See Gilchrist et al.1 for more details.
Aims and methodology
The meta-ethnography was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol46 to:
- explore how substance use featured in survivors’ and perpetrators’ narratives of IPV perpetration
- revise IPV perpetrator typologies for men who use substances.
Search strategy
The search strategy combined keywords for ‘IPV acts’ AND ‘qualitative research’ AND ‘IPV actors (e.g. survivors, perpetrators)’. PsycInfo® (American Psychological Association, Washington, DC, USA), Applied Social Sciences Index and Abstracts, and Web of Science were searched for studies published from January 1995 to December 2017. Seven experts were contacted, and forward and backward citation tracking was undertaken.
Inclusion criteria and screening
The inclusion criteria were developed using an adapted Population, Phenomenon of Interest and Context.47 Primary qualitative studies or studies with a qualitative component (e.g. mixed-methods) published in English were eligible if:
- the sample included heterosexual adult (≥ 18 years) IPV survivors and/or perpetrators (Population)
- survivors’ or perpetrators’ narratives of IPV were presented (Phenomenon of Interest) and
- the interplay between substance use and IPV perpetration was explored (Context).
Titles and abstracts were screened for studies that included the population and phenomenon of interest. Potentially eligible texts were then screened for mentions of substance use.
Data extraction, synthesis and analysis
Data were extracted into tables for analysis. The ‘Eight “Big-Tent” Criteria for Excellent Qualitative Research’ assessed study quality.48
Meta-ethnography translates studies into an interpretive order:49 participant quotations and meanings (first order), output authors’ (second order) and meta-ethnographers’ (third order) interpretations. Studies were coded into themes.
Findings
Study selection
Twenty-six studies were included (Figure 2; Appendix 1), representing 363 female survivors’ and 219 male perpetrators’ accounts.50–75
FIGURE 2 The PRISMA diagram for the meta-ethnography. (Figure not reproduced here; see the original article.)
Key themes
Five themes were identified relating to the complex interplay between substance use and IPV perpetration in the context of intoxication, withdrawal and addiction, impact on relationship and wider dynamics of power and control and psychological vulnerabilities.
Intoxication
Intoxication, related to alcohol and stimulants (methamphetamine and cocaine), was linked to IPV perpetration in all studies. Survivors generally viewed intoxicated violence within a pattern of their partner’s violent behaviour linked to power and control, while perpetrators isolated the event, blaming behaviour on intoxication, thus accounting for a new or disinhibited (violent) self.56 Survivors talked about their partners, and perpetrators talked about themselves, turning from a ‘good … to a bad husband’.51
Survivors and perpetrators accounted for character changes due to disinhibition resulting from substance use: ‘When he drinks, that violent urge is there in him’.58 Stimulants resulted in impulsivity, irritability and/or paranoia50 associated with (sexual) jealousy and acted as a trigger for physical violence.72
Violent, intoxicated turning points, could, however, usually be understood as part of a pattern of abuse when placed in wider context: the type of substance, gender dynamics, finances, personal character traits and moods and the environment.54,66,68,73
Withdrawal and addiction
Withdrawal and addiction made survivors vulnerable to IPV as substances took ‘priority over healthy functioning in the relationship and contribute[d] to a culture of violence’.72 Irritability and frustration when ‘coming down’ or ‘craving’ substances increased the risk of violence among perpetrators who were substance-dependent.72,73 Survivors and perpetrators explained that aggression and physical violence arose when men needed money to buy drugs or alcohol.62,69,72 Survivors were also susceptible to economic abuse as perpetrators spent or stole family resources.51
Survivors’ substance-using status was used to emotionally abuse her.50,63,65,72 Perpetrators used substances as a bargaining tool to coerce or force sex,62 including forcing their partner to trade sex for money or drugs.63,72
Impact on relationship
Intoxication enhanced perpetrator’s unpredictability, leaving survivors ‘living in fear’.73 Survivors had to bear perpetrators’ substance-induced emotional instability,52 and love and affection were inconsistent: ‘I never knew what way he would swing’.68 Survivors said being vigilant to perpetrators’ moods and intoxication levels to avoid or diffuse violence was exhausting and a form of abuse. Men justified violence in specifically motivated and measured ways and claimed they were in control and exacting discipline.61,65,69
Most men depicted their violence as discrete incidents,5,28 lacking awareness of their effect on survivors. By contrast, survivors emphasised an overburden of marital and familial responsibility due to their partner’s substance use,51 including unfairly distributed household chores and child care, responsibility to earn and manage money, managing a stressful lifestyle and social stigma and ‘embarrassment’.54,67,70
Where both partners used drugs, survivors reported that partners expected them to provide money, prioritising their own need for drugs.56,75
Power and control
Ideas of male superiority and expectations of respect permeated the studies: IPV was made possible and played out through traditional and unequal gender roles and exacerbated by socioeconomic deprivation.53 IPV was also motivated by the perceived impropriety of women’s substance use reflecting badly on perpetrators’ inability to ‘control their women’.69 When women also used drugs and were dependent on partners for supply and administration, relationships were difficult to escape, with some women physically punished for seeking substance use treatment.58,63,75
Psychological vulnerabilities
Many studies found an interplay between psychological vulnerabilities, substance use and IPV. Perpetrators and survivors reported ACE57 resulting in poor mental health and self-medication with substances from adolescence. Emotional instability and ‘mood’ were often related to mental illness,52,61 where depression, post-traumatic stress disorder (PTSD) and anxiety affected perpetrators’ behaviour and substance use.52,63,72 Both survivors and perpetrators explained IPV as a response to poor mental health and anger: ‘His depression just had him angry. So, he didn’t know how to cope and he just expressed himself through anger and then the violence’ (survivor).68
Conclusions
Narratives help understand motives and situations of IPV perpetration. Since survivors’ accounts offered different perspectives on IPV perpetration to perpetrators’, the research supported the need for dyadic research with both partners [WP1(ii)].
Implications for intervention development
Our findings challenged the idea that perpetrators fall into discrete typologies.38,41,76–78 Instead, IPV perpetration depends on contextual factors.79
Findings supported the need for tailored interventions that concurrently address the complex ways that substance use and IPV perpetration intersect,28,80,81 the impact on the relationship and gendered dynamics of power, control and psychological vulnerabilities with which substance use coalesces. Given the potential pathway from trauma to mental illness, substance use and IPV perpetration, a trauma-informed approach is recommended.82