Alcohol, one of the most used substances worldwide, is associated with a plethora of negative mental health consequences, including aggression and the risk of engaging in violent behaviours. This also concerns interpersonal violence (IV), the intentional act of using power of physical force against a person or group. The risk of committing IV increases steeply during the first phases of alcohol intoxication, following an inverted U-shape (Kilian et al., 2024). Individual characteristics, such as the control and inhibition of behaviour, social learning, and attentional processes are all indicated to affect the likelihood one will commit violent behaviour while intoxicated (Sontate et al., 2021). Nonetheless, a lot less is known about the victims of violent behaviour due to alcohol consumption, and how prevalent experiencing violence from other’s drinking is across the world.
The systematic review and modelling study by Kilian et al. (2024) aims to address this gap in the literature, by focusing on the prevalence of different forms of interpersonal violence (emotional, physical, sexual and intimate partner violence) committed due to the alcohol use of the perpetrator, on a national, regional and international level in 2019.
This new review and modelling study shifts the focus to the prevalence of victimhood of interpersonal violence due to other’s drinking.
Methods
The authors conducted a pre-registered international literature search, using the databases PubMed, Web of Science, Medline, PsycInfo, and Embase. Studies had to be original quantitative research studies including a general population sample of mainly adults, examine interpersonal violence from others’ drinking, and reported prevalence data. The Newcastle-Ottawa Scale was used to assess the risk of bias.
Only unique data sets were included with the largest sample size and prevalence. Combined gender data were excluded if sex- or gender-specific estimates were available. For reports that provided prevalence among alcohol users only, the prevalence for the total population was estimated using a formula that used data from the study and conservative estimates of relative risk from the literature. Fractional response regression models were used to predict past-year prevalence of emotional and physical violence. Random-effects meta regression models were used to aggregate the observed prevalence of sexual and intimate partner violence.
Results
The search identified 13,835 studies, of which 50 were eventually included. This covered around 830,000 individuals from 61 countries.
Physical violence
For physical violence, the final prediction model indicated that approximately 5.3% of men and 3.3% of women in the High Income region (this region is defined through the WHO’s Global Burden of Disease; GBD) experienced this.
The prevalence varied significantly among countries; in Malta, it was estimated at 3.6% for men and 2.2% for women, while in Portugal, these figures rose to 6.8% for men and 4.2% for women. In the region encompassing Central Europe, Eastern Europe, and Central Asia, the prevalence was similar, with 5.4% of men and 3.3% of women reported experiencing physical violence from others’ drinking. Azerbaijan had the lowest predicted rates at 1.1% for men and 0.7% for women, while in Moldova, the rates reached 9.5% for men and 5.9% for women.
In regions not covered by the modelling, observed data revealed a broader spectrum of experiences; for instance, in Latin America and the Caribbean, prevalence rates for physical violence ranged from 6.0% to 20.7% among men and from 0.8% to 3.8% among women across countries like Belize, Brazil, and Peru. In South Asia, particularly India, the figures were even higher, with rates between 9.3% and 36.3% for men and around 32.7% for women. In Southeast Asia, East Asia, and Oceania, these rates varied from 0.9% to 24.4% among men and 0.2% to 22.4% among women, depending on the country.
Emotional violence
For emotional violence, the overall estimated prevalence in the High Income region was approximately 16.8%, with the lowest estimates in Malta (12.2%) and the highest in Portugal (24.0%). In Central Europe, Eastern Europe, and Central Asia, Armenia showed a high estimated prevalence of emotional violence at 34.4%, while Azerbaijan had the lowest at 17.8%. In terms of observed lifetime prevalence in regions not included in the model, countries like Brazil reported 7.0%, and India indicated past-year prevalence rates of 41.5% for men and 38.0% for women.
One in four adults in Central Europe, Eastern Europe, and Central Asia, and one in six in High Income regions, experienced emotional violence from others’ drinking.
Sexual violence
For sexual violence, the pooled prevalence was found to be 1.3% in men and 3.4% in women, indicating that women experienced this form of violence at a significantly higher rate than men.
Intimate partner violence
Regarding intimate partner violence, estimates revealed emotional violence prevalence at 2.7%, while physical and sexual violence were notably lower at 0.6% and 0.4%, respectively, highlighting that emotional abuse was significantly more prevalent compared to the other forms of intimate partner violence.
1 in 4 adults in Central Europe, Eastern Europe, and Central Asia, and 1 in 6 in High Income regions experienced emotional violence from others’ drinking.
Conclusions
This study is the first to estimate national and regional prevalence of interpersonal violence due to others’ alcohol consumption. It found that in 2019, around one in four (25%) adults in Central Europe, Eastern Europe, and Central Asia, and one in six (17%) adults in High Income regions, experienced emotional violence from others’ drinking.
Physical violence was less prevalent, affecting 5% of men and 3% of women.
Sexual violence and intimate partner violence related to alcohol were less common, but varied significantly across studies.
Gender differences were found, with men more likely to experience physical violence and women more likely to face sexual violence.
Men were found to experience more physical violence, while women were more likely to fall victim to sexual violence.
Strengths and limitations
The article by Kilian and colleagues is a very comprehensive, elegantly executed work with a relevant and novel perspective on alcohol associated harms, namely on the victim.
The study was pre-registered and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for systematic reviews, which are all indicators of transparent and replicable research. The authors are candid in acknowledging the limitations, e.g., the absence of various countries in the study (including large parts of Asia and Africa), the caveats of self-reported data and the used data models, and cultural differences that play a role in the perception of harms associated with alcohol. Nonetheless, these hurdles may likely be inevitable when examining global self-report data and do not disqualify the added value of this research.
Moreover, although various components of alcohol induced interpersonal violence are assessed in the study, the question can be raised whether all components are suitable for a study with this design type. For example, physical violence may be more likely to be reported than other types of violence (potentially due to the need to get police involved, or because it happens in public) whereas sexual violence or intimate partner violence may happen behind closed doors and is thus underreported. Maybe this is reflected by the fact that only 10 studies on intimate partner violence and 11 on sexual violence were included. On an intuitive level, it can already be argued that this can never be a true reflection on the global prevalence of this issue. Nonetheless, the authors do also not claim it is truly representative, but it does raise the question of how types of interpersonal violence may differ and what type of study design may be more suitable to investigate this.
Moreover, the study only seemed to look at data on sex, potentially to manage the scope of the paper. However, among sexual minorities, including trans individuals, alcohol related harms, the risk of falling victim to violent behaviours may be increased (Coulter et al., 2016) and thus should not be overlooked.
The great variety in the data available globally on interpersonal violence may require a more specific approach to discover further evidence on victimhood.
Implications for practice
This paper serves as an important stepping stone in broadening the discussion of alcohol-related harms to include the victims of others’ alcohol use. A key takeaway is the alarming prevalence of interpersonal violence associated with alcohol use, particularly in Europe, and the large number of people it affects. As the World Health Organization states, there is no risk-free dosage of alcohol, and the findings of the study are yet another addition to this notion. While harm reduction strategies and educational efforts are valuable, this raises the question of whether alcohol should be subjected to stricter regulations, as many countries rely solely on age restrictions as one of the few regulatory measures for alcohol. Many substances that are illegal or tightly controlled cause fewer overall harms than alcohol. Moreover, the observed gender differences, including the higher proportion of men as perpetrators and the varying types of violence experienced by men and women, suggest that harm reduction policies could benefit from a more tailored approach. As highlighted in a previous Mental Elf blog (Clarke 2018) broad community-based efforts have shown limited success in reducing alcohol-related harms. Thus, expanding research to identify individual characteristics of both victims and perpetrators may help to more successfully prevent alcohol related violence.
The severity of the harms associated with alcohol raises the question whether more rigorous measures, including restrictions, may be more beneficial than general harm reduction efforts.
Statement of interests
Nora is currently conducting her PhD in the field of addiction studies.
Links
Primary paper
Kilian, C., Klinger, S., Manthey, J., Rehm, J., Huckle, T., & Probst, C. (2024). National and regional prevalence of interpersonal violence from others’ alcohol use: a systematic review and modelling study. The Lancet Regional Health Europe, 40, 100905.
Other references
Clarke, N. (2018). Community action has little impact on harms from alcohol use disorder. The Mental Elf. 9thOctober 2018.
Coulter, R. W., Blosnich, J. R., Bukowski, L. A., Herrick, A. L., Siconolfi, D. E., & Stall, R. D. (2015). Differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified young adults. Drug and alcohol dependence, 154, 251–259.
Sontate, K. V., Rahim Kamaluddin, M., Naina Mohamed, I., Mohamed, R. M. P., Shaikh, M. F., Kamal, H., & Kumar, J. (2021). Alcohol, Aggression, and Violence: From Public Health to Neuroscience. Frontiers in psychology, 12, 699726.