Alcohol & Violence – the Chicken or the Egg?

Alcohol problems and violent behaviors are often interrelated (Pernanen, 1991).

So which comes first?

Xue and colleagues (2009) describe four explanatory models which have been proffered:

1. Alcohol use causes violent behavior

2. Violent behavior causes alcohol use

3. Alcohol use and violent behavior cause/reinforce each other

4. No real relation – spurious (“Both behaviors are predicted by the same common set of risk factors and cluster together as a result of a single general problem behavior syndrome.” [p. 1])

The first two models are straightforward enough, and have their defenders, as does model #4.

Model #3 is more complex and may be less intuitively satisfying.  Nonetheless, according to the study’s authors, it’s probably the most accurate reflection of research to date.  In their longitudinal study of urban African American adolescents, they found that “year 1″ violent behavior predicted alcohol use at age 18, and vice versa.

What’s the policy upshot of these findings?

The bidirectional relationship between alcohol use and violent behavior observed here suggests that reducing one problem will reduce the other. Therefore, programs and policies aimed at reducing youth violence or alcohol use should take into account the link between these behaviors. Efforts to prevent violence and alcohol use should be combined and should target adolescents exhibiting multiple risk behaviors. (p. 7)

In other words, tackle both problems together and there will be synergistic effects.

The bidirectional model is also the best fit for the well-documented comorbidity between alcohol problems and depression, as various studies have pointed to causality in both directions (as well as a probable underlying common genetic component).

Evidence-based alcohol policy has a role here, too:

Price is one of the largest determinants of alcohol and tobacco use.  [Therefore] … increases in alcohol taxes reduce … the negative mental health impacts due to alcohol consumption (Saxena, et al. 2006, p. 8).

References:

Fergusson, D.M., Boden, J.M., & Horwood, L.J. (2009).  Tests of causal links between alcohol abuse or dependence and major depression. Archives of  General Psychiatry, 66(3), 260-266.

Hasin, D.S., Goodwin, R.D., Stinson, F.S., & Grant, B.F. (2005).  Epidemiology of major depressive disorder: Results from the National Epidemiologic Survey on Alcoholism and Related Conditions.  Archives of General Psychiatry, 62(10), 1097-1106. [free full text]

Pernanen, K. (1991).  Alcohol in human violence. New York:  Guilford Press.

Saxena, S., Jané-Llopis, E., & Hosman, C. (2006). Prevention of mental and behavioural disorders: Implications for policy and practice. World Psychiatry, 5(1), 5-14. [free full text]

Sihvola, E., Rose, R.J., Dick, D.M., Pulkkinen, L., Marttunen, M., & Kaprio, J. (2008). Early-onset depressive disorders predict the use of addictive substances in adolescence: A prospective study of adolescent Finnish twins.  Addiction, 103(12), 2045-2053. [free full text]

Wang, J.L. & Patten, S.B. (2002). Prospective study of frequent heavy alcohol use and the risk of major depression in the Canadian general population.  Depression and Anxiety, 15(1), 42-45.

Xue, Y., Zimmerman, M.A., & Cunningham, R. (2009). Relationship between alcohol use and violent behavior among urban African American youths from adolescence to emerging adulthood: A longitudinal study.  American Journal of Public Health, doi: 10.2105/AJPH.2008.147827.