THE SEVERETY OF INTIMATE PARTNER VIOLENCE PERPETRATION TOWARDS CURRENT PARTNER IN THE PAST 12 MONTHS: CHARACTERISTICS OF MEN IN TREATMENT FOR SUBSTANCE USE Martha Canfield , Polly Radcliffe, Ana Flavia Pires Lucas D’Oliveira, Gail Gilchrist

Declarations No conflict of interest This research was funded by the Economic and Social Research Council (ES/K002589/1) and Fundação de Amparo à Pesquisa do Estado de São Paulo (2012/ 50460-5) Preliminary findings not for circulation

Context Range of risk factors for IPV perpetration have being identified (Choenni et al., 2017) Several attempts have been made to describe types of male IPV offenders according to certain risk factors (Flynn & Graham, 2010; Kim, 2007)  Research has been driven by the examination of the relation between potential risk factors and types of IPV (i.e., emotional, physical and sexual) Lack of research on what contributes to the severity of IPV among substance users

Severity of IPV perpetration Individual characteristics of the perpetrators, e.g., endorse and express of violence-supporting attitudes (Leone et al., 2007) Coercive control present in intimate terrorism (Johnson 1995, 2000) Overall, the IPV literature suggests that mutual aggression increases the likelihood of injury for both women and men in comparison to unidirectional violence from either parties. Studies on typologies of IPV show that the abuse of control present in intimate terrorism has been associated with the most severe physical violence and has been typically perpetrated by men. Severe IPV has also been found to be associated with individual characteristics of the perpetrators including endorse and express of violence-supporting attitudes Mutual aggression increases the likelihood of injury for both women and men in comparison to unidirectional violence from either parties (Graham‐Kevan & Archer, 2005; O’Leary & Sled, 2003)

Current issues Limited research exploring support and the application of the typologies in substance using populations Physical violence remains the defining characteristic of severe IPV There is a need to improve knowledge and identification of factors that might increase the risk of severity of IPV perpetration. It is less well understood however, whether the current IPV typologies can be applied to understand the severity of violence in the context where partners’ substance use is a concern. This is largely because of limited research exploring support and the application of the typologies in non-substance use populations. Moreover, concerns exist on how IPV severity is conceptualised in the literature as physical violence remains the defining characteristic of severe violence. For instance, women who do not suffer physical violence are not recognised as victim in John’s typology of IPV even if they experience high levels of controlling behaviour. A clearer understanding of the concept of severe IPV warrants attention. Improved knowledge and identification of factors that might increase the risk of severity perpetration might provide potentially important information of who are more likely to cause severe harm to intimate partners. Such evidence is needed to be able to develop effective screening methods that will enable discernment the magnitude of IPV in order to better determine treatment strategies. Such evidence is needed to be able to develop effective screening methods that will assess the magnitude of IPV to better inform treatment strategies.

Present study Identify factors associated with IPV perpetration and severity of perpetration among heterosexual men receiving treatment for substance use Only men who were in a stable relationship (together for at least 1 year) and had perpetrated IPV towards the partner in the past 12 months. In contrast with the majority of research in IPV perpetration that focus on lifetime occurrence of the violence, we examine characteristics of male perpetrators in treatment for substance use who were in a stable relationship (together for at least 1 year) and were specifically violent to the partner in the past 12 months. We argue that the lack of a clear timeframe used in IPV research has contributed to hinder efforts to tackle IPV as little is known on whether and how characteristics of lifetime perpetrators are useful to describe current trends in IPV. Specifically asking about the occurrence and forms of the violence in the current relationship will provide more reliable conclusions of factors associated with recent IPV perpetration among men attending substance use services.

Methods Secondary analysis of two cross-sectional (Gilchrist et al., 2017) Measurements Socio-demographic characteristics, infidelity, IPV perpetration and victimization (i.e., emotional, physical and sexual) occurred in the past 12 months, IPV perpetration in previous relationship(s), general violence, fight with another man, adverse childhood experiences (ACE), whiteness IPV during childhood, attitudes towards gender, relations and roles, substance use (participant and partner), depressive symptoms, anger expression, use of substance at the IPV perpetration episode, controlling behaviours and Technology Facilitated Abuse (TFA) (ever in life). Sample From the original sample of 519 men recruited: - 162 heterosexual men, in a relationship with the same female partner for at least 12 months - 67 from England; 95 from Brazil The mean age of participants was 45.18 years (SD 10.55). 8.02% of participants reported to be homeless 46.9% reported no schooling/left high school without any qualifications 49.4% reported to practice a religion

IPV perpetration IPV perpetration in the past 12 months: binary variable on perpetrating any violence (emotional, physical and sexual) towards current partner Severity of IPV perpetration: an ordinal variable classified as: Minor violence: emotional perpetration occurred once/few times Moderate violence: moderate physical violence – e.g., throwing something, slapping, pushing– occurred at any frequency with/ without emotional perpetration Low severe violence: perpetrated emotional very often with/ without moderate physical violence High severe violence: severe physical violence –e.g., hitting/hitting with something, kicking /beating, threatening with/using a knife/gun - and sexual violence occurred at any frequency

IPV perpetration past 12 months towards current partner Minor Violence 27.9% (n=19) Moderate Violence 42% (n=68) 14.7% (n=10) Low Severe Violence 58% (n=94) 32.4% (n=22) High Severe Violence

Factors related with severe IPV perpetration Small-medium effect association (OR between 1.4 and 2.5) witnesses IPV in childhood, committed general violence, perpetration of controlling behaviours and technology-facilitate abuse, mutual violence, receiving treatment for drugs Large effect association (OR > 3.5) had committed violence towards another man and had perpetrated IPV in previous relationship. All perpetrators reported to have used substances at the most recent IPV perpetration episode A negative small effect association between severity of IPV perpetration and reports of using alcohol at the IPV perpetration episode

The probability of levels of severity: marginal effects (SE) Minor Moderate Low Severe High Severe Witness IPV .70 (.11) .79 (.09) .90 (.09) .84 (.08) General violence .88 (.08) .79(.09) .95(.04) Fight with another man  .18 (.09)  .53 (.11) -  .71 (.10) Controlling behaviours .63 (.11) .60 (.15) .86 (.07) Tech Facilitated Abused .41 (.12) .15 (.08) .10 (.09) .54 (.11) Perpetrated IPV previous relationship(s) .82 (.09) .94 (.05) .95 (.04) Mutual violence .65 (.11) .91 (.06) In treatment for drugs .76 (.10) .53 (.11) .40 (.16) Used alcohol at the IPV perpetration  .45 (.15)  .64 (.12)  .71 (.17)  .36 (.10) Bipolar .29 (.11) .10 (.07) .14(.07) I need to do somework on this table

Key findings 1 in 4 men in substance use treatment who were in a long term relationship reported perpetrating IPV towards their female partner in the past 12 months Of those who had perpetrated IPV: 25% minor, 27.9% moderate, 14.7% low severe and 32.4% severe The likelihood of perpetrating severe IPV increases for those who had witnessed IPV while growing up, committed general violence and/or violence towards another man, perpetrated controlling behaviours and/or technology facilitated abuse, perceived their partner had also perpetrated IPV towards them and had perpetrated IPV in previous relationships Findings point to the need for tailored interventions designed for this population.

Implications There is no gold standard for assessing IPV in substance use services Attempts to discern risks of IPV have been vital for the planning of appropriate intervention approaches (Alia et al., 2017) Not considering the substance use context and the etiology of the violent behaviour could lead to misidentification of a risk Our findings have potential implications for further development of screening instruments that allows for identification and assessment of IPV. Currently, there is no gold standard for assessing IPV in substance use services. Reviews of the literature have emphasised the multifaceted nature of IPV and the need for treatment approaches that recognize the different forms on how IPV exist. Attempts to discern typologies of IPV have been vital for the planning of appropriate intervention approaches. There have been, however, concerns in relation to the development and practical application of IPV typologies in the context of substance use. Not considering the substance use context and the etiology of the violent behavior together could lead to misidentification of a typology. Severity of the incident violence should not be limited by the type of violence reported as there is strong evidence suggesting that victims often experience more than on type of violence. We recommend that a dynamic assessment of types and frequency of IPV occurrence as well as the risk factors associated with the violent behaviour is essential and urgently needed in order to differentiate forms of violence and to deliver a more tailored approach to men in substance use services. Dynamic assessment of types and frequency of IPV occurrence as well as the risk factors associated with the violent behaviour is essential and urgently needed in order to differentiate forms of IPV

Implications Any consideration of preventive intervention should target factors associated with IPV perpetration Our findings raise an important issue of continued and increased IPV perpetration among this population Past research identified controlling behaviours as an important factor for continued IPV (Campbell et al., 2003) Strong association between IPV and being involved in fight with other men suggest the importance of assessing and ascribing the meaning of violence

Limitations Sample size Reports of aggression from a female partner should be considered with caution (we don’t know if it happened at same time from the survey) Cross-sectional design Controlling behaviours and TFA were not included in the classification of IPV severity perpetration (measured using a different timeframe - ever perpetrated in life) CTS-2 measures events rather than patterns of abuse

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Obrigada! martha.canfield@kcl.ac.uk