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Monday, December 10, 2007

Addiction 103 (1), 78–79.

While studies of homicide victims, for example by Parker [1], Cherpitel et al. [2] and others, have demonstrated a strong association of drinking and violence, explanations of this relationship were often elusive. A part of this conundrum was whether this resulted from personal characteristics including personality and genetics of the individual victim (or perpetrator), or the drinking group, or the effects of alcohol on the victim, or the perpetrator, or both in the moment. This produced a disinhibition explanation of violence and alcohol; i.e. because drinkers are impaired by alcohol, their ability to make reasonable decisions about behavior, including conflict avoidance, is diminished. One of my favorite drawings from the ‘Dark Side’ cartoon series shows three obviously drunk dogs standing on a hill looking down into a cage in the zoo occupied by a large black panther. Two dogs are encouraging a third to enter the panther's cage with the statement, ‘Go ahead . . . you can take him!’. This, in a nutshell, presents one of the popular explanations for why drinkers become involved in violence, i.e. drunk people make stupid decisions and get into fights.

Fortunately, three papers in this issue provide rich insights into the basis for explaining the association of alcohol and violence [3–5]. Hughes et al. [3] studied the relationship of drinking before and after going out into public spaces and violence in an effort to explore how personal drinking patterns and location or setting of pre-public drinking influenced alcohol-related problems in public spaces, including licensed alcohol establishments. They found that drinkers who began drinking at home or at a friend's home before going out to public drinking venues in England reported significantly higher levels of total consumption over the night out and an almost three times greater risk of being involved in a fight in such public drinking settings. The authors suggested that the relative price per drink differential between private drinking (using off-premise purchased alcohol) and in pubs and nightclubs (using on-premise purchased alcohol) may well contribute to this pattern. This ‘pre-loading’ on alcohol using low-cost sources prior to going out seemed to increase the risk of violence. They even proposed that ‘Measures to tackle drunkenness and alcohol-related violence in nightlife should expand beyond those solely targeted at nightlife environments’ [3].

The second study, by Boyle et al. [4], examined self-reported drinking and personal hostility within a large cohort of individuals from the United States who were involved in the Vietnam War. They found that hostility, i.e. as measured by an abbreviated version of the Cook–Medley hostility scale (ACM), was associated with total monthly intake of alcohol as well as drinks per drinking day and heavy episodic drinking. They concluded that hostility is associated with a heavy per-occasion drinking pattern and thus, not surprisingly, elevated personal mortality.

Treno et al. [5] found that individuals living in neighborhoods in California, USA with high concentrations of pubs and bars held personal values of greater acceptability of alcohol-related aggression and carried out more frequent heavy drinking at bars and pubs as well as at parties and friends' homes. While the direction of influence is unknown via this cross-sectional research, the authors concluded that both alcohol outlet densities and the personal acceptability of alcohol-related violence co-occur together.

At first glance, these three studies appear to be separate aspects of the nexus of drinking with violence [3–5]. However, all three studies found an association of heavy consumption per drinking event and self-reported violence or hostility.
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