Although historically viewed as a private family matter, for more than 30 years, intimate partner violence (IPV) has been recognized as a broad societal problem that necessitates the attention of both the mental health and criminal justice systems. According to data gathered as part of the National Crime Victimization Survey, in 2005, there were approximately 3.5 million reports of family violence and nearly 1 million female victims of intimate partner violence [1]. Moreover, estimates indicate that approximately 15–20% of partners engage in IPV at least once annually [2]. In addition, the National Center for Victims of Crime reports 32% of college students have experienced violence in a previous relationship and 21% report violence in their current relationship [3]. Acts of IPV range from beating up one’s partner repeatedly to a single episode of pushing one’s partner [2,4–6].

IPV often has serious public health consequences. According to the Department of Justice (DOJ) estimates, over 400 men and 1,200 women are killed by an intimate partner each year [1]. In fact, partner violence accounts for 11% of all homicides annually [6]. In addition, IPV often results in acute injuries (e.g., bruises, lacerations, broken bones and teeth) and may result in chronic illnesses and psychiatric conditions (e.g., chronic pain, substance use; [7,8]). Specifically, a 2001 Department of Justice (DOJ) report indicated there were 691,000 nonfatal violent victimizations committed by current or former spouses, boyfriends, or girlfriends each year. Moreover, nearly a quarter million emergency room visits each year involve a victim of IPV. According to the findings of the National Crime Victimization Survey [1], between 2001 and 2005, nonfatal intimate partner victimizations accounted for 22% of victimizations against women age 12 and older. In addition to the physical consequences, victims of IPV also may experience depression, substance abuse, anxiety, and low self-esteem as a result of the victimization. Related to this, in the United States alone, the economic costs associated with IPV against women is estimated to range from $2.3 billion to $7 billion per year [9].

Results of prior investigations, in a variety of settings, provide evidence of a link between the occurrence of IPV episodes and substance use (i.e., comorbidity model). Although both substance use and partner violence are viewed as observable manifestations of a common set of problems, neither is believed to be a cause of the other [10]. In a national sample of 5,159 families, Kaufman Kantor and Strauss [11] Kaufman Kantor and Strauss found over 20% of males and 10% of females were drinking prior to the most recent and severe act of violence. In the National Crime Victimization Survey [12], 43% of the victims of IPV reported the perpetrator had been under the influence of drugs. Studies of college student populations, which have often focused on forms of IPV that involve sexual violence, have found that 50% of assaults involve alcohol use [13]. Among prisoners convicted of murdering an intimate partner, 45% reported that they were drinking at the time of the incident, with an average blood alcohol concentration of 3 times the legal limit. For married or cohabiting patients entering treatment for alcoholism and other drugs of abuse, the proportion of these dyads reporting at least one episode of IPV in the previous year is 4–6 times higher than observed in national samples [14,15]. In addition, the strong relationship between alcohol use and perpetration of IPV has been found in primary health care settings [16], family practice clinics [17], prenatal clinics [18], and rural health clinics [19]. Yet, as noted by Gil-Gonzalez et al. [20] in their meta-analysis of studies examining the alcohol and partner violence link, these findings must be interpreted with caution since many of these study designs lack inferential power and there is also a possibility of publication bias. As consistent and powerful as these findings may be, more rigorous study is needed on this phenomenon.

It is widely recognized that alcoholism and relationship violence often have serious consequences for adults (e.g., emotional, economic, behavioral, physical, social); however, children living with alcoholic or drug-abusing parents are susceptible to the deleterious familial environments these caregivers frequently create. Although many genetic and environmental factors may increase offspring risk, and this is not to say that other factors (i.e., parenting practices, peer values, neighborhood influences) should not be examined in tandem, IPV in the context of parental alcohol abuse plays a very significant, but often overlooked, role in children’s short- and long-term outcomes. Thus, our argument, theoretical explanations, and suggestions for future research focus on the need for researchers to establish how children’s exposure to IPV and parental alcohol misuse may individually or in combination create risk for negative psychosocial outcomes. Moreover, given the clear evidence for the relationship between parental alcohol abuse and IPV, for perhaps the majority of children, mental health treatment should address both the potential harm that exposure to interparental violence and parental alcoholism create.

Given the prevalence of IPV among patients entering substance abuse treatment, coupled with the negative familial consequences associated with these types of behavior, this review will further explore what have been, to this point, two divergent lines of research: (a) the effects of parental alcoholism on children, and (b) the effects of children’s exposure to intimate partner violence. Separate literatures have evolved because in general the majority of studies have compared children of alcoholics (COAs) to non-COAs and children who witness interparental violence to controls. As such, first, we explore the impact of parental alcoholism on children’s development. Second, we examine the effect of IPV on children living in these environments. Third, we highlight theories that may help to explain the effects of IPV, parental alcoholism, and the interaction of these variables on child outcomes. Finally, we provide a brief argument for investigating IPV in the context of alcohol use disorder, which may be especially detrimental for children’s mental health treatment.

Although alcoholism often has serious emotional, economic, behavioral, physical, and social consequences for alcohol abusers and their partners, children who live with alcoholic parents often experience negative psychosocial outcomes. In general, the literature supports that COAs are more likely to develop externalizing problems such as conduct disorder, oppositional defiant disorder, delinquency, and attention deficit disorder (e.g., [21,22]), and are at elevated risk for internalizing behaviors such as depression and anxiety [23,25]. In addition, offspring of alcoholics drink earlier (e.g., [24]), are more likely to develop alcohol use problems [25–28], progress from initial alcohol use to alcohol use disorder more quickly [25,28], and are less likely to mature out of moderate to heavy drinking [30].

Although, in general, the literature supports an elevated risk for negative psychosocial development among children with a family history of alcoholism (e.g., [31]), many children who live with an alcohol-abusing parent display normal psychosocial development (e.g., [32–34]). With respect to parental alcohol abuse and IPV, Nicholas and Rasmussen [33] found that when they controlled for childhood abuse and IPV, parental alcohol use did not predict reports of aggression or depression among college-student adult children of alcoholics (ACOAs).

Undoubtedly, characteristics of the family environment contribute to the adjustment of COAs. Thus, the challenge for researchers is to refine the definition of risk by identifying specific mechanisms that lead to diverse outcomes among children raised by alcoholic parents. Although alcohol misuse during gestation has well-documented risk for physical and central nervous system insults that may result in cognitive, affective, growth, and morphologic sequelae [34], our theoretical explanations focus on factors relevant to alcohol-abusing couples that with intervention may be most amenable to change.

Results from epidemiological surveys indicate a significant proportion of school-aged children live in homes in which one or both parents abuse alcohol. More importantly, in addition to the damage caused by parental alcoholism, it appears that these home environments are often marked by high levels of violence and general interparental conflict. Given the prevalence of partner violence among married or cohabiting alcoholic patients, coupled with the number of children living in these homes, future investigations are needed to examine not only the link between alcoholism and partner violence, but also the individual and collective impact these behaviors have on these children.

Unfortunately, alcoholism treatment providers and programs have not raised IPV and its impact on children’s adjustment as an issue, in part because it has gone undetected. Given that the majority of custodial parents who enter treatment for alcoholism are reluctant to allow their children to be involved in any type of mental health treatment, regardless of whether it is individual treatment or as part of family therapy [81], the psychosocial adjustment of a significant cohort of children who live in these homes has been largely ignored. The conspicuous lack of systematic investigations examining the independent and combined relations among parental alcoholism, violence exposure, and children’s adjustment has led Nicholas and Rasmussen [33] to question the legitimacy of continuing to research externalizing behaviors in relation to being a COA if histories of interparental violence are not controlled for in the design. The results of a recent study show that families with documented incidents of domestic violence tend to have multiple young children in the home [38]; coupled with the fact that IPV rates are highest early in the marital relationship (when children are likely to be young; [82]), there is clearly a need to elucidate the factors that influence children’s adjustment. Along with exploring the effects of parents’ alcohol use and IPV on children, examining families with children in which caregivers abuse alcohol and in which children were not exposed in utero may also present an opportunity to examine the effects of postnatal social exposure on children. Furthermore, there is currently a lack of research on the relative risk to children of male- versus female-initiated partner violence; at this time, very little is known about the differential effect [36]. In addition, investigations are also needed to examine the differential impact of violence and alcoholism on male versus female children’s adjustment. Finally, given the heterogeneity in subtypes of violence, future investigations should examine the impact of various types of violence exposure (e.g., severe, nonsevere) on children’s development.

While addressing issues as complex and sensitive as the individual and combined effects of alcohol and IPV (not only between the partners, but also their children), appears overwhelming, given the seriousness and harmful short- and long-term effects of these behaviors, it is critical that the research community begin to examine these issues. For example, important questions such as “What are the interactive effects of these phenomena on children’s adjustment?” and “What is the impact of a reduction in IPV, but not in alcohol use (and vice versa)?” have yet to be explored. Further research is also needed to examine the specific mechanisms and how intervention programs might serve to mitigate harm among children from homes with an alcohol-abusing parent and where IPV is present. The results of these investigations will have important implications for the development of treatments necessary to address these complex issues.

In closing, we believe that concerted efforts are needed to investigate the psychosocial adjustment of children living in violent alcoholic homes. Without a better understanding of the psychosocial adjustment of these children and the factors (e.g., individual, dyadic, parental, biologic, and familial) that may contribute to these home environments, our ability to develop and evaluate treatments with these high-risk families will be greatly impaired. Whether parental alcohol use, coupled with interparental violence may provide unique, interactive, or cumulative risk for children in these homes is not well-understood. While these behaviors are unlikely to be the only risks children in these homes encounter, we strongly believe that each of these behaviors may result in both short-term and potentially longer lasting effects on their development. Ultimately, the knowledge gleaned from these types of investigations will lead to the greatest level of safety for patients, their partners, and their children and aid in developing better policies and treatments [82].