Intimate partner violence by men abusing and non-abusing alcohol in Poland.

Alcohol use is to one of the most of risk factors for intimate partner violence. The aim of this study was to check the difference of demographic characteristics and type of violence between of the perpetrators with a history of alcohol abuse (A) versus the perpetrators without a history of alcohol abuse (N). Data were obtained from the survey conducted in the office of the Association for Violence Prevention in the city of Lublin, Poland. 400 perpetrators and their victims (400 subjects) were examined. To collect information from victims a specially designed questionnaire was used (VQ). Besides, another questionnaire (PQ) and The Alcohol Use Disorders Identification Test (AUDIT) was used to measure alcohol use in the perpetrators. About 76% of the perpetrators scored 8 and above (AUDIT). 84.8% of the perpetrators with a history of alcohol abuse (A) versus 9.2% of the perpetrators without a history of alcohol abuse (N) committed acts of violence after alcohol consumption. The A-perpetrators were more likely to be younger, have lower education and break law, and less likely to have permanent jobs than the N- perpetrators. The significant difference in the type of violence was found: the A-perpetrators were more likely to commit physical violence (78.2%) than the Nperpetrators (33.2%) and the N-perpetrators were more likely to commit sexual violence (32.2%) than A-perpetrators (9.14%). We would like to conclude that despite similarities among perpetrators, they are not a homogenous group so different therapeutic approach should be considered.


Introduction
Violence against women by their intimate partners still occurs within societies and among different cultures. According to the data collected in 48 countries, 10% to 69% of women reported being physically assaulted by an intimate male partner [1]. Intimate partner violence is listed in the WHO World Report on Violence and Health. According to the Report, intimate partner violence refers to any behaviour within an intimate relationship that causes physical, psychological or sexual harm to those in the relationship. It is necessary to stress that the chapter of the Report referring to the issue is focused on violence against women by men because in most cases it is women who are victimized by their male partners [2].
It is difficult to determine the precise number of cases of domestic violence and other offences against women in Poland since data are not collected in a systematic way. As pointed out in the Report on violence against women in the 1990s in Poland by the Women's Rights Centre (Centrum Praw Kobiet, CPK), a non-governmental organization attempting to integrate activities against domestic violence throughout the country, statistics from the police and courts, for example, do not include victim's gender nor the relationship between victim and perpetrator [3]. However, as the authors of the report point out, according to statistics of the Ministry of Justice, men constitute 98% of the number of perpetrators of domestic violence. Statistics from courts show that in 1996 there were 15,412 cases of domestic violence, including 13,405 culminating in custodial sentence. The number of those who were sentenced rose from 10,449 in 1993 to 13,405 in 1996, and then decreased in 1997. At the same time, however, the number of suspended sentences rose from 9,143 in 1993 to 12,087 in 1997 [3].
Another source of information on the issue is a survey by the Publish Opinion Research Centre (Centrum Badania Opinii Publicznej, CBOS) conducted in 1993 and 1996 on a representative sample of 1,087 adult married women. According to the results, 18% of respondents reported having suffered from domestic violence, including 9% of women having been battered by their husbands frequently and repeatedly, and 9% of them having been beaten occasionally within their relationships. Divorced women were more likely to report having been victimized: 41% of them stated that they had been beaten frequently and 21% occasionally by their husbands. On the other hand, there was a large gap between women who reported having been victims themselves and those who admitted knowing a female victim (41% of married women and 61% of divorced women reported that they knew women who had been beaten by their husbands while having an argument) [4].
Among a variety of risk factors for intimate partner violence, alcohol use is to one of the most consistent [5,6]. This relationship appears to be complex. There is in sufficient evidence that alcohol use per se could result in committing acts of violence. Analyzing both epidemiologic studies and laboratory research on antisocial personality disorder, alcohol use and aggression, Moeller and Dougherty [7] conclude that people with the disorder are more likely to meet the criteria for alcohol abuse and dependence, are more susceptible to alcohol's aggressionrelated effects compared with those without the disorder. According to some theorists, alcohol might engender aggression in these persons who are predisposed to behave in such a manner [8,9]. Phil et al. [10] claim that alcohol has its greatest aggression-triggering effects for individuals with low executive cognitive functioning. On the other hand, alcohol misuse may provide fuel for arguments between couples [11].
All in all, even though there is a considerable body of research on the relationships of alcohol and violence, little is known about the nature of alcohol-abusing perpetrators as a group. It is possible that their acts of violence differ somehow from those committed by persons who do not misuse alcohol. Persons victimized by both groups of perpetrators might also differ; they might, for instance, seek a different kind of help. These assumptions gave rise to design and conduct the research on differences between alcohol-related and non-alcohol-related violence.

Participants
The study was conducted in the office of the Association for Violence Prevention in the city of Lublin, Poland, in 2001-2003. Telephone calls from victims were the starting point for recruiting participants (only the first call from each person was taken into consideration). Afterwards, both victims and perpetrators were asked to participate in a scientific research (one third of those who called the Association to report acts of violence refused). Those who gave their consent were asked to complete a self-administered questionnaire in an individual session at the office of the Association. A trained member of staff was present to explain and assist with any problems that might arise. This approach led to the examination of 800 subjects, including 400 victims and 400 perpetrators selected on the grounds of 1,113 telephone calls. Among them, the perpetrators of violence constituted the actual research sample, while the victims were the source of information about acts of violence. Since the author's aim was to find any differences between alcohol-abusing and non-alcohol abusing perpetrators, not only intimate partner victims were asked to participate.

Method
In order to collect data, different questionnaires were designed for victims and for perpetrators. The questionnaire for victims (VQ) included, apart from a demographic section, 12 questions referring to the circumstances under which acts of violence occurred. This questionnaire was designed for this particular study based on the previous examples published [1,5,6].
Victims were asked about the type of violence they experienced. The following types of violence were included: physical violence (striking with hands or an object, punching, kicking, beating); sexual violence (forcing someone to have sexual intercourse or other unwanted sexual contact performed solely for the gratification of the perpetrator); intimidation (repeated insults, emotional blackmail, and threats to commit physical harm, which made the victim feel afraid); neglect (persistent failure to provide basic needs for those being in a perpetrator's care, e.g. deprivation of food, leaving minors unattended).
The questionnaire for perpetrators (PQ) included, besides questions concerning sociodemographic data, the Alcohol Use Disorders Identification Test (AUDIT); polish version. AUDIT was designed by the WHO to identify hazardous and harmful alcohol use [12]. A score of 8 and above in tests has been recognized to be sensitive in predicting harm caused by alcohol consumption and current problematic drinking [13]: drinking frequency, the number of drinks consumed on a typical occasion, drinking problems and consequences following measures were examined.

Data Analysis and Statistical Methods Used
To fulfil the main aim of the study participants were divided in two groups of perpetrators with a history of alcohol abuse (A) versus of the perpetrators without a history of alcohol abuse (N). The two examined groups were compared with respect to the demographic variables, as well as the type of acts of violence they committed. The protocol of the study didn't include a comparison with healthy control.
Mann-Whitney U test was used to show the difference in demographic parameters. Chi-sugared distribution test was used to compare the other parameters assessed in the study.

Characteristics of the Whole Examined Group of Perpetrators
Considering the group of perpetrators as a whole, 82.2% of them were aged 18-45 and 12% of them were aged 46 -60; 58% of subjects had vocational (trade) education, 23.1% secondary (general or technical) education, 10% primary education and 8.3% with higher education; 16% had a permanent job at the time of the study; 23.6% had broken the law; 67.6% considered themselves to be religious and reported their church services attendance.
Most perpetrators met criteria for alcohol abuse described in DSM-IV-TR [14]. About 76% of perpetrators scored 8 and above (AUDIT). For over 58% of perpetrators, beer (5% alcohol by volume or above) was the most popular usual drink. About 26% of them drank vodka as their usual drink while 16% of them preferred wine. The majority reported drinking alcohol heavily in their own home or at a friend's place.
In 69.8% of cases, an incident of violence occurred after alcohol consumption by a perpetrator.

Comparison of A and N Group of Perpetrators, Socio-Demographic Data
Age A significant difference was found in age categories of both groups (Mann-Whitney Test U = 1036341.5; p <.01). The A-perpetrators were younger: the average rank in this group was lower (1552.10) than in the N-group (1632.97).

Education
Overall, the A-perpetrators had a lower level of education. Mann-Whitney Test showed a significant difference in the educational level of the 2 groups studied (U = 922443.0; p < .001). The average rank in the group of the A-perpetrators was lower (1435.52) than in the group of the N-perpetrators (1682.06).

Criminal history
There were more persons with a criminal record in the group of the A-perpetrators (29.7%) than in the group of N-perpetrators (12.4%). This difference was statistically significant (x 2 = 48.06; df = 2; p <.001).

Comparison of A and N Groups of Perpetrators -Type of Violence Reported
However, the A-perpetrators were more likely to commit violence against persons under the age of 15 and over the age of 60, whereas the N-perpetrators were more likely to victimize persons aged 15 -60 (x 2 = 510; df = 5, p <.001).
Among the A-perpetrators, an incident of violence most frequently occurred after alcohol consumption (84.8%). As far as the N-perpetrators were concerned, alcohol was involved in 9.2% of cases. Drinking alcohol just before committing an act of violence differed significantly in both groups of perpetrators (x 2 = 125.79; df = 2; p <.001).
As far as intimidation was concerned, no significant differences were found; about 58% of perpetrators of both groups were accused of using this type of violence (x 2 = 05, df=l, n.i.).
While comparing the victims of the A-perpetrators and the N-perpetrators, it was found that the type of victim did not differentiate the groups studied. Approximately 60% of adult women, 13% of adult men and 24% -27% of minors (persons under the age of 18 of both genders) were victimized by both groups of perpetrators (x 2 = 3.05; df = 2). There were no significant age differences between the victims of the A-perpetrators and N-perpetrators, (Mann-Whitney Test U = 1078587.5; n.i.). Both A-perpetrators and N-perpetrators most frequently performed violence in their own homes (98.2% versus 81.3% respectively).

Discussion
This study was designed to determine differences between the perpetrators with a history of alcohol abuse (A-perpetrators) versus the perpetrators without a history of alcohol abuse (N-perpetrators). The basis of our results was a survey of perpetrators of domestic violence with different patterns of alcohol consumption practices living in the city of Lublin, the capital of the voivodeship located in central-east Poland (500 000, inhabitants). We collected data from 400 perpetrators and their victims. Given that the incidents of violence occurred after alcohol consumption by perpetrators in over half of the cases, the obtained results appear to corroborate the findings of earlier studies stating a link between alcohol misuses and committing violence [15,16,17,18,19].
The results referring to the place of an incident of violence seem to support the routine activity theory by Felson [20,21]. This author claims that 3 elements are vital for committing an offence, i.e. a perpetrator's motive, access to a suitable target, and absence of "guards". Accordingly, perpetrators are likely to select a place which they find the safest and which they associate with the least amount of effort needed to act. On the grounds of this theory, incidents of violence are likely to take place at home because a person makes an easy target there (compared with those from outside), an assailant does not have to put much effort in finding a victim, and there is a lack of (or few) potential "guards" who could intervene. Besides, victims of domestic violence are unwilling to report such acts to the police [22].
Nearly 70% of the subjects studied considered themselves to be religious and reported their church service attendance. This might appear quite surprising since Christianity is expected to be negatively related to aggressive behavior. A possible explanation is that declaring one's religion is not necessarily synonymous with their obeying religious rules; the majority of Polish society tends to exhibit ritual behavior but at the same time, a considerable number of people do not know the principles of their religion, and/or are selective about them.
Perpetrators with a history of alcohol abuse were more likely to be younger, have a lower education and problems with law, and less likely to have permanent jobs (and consequently a lower income) than perpetrators without a history of alcohol abuse. These are demographic factors commonly associated with a man's risk for abusing his intimate partner [2].
The most interesting finding appears to be the difference in committing sexual violence by the 2 groups studied. Alcohol is commonly seen as an aphrodisiac [23]; drinking might give men "Dutch courage" [24], and the perpetrators could use this in order to justify their socially unacceptable behavior [25]. It seems, however, that those who perpetrate violence against their intimate partners might not need such a trigger. Instead, they might possess particular characteristics linked to committing violence, especially against women. According to the literature, men who committed sexual assault were more hostile toward women and lower in empathy; they were also likely to endorse traditional stereotypes about gender roles [26].

Conclusion
Despite similarities among the perpetrators with and without a history of alcohol abuse, those groups might not be homogenous. Perpetrators with a history of alcohol abuse were more likely to be younger, have a lower education and problems with law, and less likely to have permanent jobs (and consequently a lower income) than perpetrators without a history of alcohol abuse. Unexpectedly the A-perpetrators were significantly more frequently accused of physical and rarely of sexual abuse than N-perpetrators. The results might prove useful in identifying violent behaviours and undertaking effective prevention programs.