting the need for interventions that concurrently address the complex interconnections of IPV with substance misuse.29,80
Men in the rule-breaking pathway may require the most intensive intervention.88 Removing substance use would not be sufficient to address IPV. Rescripting childhood experiences, enhancing distress tolerance and self-regulation and reframing automatic cognitions linked to need for control, violence and entitlement towards women are key to intervening effectively with this group. For men in the entrenched substance use pathway who have experienced early adversity and disrupted connection-seeking attachments,89 a focused intervention should address emotional regulation and use of substances to cope. In the relationship insecurity pathway, IPV drivers were more situational. Treatment for/abstinence from substance use, increasing coping skills and promoting general protective factors, such as employment, may lower the risk of IPV.90
Conclusions
The psychopharmacological effects of substance use were rarely the only explanation for IPV perpetration which was primed and entangled with narratives of sexual jealousy, male participants’ perception of female impropriety and women’s apparent opposition to male authority. Our analysis highlighted ‘economic-compulsive’91 abuse, where disputes or abuse occurred due to the need to acquire (money for) substances and frequently escalated from female partners’ attempts to oppose coercive control.
Limitations
The temporal order of events, substance use and IPV was not always clear. Social desirability and under-reporting may have featured in our analysis. While the sample was not ethnically diverse, it was reflective of the national treatment population.92 Only men’s relationship perspectives were analysed to identify pathways.