In most countries, including the United States, alcohol is the most frequently used drug. Earlier this century, alcohol research tended to focus on men and was then, for the most part, ‘extrapolated’ to women. In recent decades, however, researchers have realized that the development and consequences of alcohol abuse or dependence (ADA) are not identical for men and women. Furthermore, issues related to ADA may differ among various segments of the U.S. population. In light of this, a study in the October issue of Alcoholism: Clinical & Experimental Research is the first to examine ADA among Mexican American women who report physical or sexual assault.
"In this study, women reporting interpersonal violence are much more likely to meet the criteria for ADA than women reporting no violence," said E. Anne Lown, a post-doctoral fellow and associate research scientist at the Alcohol Research Group, as well as the lead author of the study. "Abuse by a partner was not associated with ADA when we controlled for pertinent factors. Abuse by someone other than a partner, however, was strongly linked to ADA in Mexican American women." This latter category might have included childhood sexual or physical assault, ex-partner battering, stranger mugging, or date rape.
‘What is especially interesting about this study," said Tom Greenfield, Center director at the Alcohol Research Group, "is the strong relationship between alcohol abuse disorders and physical or sexual assault ‘ever’ in the person's life, which has not been reported previously among Mexican American women. This relationship was strong enough that it remained even after controlling for other factors influencing both ADA and assault, such as parental drinking problems. This study suggests that for many Mexican American women, victimization in the past may be part of the clinical picture in the present. It also leaves open the possibility that alcohol abuse disorders may make such assaults more likely."
Research on ADA and violence against women has examined three groups: women who report child abuse, a lifetime history of sexual assault, and/or intimate partner violence (also known as domestic violence). Numerous studies have shown that sexual abuse during childhood is linked to the later development of ADA. Two factors in particular, the earlier the age of sexual abuse and abuse severity (if it involved intercourse), are strongly associated with the later development of ADA. Physical abuse during childhood, however, has not generally been found to be associated with alcoholism. Three community studies of ADA and sexual assault ‘reported ever’ during a woman’s life all showed that assault preceded the alcoholism. Furthermore, one study showed that women with ADA had a 2.77 greater chance of reporting a later sexual or physical assault, which means that alcoholism may also place a woman at increased risk of assault. Research on ADA and domestic violence has yielded more contradictory results regarding male-to-female interpersonal violence.
"An outstanding weakness in previous epidemiological and biomedical research has been the use of unrepresentative samples that do not reflect today’s population composition," said William A. Vega, professor of psychiatry at Robert Wood Johnson Medical School, co-author of the paper, and principal investigator. "Although medical and mental health research has been done on Hispanics as a whole, groups of Hispanics differ greatly from one another. Mexican Americans constitute two-thirds of all U.S. Hispanics. They are, therefore, a substantial fraction of the largest ethnic minority group in the United States. Little has been written about Mexican Americans in terms of interpersonal violence or drinking. What we do know is that Mexican Americans are generally infrequent users of health and mental health services, and that Mexican American men are often occasional heavy drinkers."
Both Lown and Greenfield noted that assimilation into U.S. society tends to increase the frequency of alcohol consumption among both men and women in this ethnic group. Prevalence rates of ADA also increase in later generations, added Greenfield, after "the immigrant generation," which has higher levels of abstention than subsequent generations.
"This is a very valuable contribution to an important line of research that has only recently opened up," said Greenfield. "We critically need to understand more about how sexual and physical abuse increase the risk of alcohol problems, or are themselves made more likely if the woman abuses alcohol. This is important both for treatment and prevention of alcohol as well as other mental health problems. In addition, there is some evidence that a number of these findings are not unique to Mexican American women. Some of the results may be relevant to all cultural groups where there are numerous risk factors such as poverty, environmental stresses, discrimination, treatment barriers, and other health disparities."
Greenfield noted, however, that questions remain about the temporal sequence of alcohol and violence. "Causal sequencing still needs to be teased out," he said. "This will not be easy since prospective studies going back to childhood are rare and difficult to accomplish both for ethical and practical reasons, but we will need to begin with retrospective studies that document the sequence of events so histories can be ‘reconstructed.’"
These findings highlight the importance of screening for physical and sexual assault in settings that treat alcohol disorders, said Lown, as well as screening for alcohol disorders among women seeking services for previous or current violence. "In the first scenario," she said, ‘the success of treating alcohol disorders may be limited if underlying problems related to current or past violence are not addressed. If a woman is currently in a battering relationship, it is less likely that she can be successfully treated. If physical and mental health issues related to past trauma are not identified, these underlying issues may make her substance abuse treatment more complex. In the second scenario, many battered women’s shelters exclude women who abuse alcohol or drugs. The assaulted Mexican American women in this study, who are more likely than not to have alcohol disorders, would likely be barred from shelter, putting them and their children at risk for further battering or less safe housing alternatives."
Funding for this Addiction Science Made Easy project is provided by the Addiction Technology Transfer Center National Office, under the cooperative agreement from the Center for Substance Abuse Treatment of SAMHSA.
Articles were written based on the following published research:
Lown, E.A., & Vega, W.A. (2001, October). Alcohol abuse or dependence among Mexican American women who report violence. Alcoholism: Clinical and Experimental Research, 25(10), 1479-1486.