the relationship between childhood violence and alcohol problems among men who batter: an empirical...

Pergamon

Aggression and Violent Behavior, Vol. 1, No. 4, pp. 327-344, 1996 Copyright © 1996 Elsevier Science Lid Printed in the USA. All fights reserved

1359-1789/96 $15.00 + .00

PII S1359-1789(96)00006-7

THE RELATIONSHIP BETWEEN CHILDHOOD VIOLENCE AND ALCOHOL PROBLEMS

AMONG MEN W H O BATTER: AN EMPIRICAL REVIEW AND SYNTHESIS

William R. Downs

Center for the Study of Adolescence, University of Northern Iowa

Nancy J. Smyth

University at Buffalo - - SUNY

Brenda A. Miller

Research Institute on Addictions, Buffalo, New York

A B S T R A C T . The available literature indicates that: (a) experiences of childhood violence are associated with mediator variables, including antisocial behaviors and depressive symptomatology, that are themselves associated with development of alcohol problems and perpetration of parmer violence for men in adulthood; (b ) experiences of childhood violence and, more strongly, observation of interparental violence during childhood predict perpetration of partner violence in adulthood for males; (c) presence of partner violence is associated with certain types of alcohol problems for men; and (d) both partner violence and alcohol problems are associated with marital conflict. However, available research has often excluded important moderator variables, such as history of familial and parental alcohol problems and history of parental psychiatric disorders. Based on the available research, two indirect pathways between childhood violence and adulthood problems (i.e., alcohol problems and partner violence) are proposed as guides for future research in the areas of family violence and alcohol problems for men. Further, bidirectional associations between alcohol problems and partner violence are proposed. Finally, inclusion of important moderator and mediator variables in multivariate research designs is suggested. C o p y r i g h t © 1996 E l sev i e r Sc i ence Ltd

Correspondence should be addressed to William R. Downs, PhD, Center for the Study of Adolescence, University of Northern Iowa, 115 Sabin Hall, Cedar Fall, IA 50614-0401.

327

328 W. R. Downs, N. J. Smyth, and B. A. Miller

THIS ARTICLE has two purposes: (a) to review the literature on the associations among childhood violence, perpetration of partner violence, presence of alcohol problems, and presence of psychiatric problems in males; and (b) to synthesize this literature into a theoretical model of the associations among childhood violence, alcohol problems, and perpetration of partner violence for men.1 History of parental alcohol and psychiatric problems, antisocial behaviors during childhood and adulthood, depressive symptomatology, and marital conflict are hypothesized as additional causative and mediator variables for alcohol problems in this model. Antisocial personality disorder is also considered as a moderator variable for the association between partner violence and alcohol problems, but is criticized on both empirical and theoretical grounds.

CHILDHOOD VIOLENCE, PARTNER VIOLENCEt AND ADULT ALCOHOL PROBLEMS

Childhood Violence and Adult Alcohol Problems

Some studies have found a weak or absent relationship between experiences of childhood violence and the development of adulthood alcohol problems for men. Reporting results of a meticulous longitudinal study, McCord (1983) found that parentally abused or neglected males did not differ reliably from parentally loved males in the proportion who became alcoholic in adulthood. History of physical abuse or sexual abuse during childhood did not predict number of lifetime symptoms of alcohol problems, diagnosis of alcohol dependence, or arrest for adulthood alcohol or drug offenses for men (Ireland & Widom, 1994; Widom, Ireland, & Glynn, 1995). However, these latter two studies may have underestimated the effect of childhood maltreatment, since an unknown but large percentage of cases in the nonabused control group may have, in fact, experienced maltreatment during childhood.

Conversely, retrospective research has typically demonstrated a link between experiences of childhood violence and the development of alcohol problems in adulthood for both male and female respondents (Hill, Nord, & Blow, 1992; Rohsenow, Corbett, & Devine, 1988), and for male respondents (Blane, Miller, & Leonard, 1988; Holmes & Robins, 1987, 1988; Kroll, Stock, & James, 1985; Schaefer, Sobieraj, & Hollyfield, 1988). Empirical work on a sample of parolees revealed that greater exposure to childhood victimization led to an increased likelihood of an adulthood diagnosis of alcohol dependence (Blanc et al., 1988). Brown and Anderson (1991) found that physically abused adult inpatients had higher rates of alcohol-use disorders than nonabused patients.

Other studies have found an association between sexual abuse and alcohol problems for males. Singer, Petchers, and Hussey (1989) found that sexually abused adolescent psychiatric inpatients reported more frequent intoxication compared to a nonabused inpatient control group. Harrison, Hoffman, and Edwall (1989) reported that sexually victimized adolescent males in inpatient substance abuse treatment were more likely to report daily drinking than nonvictimized male inpatients. Dembo et al. (1987) found that problems exhibited by adolescent males who have been physically or sexually abused include drinking and drug use. Still other studies have found that the combination of alcohol problems and a history of childhood violence resulted in greater problems for men. Schaefer, Sobieraj, and Hollyfield (1988) found that alcoholic men physically abused during childhood reported higher MAST

lSeveral studies suggest that gender can influence the association between family violence and alcohol problems (e.g., Holmes & Robins, 1988; Jaffe, Wolfe, Wilson, & Zak, 1986; Marshall & Rose, 1990). Examining the association between family violence and alcohol problems for both males and females is beyond the scope of this paper.

Childhood Violence and Alcohol Problems 329

scores and higher scores on all SCL-90 subscales, as well as the global scale, than did nonabused alcoholics.

However, with few exceptions, the literature has not specified, nor has it controlled for, the effect of additional important variables in examining the association between childhood violence and the development of alcohol problems in adulthood. One primary variable frequently excluded from analysis is familial history of alcohol problems. Parental alcoholism has been found to be a consistent and strong predictor of the development of alcoholism in children (Babor et al., 1992; Chassin, Rogosch, & Barrera, 1991; Lewis & Bucholz, 1991), although Hesselbrock, Hesselbrock, and Stabenau (1985) suggested the need to examine both unilineal and bilineal familial histories of alcoholism, instead of only parental alcoholism. Other studies have found parental alcohol problems related to physical violence against children (Famularo, Kinscherff, & Fenton, 1992; Kantor & Straus, 1990). Widom (1992) found that parental alcohol problems and experiences of child abuse interacted to place the child at increased risk of alcohol problems.

Childhood Violence and Partner Violence

Several studies have indicated that violence in the family of origin is related to the perpetration of dating violence in adolescence (Riggs, O'Leary, & Breslin, 1990; Smith & Williams 1992) and the perpetration of partner violence in adulthood (Caesar, 1988; Kalmuss, 1984; Rosenbaum & O'Leary, 1981). Among incarcerated offenders, experiences of physical abuse predicted both familial and extra-familial violence (Dutton & Hart, 1992a), while history of childhood violence (physical, sexual, or observation) predicted familial violence (Dutton & Hart, 1992b). Also, violence in the family of origin has been found to differentiate men who perpetrate partner violence from nonviolent men who are in conflicted marital relationships (Kroll et al., 1985) and men who are assaultive outside the family (Shields, McCall, & Hanneke, 1988).

Further, there may be an interaction effect for childhood violence, alcohol problems, and partner violence. Hamberger and Hastings (1987) found that alcoholic batterers were more likely than nonalcoholic batterers to have witnessed father-to-mother violence in childhood. Kroll et al. (1985) found that alcoholic men who were physically abused during childhood were more likely to perpetrate domestic violence than alcoholic men not physically abused during childhood. Thus, the association between childhood violence and perpetration of partner violence may be stronger among men who develop alcohol problems in adulthood than among those who do not.

In comprehensive literature reviews, Tolman and Bennett (1990) and Hotaling and Sugarman (1986) concluded that observation of interparental violence was more strongly related to the perpetration of partner violence than were experiences of childhood physical violence. In an extensive literature review, Holtzworth-Munroe and Stuart (1994) more precisely specified the association between childhood violence and perpetration of partner violence in adulthood for men. First, Holtzworth-Munroe and Stuart proposed three types of male batterers: (a) family only, whose violence is generally restricted to family members; (b) dysphoric/bordedine, whose violence is primarily targeted toward family members and who are the most emotionally volatile group; and (c) antisocial batterers, with both familial and extrafamilial violence and extensive histories of related criminal behavior. Based on their literature review, Holtzworth-Munroe and Stuart concluded that observation of interparental violence during childhood as well as experiences of physical abuse during childhood were more strongly predictive of the antisocial batterer than the remaining two types.

However, Tolman and Bennett (1990) concluded that the mechanism between violence in the family of origin and partner violence is unclear. As with the research on alcohol problems,


studies of the association between violence in the family of origin and perpetration of partner violence in adulthood have frequently excluded important variables in the analysis, resulting in specification error. One excluded variable is history of parental psychiatric disorder. For example, history of parental psychiatric disorder has been found related to the development of conduct disorder and antisocial personality disorder (Cadoret & Cain, 1980, 1981; Robins, 1981) in the succeeding generation.

Based on results such as these, DiLalla and Gottesman (1991) suggested that children of antisocial personality disorder (ASP) positive parents are more likely to be physically abused and to inherit a predisposition toward all types of socially deviant behavior, including the perpetration of violence in adulthood. This argument implies that parental ASP can account for the covariation in experiences of childhood violence and perpetration of partner violence via the transmission of ASP to the children. Antisocial behaviors and depressive symptomatology are two additional necessary control variables, both having been found related to partner violence (antisocial behaviors - - Saunders, 1992; depression - - Saunders & Hanusa, 1986) and resulting from childhood violence (antisocial behaviors - - Fagan, Stewart, & Hansen, 1983; depression - - Boisso, Lutz, & Gray, 1989).

Alcohol Use and Perpetration of Partner Violence

Many studies have suggested an association between partner violence and the perpetrator's use of alcohol or intoxication (e.g., Kantor & Straus, 1989; Leonard, Bromet, Parkinson, Day, & Ryan, 1985; Miller, Downs, Testa, & Keil, 1991). Fagan, Barnett, and Patton (1988) found that a consistently higher quantity-frequency of alcohol consumption was specific to maritally violent men as opposed to married men who had been convicted of a violent crime but did not assault their wives. Other studies have suggested that it is problem drinking, rather than level of consumption, that is most predictive of partner violence (e.g., Leonard et al., 1985; Reider, Zucker, Noll, Maguin, & Fitzgerald, 1988; Van Hasselt, Morrison, & Bellack, 1985). Neither Leonard et al. (1985) nor Reider et ~1. (1988) found that current consumption of alcohol was related to partner violence. However, both researchers found, after controlling for additional variables, that measures of alcohol problems were related to partner violence.

Despite evidence for the link between men's alcohol problems and their perpetration of partner violence, some caveats are in order. First, the relationship between partner violence and alcohol problems has not been examined longitudinally. Thus, a causal direction cannot accurately be assigned to observed empirical relationships between partner violence and alcohol problems. In addition, the literature does not specify whether the association between alcohol problems and partner violence is spurious, resulting from uncontrolled additional variables. Also, the literature does not indicate whether the association between alcohol problems and perpetration of partner violence is mediated by other variables.

An additional issue derives from recent work on typologies of male batterers. Holtzworth- Munroe and Stuart (1994) concluded that alcohol abuse is a powerful discriminator among the types of batterers, with alcohol abuse lowest for family-batterer and highest for the antisocial batterer. Consequently, studies that fail to take into account the variation in alcohol abuse among subtypes of batterers may fall to specify precisely the association between alcohol abuse and perpetration of partner violence. However, the f'mding that alcohol consumption was more strongly related to partner violence than other forms of violence among married men (Fagan, Barnett, & Patton, 1988) seems to contradict the conclusion that alcohol abuse is lowest for the family-only batterer, and indicates the complexity of the associations between alcohol abuse and partner violence.

Childhood violence has been found to be related both to adulthood alcohol problems and perpetration of partner violence for men; thus, the association between these latter two vari-


ables may be spurious and due to their common association with prior childhood violence. Further, recent studies that have examined typologies of alcohol problems and partner violence have indicated an additional set of variables that may theoretically or empirically link alcohol problems and partner violence for men. In the most extensive analysis, Holtzworth- Muntt~ and Stuart (1994) outlined variables such as childhood violence, association with defiant peers, and impulsivity as potential linkages between alcohol problems and partner violence for men. Their model is essentially linear, with the family-only batterer low in these variables, the dyspboric batterer generally intermediate, and the antisocial batterer high.

Much of the earlier empirical work that undergirds this typology has used cluster or factor analyses of personality indices. However, as Holtzworth-Munroe and Stuart (1994) noted, these analyses have been primarily descriptive in nature, without attempts to view personality dimensions as causally important or to attribute causal direction among personality dimensions and partner violence. Consequently, with the exception of impulsivity, such personality variables were generally excluded from their developmental model of partner violence. However; personality and psychopathological variables may be useful in linking alcohol problems and partner violence for men. From the earlier empirical work, antisocial behaviors, antisocial personality disorder, and depressive symptoms (though not a diagnosis of major depression) have emerged as the most likely control variables for the association between alcohol problems and parmer violence for men (e.g., Cloninger, 1987; Dutton & Hart, 1992b; Saunders 1992). 2

Marital conflict is a primary mediator variable excluded from much existing research. In a comprehensive literature review, Hotaling and Sugarman (1990) found marital conflict to be a consistent risk factor related to women being assaulted by their partners. Although marital conflict was not explicitly included in their developmental model of partner violence, Holtzworth-Munroe and Stuart (1994) proposed that the family-only batterer had poor spouse communication skills, and that all three types had low levels of marital skills. Also, marital conflict has been found related to alcohol problems (Halford & Osgarby, 1993). Marital conflict may derive from disagreements over the male partner's alcohol consumption and thereby lead to episodes of partner conflict (Downs, 1989). Alternatively, men's partner violence may result in the woman defending herself, this defense then being a source of future conflict and alcohol use for the male. 3

Summary In sum, there is empirical support for associations among childhood violence, adulthood alcohol problems, and perpetration of partner violence for men. However, the literature has been lacking in the development of a theoretical framework for these associations. In addition, the literature has largely excluded variables likely to affect these associations, such as family history of alcoholism, parental history of psychiatric disorders, personal history of or current elevated personality scores, and marital conflict. In the next section, existence of behavioral problems, depressive symptoms, and (where data is available) comorbid psychiatric diagnoses are examined as variables that may link family violence and alcohol problems

for men.

2Borderline personality has also appeared in typologies of batterers (Dutton, 1988; Hamberger & Hastings, 1989; Hastings & Hamberger, 1988), but not in typologies of alcoholic men.

3Downs and Miller (1994) found that the female partner's alcohol problems did not lead to partner violence; instead, experiences of partner violence resulted in increases in alcohol problems for women. Further, Barnett and Fagan (1993) found that women are mote likely to drink heavily after an episode of partner violence as opposed to prior or during the violence. Thus, the woman's drinking is unlikely to lead to conflict and, thereby, to partner violence. It is more likely that the woman's drink- Lug is a consequence of her experiences of partner violence.

332 W. R. Downs, IV. J. Smyth, and B. A. Miller

PATHWAYS FROM CHILDHOOD VIOLENCE TO ALCOHOL PROBLEMS ANTISOCIAL PERSONALITY DISORDER

Childhood Violence and Antisocial Behaviors

One possible route between childhood violence and alcohol problems for males is via antisocial behaviors that develop during adolescence and adulthood. Although no study has examined the association between experiences of physical abuse and diagnoses of conduct disorders during adolescence, several studies have found that experiences of childhood violence were related to antisocial behaviors for adolescent males. Problems exhibited by adolescent males who have been physically and/or sexually abused include delinquency and sexual acting out (Malamuth, Sockloskie, Koss, & Tanaka, 1991). Similar problems have been found among boys who observed violence between their parents, for example, behavior problems (Hughes, Parkinson, & Vargo, 1989) and aggressive behavior (Pollock et al., 1990). In their literature review of the long-term effects of physical abuse, Malinosky-Rununell and Hansen (1993) concluded that: (a) aggressive and violent adolescents had higher rates of childhood maltreatment than the general population; (b) violent adolescent males in residential facilities experienced more childhood physical abuse than nonviolent controls, and (c) among adolescents in mental health treatment, those with histories of physical abuse were more aggressive than those without histories of physical abuse.

In addition, several studies have found an association between experiences of parental violence during childhood and perpetration of nonfamilial violent behavior in adulthood, especially for males. Pollock et al. (1990) found that men with a history of being physically abused reported more aggressive and antisocial behaviors than men not physically abused. In their literature review, Malinosky-Rummell and Hansen (1993) concluded that violent male inmates and outpatients reported higher levels of physical abuse during childhood than nonviolent controls. Fagan, Stewart, and Hansen (1983) also found that generally violent males were more likely to have been severely abused as children. In their literature review, Holtzworth-Munroe and Stuart (1994) examined the association between antisocial behaviors and partner violence via the personality trait of impulsivity, noting a general relationship between impulsivity and partner violence. These authors specifically proposed a linear relationship between subtypes of batterers and impulsivity, with the family-only type lowest and the antisocial type highest in this variable.

Comorbidity of Alcohol Problems and Antisocial Personality Disorder

According to the DSM-IV (American Psychiatric Association, 1994), the essential feature of Antisocial Personality Disorder is a pattern of the violation of, and disregard for, the fights of others. 4 Its onset is in childhood and it persists into adulthood. Unlike the literature on

4Based on the DSM-IV, diagnostic criteria for Antisocial Personality Disorder are as follows: (A) There is a pervasive pattern of disregard for and violation of the rights of others occuring since age 15 years, as indicated by three (or more) of the following: (1) failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest; (2) deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure; (3) impulsivity or failure to plan ahead; (4) irritability and aggressiveness, as indicated by repeated physical fights or assaults; (5) reckless disregard for safety of self or others; (6) consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations; (7) lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mis- treated, or stolen from another. (B) The individual is at least age 18. (C) There is evidence of Conduct Disorder with onset before age 15. (D) Antisocial behavior does not occur exclusively during the course of Schizophrenia or a Manic Episode.


childhood violence, the alcoholism literature has extensively examined diagnoses of ASP. ASP has been found one of the most frequent cooccurring diagnoses with alcohol dependence (Helzer & Pryzbek, 1988; Hesselbrock, Hesselbrock, & Stabenau, 1985; Liskow, PoweU, Nickel, & Penick, 1991). Alcoholic men in the general population (15%) are almost four times as likely to have this diagnosis than their nonalcoholic counterparts (4%) (Helzer & Pryzbeck, 1988). General population men diagnosed with ASP are three times more likely than their non-ASP counterparts to abuse alcohol (Robins, Tipp, & Pryzbeck, 1991). Further, Hesselbrock, Meyer and Keener (1985) found a 49% prevalence rate of ASP among male inpatient alcoholics, considerably higher than the 15% prevalence rate of ASP among alcoholic males in the general population study reported in the Epidemiologic Catchment Area (ECA) study (Helzer & Pryzbeck, 1988). ASP has been found related to early onset of alcohol problems, referred to as primary ASP and secondary alcoholism (Hesselbrock, Meyer, & Keener, 1985; Liskow et al., 1991; Schuckit, 1973).

Comorbidity of alcohol problems and other diagnoses have been used in attempts to type alcohol problems, with ASP or the presence of antisocial behaviors emerging in one of the types. In one of the more well-known typologies, Cloninger (1987) proposed Type II or male-limited alcoholics are characterized by an earlier onset of alcohol problems, spontaneous alcohol-seeking behavior, and antisocial behavior while drinking. Zucker (1987) also reported a type of antisocial alcoholism characterized by early onset of alcohol problems, antisocial behavior, and a poor prognosis. In an empirically derived typology, Babor et al. (1992) reported that Type B alcoholics were characterized by earlier onset, childhood risk factors, greater severity of dependence, other substance abuse, more serious consequences despite fewer years of drinking, and cooccurring psychiatric disorders, including manifestation of ASP traits. The authors proposed that genetic predisposition and childhood antecedents are related to a more virulent form of alcoholism in adulthood.

There is additional evidence that alcoholics with ASP have more severe problems than alcoholics without additional diagnoses. Liskow et al. (1991) divided their sample into several comorbid categories, alcoholism/ASR alcobolisrrdASP/Depression, alcoholism/ASP/ drug dependence, and a category of alcoholism only. All patients with ASP had onset of ASP prior to onset of other diagnoses. ASP groups reported an earlier alcoholism onset, more rapid course, and more alcoholism symptoms than the non-ASP group. Specifically, ASP/ drug and ASP/Depression reported the most severe progressive course of alcoholism, fol- lowed by the ASP group, and with the alcoholism only group reporting the least severe course of alcoholism. The ASP/depressed group also had the highest levels of psychopathology. Given these data, comorbidity of ASP and alcoholism could account for Dutton's (1988) and Saunders' (1992) findings, as well as Holtzworth-Mun_roe and Stuart's (1994) conclusions, that batterers with antisocial tendencies had higher rates of both alcohol abuse and partner violence than remaining batterers.

There is some evidence that ASP precedes alcoholism. In a multivariate study, Lewis and Bucholz (1991) found that gender, ASP, adolescent conduct disorders, and a family history of problem drinking predicted alcoholism in adulthood. Further, antisocial behavior preceded pathological drinking in both men and women with either ASP and alcoholism or conduct disorders and alcoholism. Also, in literature reviews, Zucker (1989) and Zucker and Gomberg (1986) reported several studies that found childhood antisocial behavior to be related to later development of alcoholism. Given that childhood maltreatment may lead to antisocial behaviors, and that antisocial behaviors may lead to development of alcohol problems, there may be an indirect path from childhood violence to alcohol problems via the mediating variable of Antisocial Personality Disorder or, more generally, antisocial behaviors.


PATHWAYS FROM C H I L D H O O D VIOLENCE TO ALCOHOL PROBLEMS - - DEPRESSIVE SYMPTOMATOLOGY

Childhood Violence and Depressive Symptoms

A second possible route between violent homes during childhood and adult alcohol problems is via the development of depressive symptomatology and lower self-esteem during adolescence and adulthood. Straus (1993) found that frequency of corporal punishment from both mother and father and observation of violence between parents during adolescence predicted both depressive symptoms and suicidal thoughts during adulthood for men. Cavaiola and Schiff (1989) found that abuse was related to lower self-esteem among a sample of chemically dependent adolescents. Other studies have found experiences of sexual abuse to be related to depressive symptomatology for boys ages 10-16 (Boney-McCoy and Finkelhor, 1995), males (Bagley, 1991; Boisso, Lutz, & Gray, 1989), and male juvenile sex offenders (Becker, Kaplan, Tenke, & Tartaglini, 1991). Harrison et al. (1989) found a connection between sexual abuse and suicide for males. Dembo, Williams, Wothke, and Schmeidler (1993) found that both sexual and physical abuse led to psychological problems during adolescence as measured by self-derogation and the SCL-90.

Depressive Symptomatology and Alcohol Problems

Since one consequence of chronic alcohol use can be depressive symptoms, i t is not unusu- al for men with alcohol problems to experience some depressive symptomatology (Schuckit & Monteiro, 1988). However, The ECA study (Helzer & Pryzbeck, 1988) revealed that men with alcohol problems are only slightly more likely to have a diagnosis of depression than are men without alcohol problems (5% vs. 3%). ECA findings indicated that a large majori- ty of men (78%) with coexisting depression and alcohol problems experience secondary depression, that is depression whose onset follows that of the chronic alcohol abuse; a minority (22%) has depression that precedes the onset of alcoholism. Thus, comorbidity of alcohol problems and a diagnosis of major depression is rather low, and most of such comorbidity appears due to primary alcohol dependence and secondary alcoholism.

However, an additional issue concerns the coexistence of depressive symptoms and alcohol problems. Reider, Zucker, Maguin, Noll, and Fitzgerald (1989) found a significant cor- relation between lifetime alcohol problems and depression as measured by the Beck Depression Inventory and Hamilton Rating Scale for current and worst ever depression. More specifically, Lewis and Bucholz (1991) found that alcoholism was associated with dysthymia in men having neither a diagnosis of conduct disorder nor a family history of problem drinking. Thus, while comorbidity of alcohol problems and major depression may not be connected with childhood violence, depressive symptoms may result from childhood violence and lead to alcohol problems in men otherwise at a low risk for alcohol problems. That is, there is the possibility that depressive symptoms, or a low-grade depression (dysthymia), rather than a diagnosis of major depression is a sufficient condition to link childhood violence and adulthood alcohol problems for men.

Summary

In summary, there is support in the literature for relationships among childhood violence, development of antisocial behaviors in adolescence and adulthood, depressive symptomatology in adolescence and adulthood, and presence of alcohol problems in adulthood. However, development of a theoretical framework to account for these associations has largely been absent from the literature. Without such a framework, studies on these phenomena have frequently excluded important control variables, such as familial history of alcohol problems.


In addition, there is debate in the literature over basic issues such as whether intergenerational transmission of ASP can account for both alcohol problems and partner violence in the male children of ASP positive parents.

Co-Existence of Psychiatric Symptomatology and Partner Violence

In their literature review, Tolman and Bennett (1990) reported that several studies found batterers compared with nonbatterers to have elevated scores on personality indices. For example, Hastings and Hamberger (1988) found that batterers generally had higher overall scores on the MiUon Clinical Multiaxial Inventory (MCMI). Findings of elevated levels of psychopathology have been consistent enough for Holtzworth-Munroe and Smart (1994) to identify psychopathology as one of three dimensions that describe typologies of batterers. However, there has been considerable heterogeneity in specifically which set of personality traits consistently predicts perpetration of partner violence (Tolman & Bennett, 1990) or whether any set of personality waits predict partner violence (Saunders, 1993). In addition, few of the studies employed psychiatric diagnoses in examining partner violence, instead using standardized instruments such as the SCL-90.

Partner Violence and Antisocial Behavior

Antisocial behavior has consistently been found a factor in the perpetration of partner violence by men. Several typologies of batterers based on diverse methodologies have found a subtype that corresponds to ASP positive males. Saunders' (1992) cluster analysis of 165 batterers found three types: family-only, generalized, and emotionally volatile. The generalized aggressors reported higher levels of antisocial behaviors, alcohol abuse, and severe violence than the other two types. Dutton (1988) also found a generalized aggressor type similar to that found by Saunders (1992). Gondolf (1988) found subtypes of batterers labeled as sociopath- ic (likely to have been arrested, were severely violent, and less repentant for their violence) and antisocial (less likely to have been arrested, but also severely violent and less repentant for violence). Using the MCMI-II, Hart, Dutton, and Newlove (1993) found ASP to be the second most likely personality disorder (after aggressive/sadistic) among both court-referred (60%) and self-referred (45%) batterers. Based on their review, Holtzworth-Munroe and Smart (1994) identified the antisocial batterer as one type, characterized by severe family violence, extrafamilial violence, and an extensive related history of criminal behavior.

Despite evidence for the link between antisocial behavior in general, and ASP in particular, and perpetration of partner violence for men, some caveats are in order. First, there is the question of a whether the link between ASP and partner violence is tautological, because one of the diagnostic criteria for ASP specifically encompasses physical assault, including spouse-beating and child abuse. In fact, partner violence is itself an antisocial behavior; cat- egorizing it as such does little to explain the dynamics of partner violence. Second, the theoretical explanations for a link between ASP and partner violence have not been explored, beyond the recognition that both partner violence and antisocial behaviors are part of a pattern of deviant behavior. Third, the link between ASP and partner violence may be due to the overrepresentation of ASP among batterers in treatment (e.g., Gondolf, 1988). Finally, only a statistical minority of batterers have been found in the antisocial subtypes.

Partner Violence and Depression

Depressive symptomatology is a second variable that may link experiences of childhood violence and perpetration of partner violence in adulthood for men. Dinwiddie (1992) found that batterers had higher lifetime rates of alcoholism, ASP, and depression but not other psychiatric


disorders compared with nonbatterers. Floumoy and Wilson (1991) found male batterers to have elevated depression scales on the MMPI. Saunders' (1992) emotionally volatile batterer was high on depression, anger, and jealousy. Hamberger and Hastings (1989) found depression to be higher among identified batterers than nonbatterers. Although depressive symptomatology was not explicitly part of their developmental model, Holtzworth-Munroe and Stuart (1994) indicated that related variables of guilt and remorse were indicative of the family-only batterer.

Despite evidence for the link between depressive symptomatology and men's perpetration of partner violence, some cautions are in order. First, the relationship between depression and perpetration of partner violence has not been examined longitudinally. Thus, the causal direction between depressive symptoms and partner violence has yet to be established. Saunders (1993) noted that depression among batterers may be a result of having been publicly iden- tiffed as a batterer or to having been separated from the partner as opposed to depression con- tributing to the violent behavior of the batterer. Also, the literature does not specify whether the association between depression and parmer violence is spurious, resulting from uncontrolled additional variables such as prior experiences of childhood violence. In addition, depression may be linked to partner violence in men at lower risk of alcohol problems than ASP positive men (e.g., Saunders, 1992).

Summary

In smmlmry, there is support in the literature for relationships among childhood violence, development of antisocial behaviors in adolescence and adulthood, depressive symptomatology in adolescence and adulthood, and perpetration of partner violence in adulthood. However, as with alcohol problems, the development of a theoretical framework to account for these associations has been absent from the literature. The purpose of the next section is to address these issues and propose a theoretical framework to facilitate research on family violence and alcohol problems for men.

OVERVIEW OF THEORETICAL MODEL

ASP as a Link for the Association of Alcohol Problems and Family Violence

Instead of direct paths between childhood violence and adulthood alcohol problems, indirect paths are hypothesized. Drinking problems of sufficient severity to warrant a diagnosis of alcohol dependence - - a diagnosis that may take several years to develop - - imply the need for intervening variables that connect experiences of childhood violence and adulthood alcohol problems. Antisocial behavior during childhood, adolescence, and adulthood may be sequelae of violence in the family of origin and may result in alcohol problems or perpetration of partner violence in adulthood or both. Both Saunders (1992) and Dutton (1988) found higher levels of childhood abuse for a subtype of batterer that could be described as antisocial. Holtzworth-Munroe and Smart (1994) proposed that the antisocial type of batterer had higher levels of both childhood violence and alcohol abuse.

The literature on alcohol dependent males refers to the comorbidity of alcohol dependence and ASP. Within this framework, there would be the hypothesized link in which childhood violence (i.e., experiences of parent-to-child violence, experiences of childhood sexual abuse, observation of parent-to-parent violence) is related to childhood antisocial behavior and through this variable are related to adolescent conduct problems, adolescent substance abuse, and adulthood antisocial personality disorder. These mediator variables are then hypothesized to be related to the development of alcohol problems in adulthood, in particular early onset of alcoholism in men with a diagnosis of antisocial personality disorder,


referred to as primary ASP and secondary alcoholism (Cloninger, 1987; Hesselbrock, Meyer, & Keener, 1985; Liskow, Powcll, Nickel, & Penick, 1991; Schuckit, 1973). These mediator variables are also hypothesized to be related to men's perpetration of partner violence in adulthood. These pathways would result in the generalized or antisocial batterer as described by Holtzworth-Munroe and Smart (1994).

Given this hypothesis, ASP may be a moderator variable that links alcohol problems and perpetration of partner violence for men. That is, the association between alcohol problems and partner violence for men may be stronger in the presence of a diagnosis of ASP than in its absence. For example, presence of both alcohol problems and ASP has been found to increase the likelihood of partner violence within an interactive model (Bland & Orn, 1986). Also, using a sample of young marital couples at high risk for alcoholism, Reider et al. (1988) found that husband's total Antisocial Behavior score predicted both husband's lifetime alcohol related problems and severity of husband-to-wife violence. Murphy and O'Farrell (1992) found that episodic drinking, earlier onset of alcohol problems, and higher likelihood of arrest differentiated maritally aggressive and nonaggressive alcoholics.

A factor analysis of these variables revealed one factor similar to Cloninger's (1987) type II alcoholism syndrome of early onset alcoholism associated with ASP. Further, since ASP typically precedes development of both alcohol problems and partner violence, it is possible that ASP results in the development of alcohol problems and the initial development of partner violencc. For alcohol problems, Forrcst (1994) suggests that the combination of nar- cissistic injury (resulting from childhood abuse) and the development of avoidant coping strategies in childhood predispose an individual with ASP to abuse alcohol. For partner violence, the mechanisms for this development might involve an interaction of impulsiveness, irritability, and lack of remorse. However, criticisms of the ASP diagnosis lead to the suggested use of antisocial or criminal behaviors in general as opposed to a diagnosis of ASP as the variable of interest.

Cn'ticisms of ASP

Clearly the diagnosis of ASP is based on the assumption that its diagnostic criteria have sufficient validity to identify persons who consistently disregard and violate the rights of others, and who are incapable of adopting the moral codes of the larger society. If this assumption is in fact correct, there is still the issue of conflict between subgroups resulting in behaviors that are interpreted as violating the rights of others. That is, if one adopts the codes of a subgroup, and if those subgroup codes conflict with those of the predominant society, this cultural conflict may result in behaviors that fit the diagnostic criteria of ASE The underlying problem in this case is not the presence of ASP within the individual. Rather, the problem is conflict between a given subgroup and the larger society. It is this conflict that may result, in this case, in a misdiagnosis of ASR

In addition to this criticism of ASP on the theoretical level, several empirical issues need to be addressed. Despite fairly consistent research showing that a certain type of alcohol problems for men contains elements of ASP, Alterman and Cacciola (1991) have noted several problems with the use of ASP in typologies of alcohol problems. First, there is the issue of low interrater reliability for ASP diagnoses, in part because the operationalization of criteria are related to the referential frameworks of those making the assessments. In particular, there are likely to be disagreements over the clinical significance regarding some of the less severe manifestations of antisocial behavior that appear before age 15. Related to this issue is that of low diagnostic stability for a diagnosis of ASP. Recent functioning appears to influence the diagnosis of ASP. Finally, some antisocial behaviors are related to substance abuse and some are not, leading to the possibility of a tautological link between ASP and alcohol problems.


As Rogers, Dion, and Lynett (1992) noted, the ASP diagnosis using DSM-HI-R criteria is based on the assumptions that all criteria are accorded equal weight and no distinctions are made based on severity or frequency of the criteria. As a result, the possible combinations and variations in criteria that result in a diagnosis of ASP are approximately 3.4 x 108. Further, Rogers and Dion (1991) noted that the DSM-IH-R (American Psychiatric Association, 1987) replaced many developmental symptoms with criminal acts as criteria, thus equating ASP with criminality.

The diagnosis of Conduct Disorder based on DSM-III-R criteria also has been problem- atic in that it has included several nonviolent criteria in which the seriousness of the behavior can be open to interpretation based on the environment of the individual. These criteria include: often truant from school, has runaway from home overnight at least twice, and has used a weapon in more than one fight (American Psychiatric Association, 1987). All of these behaviors could be responses to a harsh environment (i.e., crime in the school, being sexually abused at home, and crime in the neighborhood). In this manner, the diagnosis of Conduct Disorder may confuse the issues of psychiatrically defined disorder with those of environ- mentally determined differences in values for varying social classes, and diverse survival strategies for various subgroups within society.

Further, diagnoses of both Conduct Disorder and ASP group together criteria that are based on substantially different behaviors (some violent and some nonviolent). Both diagnoses may, therefore, be multidimensional in nature. However, neither diagnosis has been subjected to a conf'mnatory factor analysis to examine the issue of dimensionality implied by such variegated diagnostic criteria. Related to the need for a confirmatory factor analysis is the need to examine which components of ASP are related to which adulthood problems. For example, instead of an ASP diagnosis, number of ASP symptoms may be most important in typologies of alcohol problems (Alterman & Cacciola, 1991). Also, different clusters of symptoms may be most predictive of different types of alcohol problems. Further, presence or absence of other personality disorders must be taken into account in predicting types of alcohol problems; the issue may not be ASP versus absence of ASP alone, but rather the cooccurrence of ASP with other personality disorders or with diagnoses, such as depression.

Summary The diagnosis of ASP may be a variable too constricted to encompass the full range of antisocial behavior, as well as the underlying personality dimensions involved in the linkage between antisocial behavior and partner violence. By definition, a diagnosis is a dichotomous distinction; it may be that a dimensional model, in which behavior is viewed on a continu- um, is more useful to understanding the linkage. Examination of criminal behaviors in general as well as the proposed personality traits of impulsivity and irritability may result in more valid explanations of the linkage between antisocial behaviors and partner violence.

DEPRESSION AS A LINK FOR THE ASSOCIATION OF ALCOHOL PROBLEMS AND FAMILY VIOLENCE

Again, indirect paths instead of direct paths between childhood violence and adulthood alcohol problems are hypothesized. Depression may be a link between violent homes during childhood and adult alcohol problems or perpetration of panner violence in adulthood. Depression during childhood, adolescence, and adulthood may be sequelae of childhood violence, especially sexual violence, and may result in alcohol problems or perpetration of partner violence in adulthood. In a similar manner, childhood violence may result in Post Traumatic Stress Disorder (PTSD) and lack of self-esteem for men. Men who experience


parental violence may have taught themselves not to feel the pain of PTSD by medicating this pain with alcohol or substance use (Saunders, 1993).

Thus, for the relationship between childhood violence and adulthood alcohol problems, a link is hypothesized in which childhood violence (i.e., experiences of parent-to-child violence, experiences of childhood sexual abuse, observation of parent-to-parent violence) is related to depressive symptoms during adolescence and young adulthood. Depressive symptoms, dysthymia, and the diagnosis of depression are hypothesized to lead to the development of later onset alcohol problems, especially in men with low risk for development of alcohol problems. Given the results on PTSD and self-esteem, this path between childhood violence and alcohol problems for men may not be specific to depressive symptoms, but rather may be broadened to include these latter two variables.

Depressive symptoms are also hypothesized to be related to the perpetration of partner violence in adulthood. The direction of the relationship between depression and partner violence has been a source of controversy in the literature (Saunders, 1993). In the absence of empirical data, a bidirectional association is postulated for depressive symptoms and partner violence. In addition, depressive symptoms may interact with alcohol problems to increase the probability of partner violence. Presence of both alcohol problems and Major Depressive Episode has been found to increase the likelihood of partner violence within an interactive model (Bland & Orn, 1986).

Additional Control Variables

Family history of alcohol problems is hypothesized as a moderator variable for the associations among experiences of childhood violence, the development of alcohol problems, and the perpetration of partner violence in adulthood for the offspring. Further, history of parental psychiatric problems is also hypothesized as a moderator variable for the relationship between experiences of childhood violence and the development of alcohol problems. Marital conflict is hypothesized as a mediator variable for the relationship between partner violence and alcohol problems for men. Men's alcohol problems are hypothesized to be related to marital conflict, and through this variable to men's partner violence. Conflicts about men's alcohol use may escalate into the perpetration of partner violence. Also, men's partner violence is hypothesized to be related to marital conflict and through this variable be related to men's alcohol problems. In particular, men's partner violence is hypothesized to be related to the woman defending herself (partner-to-man violence) and through this variable to be related to further dyadic conflict that results in further men's violence to partner. Finally, both ASP and depressive symptoms are hypothesized to lead to marital conflict. However, marital conflict may also lead to depressive symptoms in men (e.g., Saunders, 1993).

SUMMARY AND CONCLUSIONS

The available literature indicates that: (a) experiences of childhood violence are associated with mediator variables, including antisocial behaviors and depressive symptomatology, that are themselves associated with the development of alcohol problems and the perpetration of partner violence for men in adulthood; (b) experiences of childhood violence and, more strongly, observation of interparental violence during childhood predict perpetration of partner violence in adulthood for males; (c) presence of partner violence is associated with certain types of alcohol problems for men; and (d) both partner violence and alcohol problems are associated with marital conflict. The literature is mixed on whether there is a direct link between experiences of childhood violence and the development of alcohol problems for men, with retrospective research supporting this linkage and research based on following samples of adolescents into adulthood contradicting this linkage. Based on this research, two


indirect pathways between childhood violence and adulthood problems (i.e., alcohol problems and partner violence) are proposed. Further, bidirectional associations between alcohol problems and partner violence are proposed.

Empirical evidence on these associations is of sufficient strength to warrant action by policymakers, clinicians, and researchers. Policymakers can provide structures to encourage coordinated and cooperative models of working together among those engaged in providing services for alcohol problems, experiences of childhood violence, and the perpetration of partner violence, and, more generally, mental health. As managed health care dominates the provision of services for the future, policymakers need to ensure that the relationships among childhood victimization, alcohol problems, mental health issues, and the perpetration of partner violence are understood, covered, and effectively treated in our systems of service delivery. Not only can this lead to more humane responses, such understanding is key to the development of successful approaches to complex problems.

Clinicians providing alcoholism and other drug treatment services need to recognize that family violence is a significant experience for men. Screening for childhood experiences of physical and sexual abuse, as well as adult perpetration of partner violence should occur. Failure to address the importance of family violence for men in treatment may contribute to relapse through one of several possible pathways. However, for many treatment programs, the expertise and experience to provide this type of counseling may not be readily available within the program. Training of personnel and/or collaborating with family violence and other victimization service providers may be necessary.

Screening for alcohol and drug problems needs to occur in treatment and intervention settings that provide services for family violence, in particular men who perpetrate partner violence. Recognition of alcohol and/or drug problems among men who have perpetrated partner violence may be threatening to some because of the concern that the alcohol and/or drug problem will be used as a rationale for their violence. Although removal of the alcohol and/or drug problems will not by itself result in the cessation of partner violence for most men, presence of such problems may in fact contribute to partner violence through one of several pathways. Thus, cessation of alcohol and/or drug problems must be viewed as part of the overall effort to eliminate perpetration of partner violence for men.

Finally, researchers need to continue exploration of the connections among childhood vie- timization, the development of men's alcohol problems, and men's perpetration of partner violence. Most of the available literature has examined only bivariate associations between pairs of variables, failing to control for additional important factors, such as the history of parental psychiatric disorders including parental alcohol problems. In addition, there have been few attempts to develop an overall theoretical framework to account for the associations among these variables. There is a need for research using multivariate data analytic strategies that examines the roles of these additional factors, as well as more theoretical development to account for empirical findings. Further, additional populations of men can provide better information on the extent to which these associations are robust across different groups of men. Associations need to be tested for men at different developmental stages and for men who are at various stages of alcohol problems. Especially valuable would be to determine whether the links hold for men in different geographic regions, from various cultural backgrounds, and from more diversified socioeconomic backgrounds. Careful testing of the models for how and why family violence is related to men's alcohol problems is needed.

Acknowledgements - - This research is funded in part by the National Institute on Alcohol Abuse and Alcoholism, NIH, Grant No. R01AA07554. The authors wish to express their appreciation to Daniel G. Saunders, PhD, Associate Professor of the University of Michigan School of Social Work for his


very helpful editorial suggestions on an earlier draft of this article. An earlier version of this paper was presented at the annual meeting of the American Society of Criminology, Phoenix, AZ, October

27-30, 1993.

REFERENCES Alterman, A. I., & Cacciola, J. S. (1991). The antisocial personality disorder diagnosis in substance abusers:

Problems and issues. Journal of Nervous and Mental Disease, 179(7), 401-409. American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (3rd ed., rev. ed.)

Washington, DC: Author. American Psychiatric Association. ( 1994 ). Diagnostic and statistical manual of mental disorders ( 4th ed. ). Washington,

DC: Author. Babor, T. E, Hofmann, M., DelBoca, E K., Hesselbrock, V., Meyer, R. E., Dolinsky, Z. S., & Rounsaville, B. (1992).

Types of alcoholics, I: Evidence for an empirically derived typology based on indicators of vulnerability and severity. Archives of General Psychiatry, 49, 599-608.

Bagley, C. (1991). The long-term psychological effects of child sexual abuse: A review of some British and Canadian studies of victims and their families. Annals of Sex Research, 4, 23-48.

Barnett, O. W., & Fagan, R. W. (1993). Alcohol use in male spouse abusers and their female partners. Journal of Family Violence, 8, 1-25.

Becker, J. V., Kaplan, M. S., Tenke, C. E. & Tartaglini, A. (1991). The incidence of depressive symptomology in juvenile sex offenders with a history of abuse. ChildAbuse and Neglect, 15, 531-536.

Bland, R. C., & Ore, H. (1986). Psychiatric disorders, spouse abuse and child abuse. Acta Psychiatrica Belgium, 86, 444-449.

Blanc, H. T., Miller, B. A., & Leonard, K. E. (1988). lntro- and inter-generational aspects of serious domestic violence and alcohol and drugs. Washington, DC: National Institute of Justice.

Boisso, C. V., Lutz, O. J., & Gray, S. A. (1989, August). Psychological Characteristics of Adolescent Males Who Have Been Sexually Abused. Paper presented at the Annual Meeting of the American Psychological Association, New Orleans, LA.

Boney-McCoy, S., & Finkelhor, D. (1995). Psychosocial sequelae of violent victimization in a national youth sample. Journal of Consulting and Clinical Psychology, 63(5), 726-736.

Brown, G. R., & Anderson, B. (1991). Psychiatric morbidity in adult inpatients with childhood histories of sexual and physical abuse. American Journal of Psychiatry, 148, 55-61.

Cadoret, R. J., & Cain, C. (1980). Sex differences in predictions of antisocial behavior in adoptees. Archives of General Psychiatry, 37, 1171-1175.

Cadoret, R. J., & Cain, C. (1981). Environmental and genetic factors in predicting adolescent antisocial behaviors in adoptees. Psychiatric Journal of the University of Ottawa, 6, 220-225.

Caesar, P. L. (1988). Exposure to violence in the families-of-origin among wife-abusers and maritally nonviolent men. Violence and Victims, 3(1 ), 49-63.

Cavaiola, A. A., & Schiff, M. (1989). Self-esteem in abused chemically dependent adolescents. Child Abuse and Neglect, 13, 327-334.

Chassin, L., Rogosch, E, & Barrera, M. (1991). Substance use and symptomatology among adolescent children of alcoholics. Journal of Abnormal Psychology, 100(4), 449-463.

Cloninger, C. R. (1987). Neurogenetic adaptive mechanisms in alcoholism. Science, 236, 410-416. Dembo, R., Dertke, M., LaVoie, L., Borders, S., Washburn, M., & Schmeidler, J. (1987). Physical abuse, sexual vic-

timization and illicit drug use: A structural analysis among high risk adolescents. Journal of Adolescence, 10, i 3-33.

Dembo, R., Williams, L., Wothke, W., & Schmeidler, J. (1993, September). The role of fumily problems, sexual victimization and physical abuse experiences on high risk youths' emotional~psychological functioning: A longitudinal study. Paper presented at the Annual Meeting of the American Society of Criminology, New Orleans, LA.

DiLalla, L. E, & Gottesman, I. I. (1991). Biological and genetic contributions to violence: Widom's untold tale. Psychological Bulletin, 109, 125-129.

Dinwiddie, S. H. (1992). Psychiatric disorders among wife batterers. Comprehensive Psychiatry, 33(6), 411-416. Downs, W. (1989). The role of alcohol use in family violence. Paper presented at the Annual Meeting of the Academy

of Criminal Justice Sciences, Washington, DC. Downs, W. R., & Miller, B. A. (1994). Women's alcohol problems and experiences of parmer violence: A longitu-

dinal examination. Paper presented at the Annual Meeting of the Research Society on Alcoholism, Maui, HI. Dutton, D. G. (1988). Profiling of wife assaulters: Preliminary evidence for a trimodal analysis. ~olence and Victims,

3(1), 5-29. Dutton, D. G., & Hart, S. D. (1992a). Risk markers for family violence in a federally incarcerated population.

International Journal of Law and Psychiatry, 15, 101-112.


Dutton, D. G., & Hart, S. D. (1992b). Evidence for long-term, specific effects of childhood abuse and neglect on criminal in behavior men. International Journal of Offender Therapy and Comparative Criminology, 36(2), 129-137.

Fagan, J. A., Stewart, D. K., & Hansen, K. V. (1983). Violent men or violent husbands? Background factors and sit- uational correlates. In D. Finkelhor, R. J. Gelles, G. T. Hotaling, & M. A. Straus (Eds.), The dark side of families: Current family violence research. Beverly Hills, CA: Sage Publications.

Fagan, R. W., Barnett, O. W., & Patton, J. B. (1988). Reasons for alcohol use in maritally violent men. American Journal of Drug and Alcohol Abuse, 14, 371-392.

Famularo, R., Kinscherff, R., & Fenton, T. (1992). Parental substance abuse and the nature of child maltreatment. Child Abuse and Neglect, 16, 475--483.

Floumoy, P. S., & Wilson, G. L. (1991). Assessment of MMPI profiles of male batterers. Violence and Victims, 6(4), 309-320.

Forrest, G. G. (1994). Chemical dependency and antisocial personality disorder. New York: I-Iayworth Press. Gondolf, E. W. (1988). Who are those guys? Toward a behavioral typology of batterers. Violence and Victims, 3(3),

187-203.

Halford, W. K., & Osgarby, S. M. (1993). Alcohol abuse in clients presenting with marital problems. Journal of Family Psychology, 6(3), 245-254.

Hamberger, L. K., & Hastings, J. E. (1987, April). The male batterer and alcohol abuse: Differential personality characteristics. Paper presented at a symposium on the male batterer: Alcohol use, jealousy, and consequences of abuse, Western Psychological Association, Long Beach, CA.

Hamberger, L. K., & Hastings, J. E. (1989, August). Psychopathology differences between batterers and nonbatterers: Psychosocial modifiers. Paper presented at the Annual Meeting of the American Psychological Association, New Orleans, LA.

Harrison, P. A., Hoffmann, N. G., & Edwall, G. E. (1989). Sexual abuse correlates: Similarities between male and female adolescents in chemical dependency treatment. Journal of Adolescent Research, 4(3), 385-399.

Hart, S. O., Dutton, D. G., & Hewlove, T. (1993). The prevalence of personality disorder among wife assaulters. Journal of Personality Disorders, 7(4), 329-341.

Hastings, J. E., & Hamberger, L. K. (1988). Personality characteristics of spouse abusers: A controlled comparison. Violence and Victims, 3(1 ), 31-48.

Helzer, J. E., & Pryzbeck, T. R. (1988). The cooccurrence of alcoholism with other psychiatric disorders in the general population and its impact on treatment. Journal of Studies on Alcohol, 49, 219-224.

Hesselbrock, V. M., Hesselbrock, M. N., & Stabenau, J. R. (1985). Alcoholism in men patients subtyped by family history and antisocial personality. Journal of Studies on Alcohol, 46(1), 59-64.

Hesselbrock, M. N., Meyer, R. E., & Keener, J. J. (1985). Psychopathology in hospitalized alcoholics. Archives of General Psychiatry, 42, 1050-1055.

Hill, E. M., Nord, J. L., & Blow, E C. (1992). Young-adult children of alcoholic parents: Protective effects of positive family functioning. British Journal of Addiction, 87, 1677-1690.

Holmes, S. J., & Robins, L. N. (1987). The influence of childhood disciplinary experience on the development of alcoholism and depression. Journal of Child Psychology and Psychiatry, 28(3), 399-415.

Holmes, S. J., & Robins, L. N. (1988). The role of parental disciplinary practices in the development of depression and alcoholism. Psychiatry, 51, 24-35.

Holtzworth-Munroe, A., & Stuart, G. L. (1994). Typologies of male batterers: Three subtypes and the differences among them. Psychological Bulletin, !16(3), 476-497.

Hotaling, G. T., & Sugarman, D. B., (1986). An analysis of risk markers in husband to wife violence: The current state of knowledge. Violence and Victims, 1(2), 101-124.

Hotaling, G. T., & Sugarman, D. B. (1990). A risk marker analysis of assaulted wives. Journal of Family Violence, 5(1), 1-13.

Hughes, H. M., Parkinson, D., & Vargo, M. (1989). Witnessing spouse abuse and experiencing physical abuse: A "double whammy"? Journal of Family Violence, 4, 197-209.

Ireland, T., & Widom, C. S. (1994). Childhood victimization and risk for alcohol and drug arrests. International Journal of the Addictions, 29(2), 235--275.

Jaffe, P., Wolfe, D., Wilson, S. K., & Zak, L. (1986). Family violence and child adjustment: A comparative analysis of girls' and boys' behavioral symptoms. American Journal of Psychiatry, 143, 74-77.

Kalmuss, D. (1984). The intergenerational transmission of marital aggression. Journal of Marriage and the Family, 46, 11-19.

Kantor, G. K., & Straus, M. A. (1989). Substance abuse as a precipitant of wife abuse victimizations. American Journal of Drug and Alcohol Abase, 15(2), 173-189.

Kantor, G. K., & Strans, M. A. (1990). Parental drinking and violence and child aggression. Paper presented at the Annual Meeting of the American Psychological Association, Boston, MA.

Kroll, P. D., Stock, D. F., & James, M. E. (1985). The behavior of adult alcoholic men abused as children. The Journal of Nervous and Mental Disease, 173(11), 689-693.

Childhood l, rtolence and Alcohol Problems 343

Leonard, K. E., Bromet, E. J., Parkinson, D. K., Day, N. L., & Ryan, C. M. (1985). Patterns of alcohol use and physically aggressive behavior in men. Journal of Studies on Alcohol, 46, 279-282.

Lewis, C. E., & Bucholz, K. K. (1991). Alcoholism, antisocial behavior and family history. British Journal of Addiction, 86, 177-194.

Liskow, B., Powell, B. J., Nickel, E., & Penick, E. ( 1991). Antisocial alcoholics: Are there clinically significant diagnostic subtypes? Journal of Stadies on Alcohol, 52(1), 62-69.

Malamuth, N. M., Sockloskie, R. J., Koss, M. P., & Tanaka, J. S. (1991 ). Characteristics of aggressors against women: Testing a model using a national sample of college students. Journal of Consulting and Clinical Psychology, 59, 670-681.

Malinosky-Rummell, IL, & Haasen, D. J. (1993). Long-term consequences of childhood physical abuse. Psychological Bulletin, 114(1), 68-79.

Marshall, L. L., & Rose, P. (1990). Premarital violence: The impact of family of origin violence, stress, and reci- procity. Violence and ~rurtims, 5, 51--64.

McCord, J. (1983). A forty-year perspective on effects of child abuse and neglect. Child Abuse and Neglect, 7, 265-270.

Miller, B. A., Downs, W. R., Testa, M., & Keil, A. (1991, November). Thematic analyses of severe spousal violence incidents: Women's perceptions of their victimization. Paper presented at the Annual Meeting of the American Society of Criminology, San Francisco, CA.

Murphy, C. M., & O'FarreU, T. J. (1992). Factors associated with marital aggression in male alcoholics. Paper presented at the Annual Meeting of the Association for the Advancement of Behavior Therapy, Boston, MA.

Pollock, V. E., Briere, J., Schneider, L., Knop, J., Mednick, S. A., & Goodwin, D. W. (1990). Childhood antecedents of antisocial behavior: Parental alcoholism and physical abusiveness. American Journal of Psychiatry, 147(10), 1290-1293.

Reider, E. E., Zucker, R. A., Noll, R. B., Magnin, E. T., & Fitzgerald, H. E. (1988). Alcohol involvement and family violence in a high risk sample: L Spousal violence. Paper presented at the Annual Meeting of the American Psychological Association, Atlanta, Georgia.

Reider, E. E., Zucker, R. A., Magnin, E. T., NoU, R. B., & Fitzgerald, H. E. (1989, August). Alcohol involvement and violence towards children among high risk families. Paper presented at the Annual Meeting of the American Psychological Association, New Orleans, LA.

Riggs, D. S., O'Leary, K. D., & Breslin, E C. (1990). Multiple correlates of physical aggression in dating couples. Journal of Interpersonal Violence, 5, 61-73.

Robins, L. N. (1981). Epidemioiogical approaches to natural history research. Journal of the American Academy of Child Psychiatry, 20, 566-580.

Robins, L. N., Tipp, J., & Pryzbeck, T. (1991). Antisocial personality. In L. N. Robins & D. A. Regier (Eds.), Psychiatric disorders in America: The epidemiologic catchment area study (pp. 258-290). New York: Free Press.

Rogers, R., & Dion, K. (1991). Rethinking the DSM IH-R diagnosis of antisocial personality disorder. Bulletin of American Academy of Psychiatry Law, 19(1), 2 i -31.

Rogers, R., Dion, K., & Lynett, E. (1992). Diagnostic validity of antisocial personality disorder. Law and Human Behavior, 16(6), 677-689.

Rohsenow, D. J., Corbett, R., & Devine, D. (1988). Molested as children: A hidden contribution to substance abuse? Journal of Substance Abuse Treatment, 5, 13-18.

Rosenbaum, A., & O'Leary, K. D. (1981). Marital violence: Characteristics of abusive couples. Journal of Consulting and Clinical Psychology, 49(1), 63-71.

Saanders, D. G. (1992). A typology of men who batter: Three types derived from cluster analysis. American Journal of Orthopsychiatry, 62(2), 264-275.

Saunders, D. G. (1993). Husbands who assault: Multiple profiles requiting multiple responses. In N. Z. Hilton (Ed.), Legal responses to wife assault (pp. 9-34). Newbury Park, CA: Sage.

Saunders, D. G., & Hanusa, D. (1986). Cognitive-behavioral treatment of men who batter. The short-term effects of group therapy. Journal of Family Violence, 1, 357-372.

Schaefer, M. R., Sobieraj, K., & Hollyfield, R. L. (1988). Prevalence of childhood physical abuse in adult male vet- eran alcoholics. Child Abuse and Neglect, 12, 141-149.

Schuckit, M. A. (1973). Alcoholism and soeiopathy. Journal of Studies on Alcohol, 34, 157-164. Schuckit, M. A., & Monteiro, M. G. (1988). Alcoholism, anxiety and depression. British Journal of Addiction, 83,

1373-1380. Shields, N. M., McCall, G. J., & Hanneke, C. R. (1988). Patterns of family and nonfamily violence: Violent hus-

bands and violent men. Violence and Victims, 3(2), 83-97. Singer, M. L, Petchers, M. K., & Hussey, D. (1989). The relationship between sexual abuse and substance abuse

among psychiatrically hospitalized adolescents. Child Abuse and Neglect, 13, 319-325. Smith, J. P., & Williams, J. G. (1992). From abusive household to dating violence. Journal of Family Violence, 7(2),

153-165.


Sttaus, M. A. (1993). Corporal punishment of children and depression and suicide in adulthood. In L McCord ted.), Coercion and panislunent in long-term perspective. New York: Cambridge University Press.

Tolman, R. M., & Bennett, L. W. ( 1990). A review of quantitative research on men who batter. Journal oflnterpersonal l/'m/ence, 5(I), 87-118.

Van Hasselt, V. B., Morrison, R. L., & Bellack, A. S. (1985). Alcohol use in wife abusers and their spouses. Addictive Behaviors, 10, 127-135.

Widom, C. S. ( 1992, May). Child abuse and alcohol use. Paper prepared for the Working Group on Alcohol-Related Violence: Fostering Interdisciplinary Perspectives, convened by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), Washington, DC.

Widom, C. S., Ireland, T., & Glynn, P. J. (1995). Alcohol abuse in abused and neglected children follow-up: Are they at increased risk? Journal of Studies on Alcohol, 56, 207-217.

Zucker, R. A. (1987). The four alcoholisms: A developmental account of the etiologic process. In P. C. Rivers (Ed.), Alcohol and addictive behavior (pp. 27-83). Lincoln, NE: University of Nebraska Press.

Zucker, R. A. (1989). Is risk for alcoholism predictable? A probabilistic approach to a developmental problem. Drugs and Society, 3, 69-93.

Zucker, R. A., & Gomberg, E. S. L. (1986). Etiology of alcoholism reconsidered: The case for a biopsychosocial process. American Psychologist, 41, 783-793.

the relationship between childhood violence and alcohol problems among men who batter: an empirical...

Documents